A growing number of Americans who are 50 to 64 are losing their health insurance, casualties of rising unemployment and the increasing number of businesses that can't afford to cover their workers.
The AARP estimates more than 7 million people in this age group are uninsured, a number that is rising fast and adding a new dimension to the national health care debate. Until now, much of the focus has been on getting more young people insured, or preserving benefits for the millions older than 65 on Medicare.
But the not-quite-ready-for-Medicare set face a double threat: loss of access to health care just when they need it most.
The newly uninsured who try to get coverage on their own are learning that it's often unaffordable at best, and virtually unavailable at worst. Individual plans for people older than 50 cost several times more than employer-sponsored plans, and they often exclude people with such health problems as diabetes, obesity or depression — many of which become increasingly common with age. Other common conditions, such as high blood pressure or cholesterol, can mean higher rates.
Studies have shown that uninsured people are more likely to put off necessary treatments than people who are insured, and that can lead to declining health for them and higher public costs in the long run.
A new Harvard study published in the Annals of Internal Medicine found that people with intermittent or no health insurance end up costing Medicare $1,000 more per year when they turn 65 than those who had coverage all along.
And that's if they even reach Medicare age. Another Harvard study, published in the policy journal Health Affairs, found that the risk of death among uninsured people age 50-64 is 43 percent higher than it is for people with coverage.
"We are quite concerned," said David Sloane, the AARP's senior vice president of government relations and its chief lobbyist. Half of the AARP's 40 million members are age 50 to 64.
While current health reform proposals address some barriers — such as removing exclusions for pre-existing conditions — a significant obstacle remains: Insurance companies would still be allowed to charge older people higher rates.
"That's an issue that is still a struggle," Sloane said. "There's still not a problem with discriminating against older Americans, and that seems harsh."
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Saundra Cunnagin of Tampa is looking for health insurance for her and her husband, Leonard Sixt. He lost his job because of a corporate merger; she was recently reduced to part-time work. Both are 59, six years away from Medicare.
Cunnagin still has coverage through her employer, paying $450 a month for a high-deductible plan that covers her and her husband. But she doesn't know how much longer she'll be employed.
The couple have no so-called pre-existing conditions, health problems that could shut them out of the insurance market. But the costs are a huge barrier.
Her search turned up options such as a high-deductible plan for two that would cost about $2,800 a month. The same policy would cost a couple age 30 to 35 about $275 a month, she said.
She also found a catastrophic hospitalization policy, with a $10,000 deductible, that would cost about $900 a month. But that wouldn't cover preventive care such as mammograms and checkups, which she said would add another $6,000 to $8,000 a year in out-of-pocket costs.
"That's some serious money that you've got to budget out of your retirement funds," said Cunnagin, who works about 20 hours a week as a comptroller for a construction company. "It becomes a big burden, or an impossible burden."
Insurance companies such as Humana and Aetna have been working to accommodate the growing ranks of the recently uninsured. David Heizer, a sales representative for Humana, is seeing more people age 50 to 64 who have been laid off, reduced to part-time work, whose employers no longer offer health benefits, or who retired early and now are learning their former employers can no longer cover retirees.
Heizer said Humana offers plans with higher deductibles (as much as $10,000 a year) that can have monthly premiums as low as $200 for someone in their 50s. Other plans feature lower out-of-pocket costs but have higher premiums.
Aetna offers health plans for 50- to 64-year-olds through AARP, at similar rates to Humana's. Company spokesman Ethan Slavin said there has been "strong interest" in the plans since their launch in January 2008.
Aetna, Humana and other companies allow potential customers to get instant rate quotes online, based on age, city of residence and type of health plan. But quotes are subject to change based on one's medical history. Aetna, for example, advises that such rate adjustments for Florida residents can be up to 150 percent higher than the initial quote.
Insurance underwriters can also attach riders to health plans that set limitations or exclusions for treatment of pre-existing conditions. So you might have insurance, but it may not cover the treatment you need most.
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Even if you can afford the high cost of individual insurance, that doesn't necessarily mean you'll get it.
A number of medical conditions may disqualify you. Among those listed on Humana's Web site: AIDS/HIV, cancer, diabetes, emphysema, heart attack, stroke, angioplasty, hepatitis, liver disease, fibromyalgia, organ or tissue transplant, anorexia or bulimia. Coverage may also be denied to people who are severely overweight or underweight.
Sometimes you don't even need to actually have one of these conditions to be uninsurable.
Joseph Wells, a 54-year-old from Brandon, lost a high-end national sales job and his employer health coverage through Aetna in August 2008. Two insurers then denied him for an individual health plan because of a four-day stay at Tampa General Hospital because a doctor "had an impression I may have had a stroke."
After numerous tests, Wells said he was discharged without a diagnosis, but with a prescription for the painkiller Soma. A followup with his primary physician revealed that all he had was a sinus infection.
After his denials, Wells used COBRA to continue his previous employer coverage until he landed a new job — and new insurance — in February.
Wells, who is married and has grown children, once thought of perhaps retiring early or changing his career path. He has scrapped those dreams now that he knows his insurance status.
"I'm not a huge Obama fan," he said. "But I do know we need to fix our health care problem."
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Nobody thinks current reform proposals will fix the 50-to-64 problem entirely.
Sloane, of the AARP, thinks it will help. Current proposals would end exclusions for pre-existing conditions, provide subsidies to help lower- to middle-income people afford coverage, limit out-of-pocket costs, and eliminate the common practice of charging higher rates based on gender. Generally, individual policies are far costlier to women than men during the childbearing years, a situation that changes with age. Critics say that's tantamount to illegal discrimination.
The age differential is another matter entirely. Interestingly, on this point even the AARP's membership is divided, with many over-65ers fearful that their Medicare benefits will be cut to help younger Americans.
Current reform proposals would still allow companies to charge older people higher premiums, based on the fact that they generally use more health care. Sen. John Kerry, D-Mass., has called this practice "age discrimination, pure and simple," but his is a minority opinion.
"You want people to have consistent coverage throughout their lives, but it becomes more important from ages 50 and on," Sloane said.
"More things can go wrong. They need more health care."
Richard Martin can be reached at firstname.lastname@example.org or (727) 893-8330.