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Pre-existing condition insurance plan, part of health care reform act, 'a lifeline,' St. Petersburg woman says

Marlys Lenz Cox dropped her insurance when premiums soared past $1,100. Her pre-existing condition plan premium is now under $400.


Marlys Lenz Cox dropped her insurance when premiums soared past $1,100. Her pre-existing condition plan premium is now under $400.


On Monday, as the Supreme Court begins hearing arguments for and against the Affordable Care Act, Marlys Lenz Cox will be across the street, stating her own case.

The St. Petersburg woman was invited to Washington by the advocacy group Families USA. She is one of three patients scheduled to speak at a news conference Monday morning about the law, and she is unequivocal.

"I felt like President Obama threw me a lifeline with PCIP,'' she said of the Pre-existing Condition Insurance Plan, one of the first provisions of the health care reform act to take effect.

Cox, 57, had been insured by Blue Cross Blue Shield for years under an individual policy.

She's had serious health issues, including hepatitis C diagnosed in her mid 40s that she believes stems from a blood transfusion she received as a child.

By early last year, the premiums had soared to $1,100 a month, out of reach for a woman whose income is $40,000 a year in alimony plus $60-a-day take-home pay from substitute teaching at St. Petersburg High School when her health allows it. She got a checkup, took a deep breath and dropped her insurance.

When it was time for her annual mammogram, she paid cash. A lump was found, and she called around until she found a doctor who would do a biopsy for $900.

She had cancer, and no way to pay for treatment. The hospitals and clinics she called offered only sympathy. Some of those she spoke with shared horror stories about their own family members' insurance woes.

One person even suggested she'd be better off if she'd been hit by a car and could go to the emergency room.

"I was spending hours a day begging for my life from strangers,'' Cox recalls. But with too much income to qualify for aid and not enough to afford cancer treatment, no one knew how to help her.

By fall, she had been without coverage six months and qualified for PCIP, for which she paid $625 a month (her premium now is down to $376).

She went to Moffitt Cancer Center in Tampa for two lumpectomies and radiation, and is well enough to teach again some days.

"It's the best coverage I've ever had,'' she said of PCIP. "You don't worry about someone cheating you, and randomly telling you they won't pay.''

Monday may offer Cox her biggest stage yet, but it won't be her first time to speak in public about health care.

"I've called my congressman, I've signed petitions, I've carried signs'' around town, she said. "I'd have these tea party members yelling at me to pay for my own insurance.

"I'd go talk to them, and they were veterans or on Medicare, and they seemed not to grasp they were getting government help.''

. Fast facts

More on PCIP

To qualify for the Pre-existing Condition Insurance Plan, you must:

• Be a citizen or legal resident

• Have been without coverage for at least the last six months.

• Have been denied coverage because of your health condition.

In Florida, monthly premiums are $118 to $505 depending on your age and the plan you select. Go to or call toll free (866) 717-5826.

Pre-existing condition insurance plan, part of health care reform act, 'a lifeline,' St. Petersburg woman says 03/21/12 [Last modified: Wednesday, March 21, 2012 10:10pm]
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