Soon after President Barack Obama signed the Affordable Care Act into law in March 2010, Cheryl Martin's husband asked her to start looking for a health insurance policy that would cover them both. Neither had insurance.
While their three children were growing up, he'd traveled nationwide as a contractor to oversee the construction of compressor stations for transporting natural gas. She minded the home fronts in Lamar and now Bartlesville.
Martin found coverage for her husband but, because of a stent in her heart, she was turned down. She was referred to the Oklahoma Temporary High Risk Pool, whose members must be legal U.S. residents and have gone uninsured for six months or longer.
The pool, and other states' temporary pools, were created by the Affordable Care Act and funded by the federal government to serve as a bridge for the sick until 2014 — when insurers can't deny medical coverage based on pre-existing health conditions and new online health insurance marketplaces will be available offering affordable insurance.
It wasn't but six weeks after Martin joined the high risk pool that she — in sudden, severe pain — went to the emergency room, where doctors diagnosed her with two broken ribs, pneumonia and, after several tests, lung cancer, she said.
“Let me tell you, I felt thankful — blessed — to have the insurance,” Martin, 50, said. “I'd learned from experience that they won't hardly help you if you don't have it.”
Cancer treatments are unbelievably expensive, said Martin, who's had more than $950,000 in care.
Focus on transition
Martin is among some 900 Oklahomans covered under the temporary high risk pool who must roll off it at midnight Dec. 31. An additional 2,676 on the 17-year-old state high risk pool are expected to transition to the coverage under the new marketplace, before open enrollment ends March 31.
A Colorado customer of Martin's husband, who offers workers health insurance, recently hired him so that Cheryl Martin would have coverage. But at least two temporary high risk pool members already are planning to shop for new policies in Oklahoma's new federally run online health insurance marketplace: the single mother of a 19-year-old Tulsan who suffers from a rare, life-threatening, colorectal condition, and a 34-year-old Carney man with liver complications who, through compounded bad luck, lost his home and business in the May tornadoes.
“At this point, our primary focus is transitioning members to the exchange,” said Tanya Case, executive director of the temporary high risk pool.
Administered by Blue Cross and Blue Shield, the pool has annual medical and prescription drug out-of-pocket deductibles of $2,000 and $200, respectively.
Premiums run from $128 a month for nonsmoking members 18 and younger to $746 for smoking members 60 and older.
By comparison, most monthly premiums on the new insurance marketplace will cost between $200 and $700, based on consumers' ages, tobacco use and where they live in the state, according to a recent report by Oklahoma Watch. That's before federal subsidies, which will be based on income and family size, for which Case expects most members to qualify.
‘As good as it gets'?
Tulsa single mother Lisa Schwartz, whose 19-year-old daughter, Mac, receives benefits under the pool, is scared that the new coverage won't permit the lifesaving lengths they were allowed to go under the temporary high risk pool. Since Mac was struck with a rare colorectal condition after a ruptured appendix that went undiagnosed and unattended for days five years ago, she's undergone 17 abdominal surgeries, two brain surgeries, three back surgeries and 17 spinals, spending more time hospitalized than not.
Even so, she graduated from Mingo Valley Christian School and lasted a semester on a full-ride scholarship to Pacific University in Forest Grove, Ore., before falling ill again.
Mac has lost half her intestines and currently wears an ostomy bag. Those supplies and anti-vomiting and anti-nausea prescriptions alone run some $1,500 or more a month.
“I already have hundreds of thousands of dollars in debt because I had to go uninsured when Mac hit the adult system, and rolled off Medicaid and other public assistance for children,” said Schwartz, who works as a legal assistant at a small firm that doesn't offer group health insurance.
“We've been told that this is as good as it gets; we're at a new normal,” Schwartz said. In the meantime, Schwartz feverishly is pursuing the Social Security Administration's Supplemental Security Income (SSI) benefits for her daughter.
‘Doing what we can'
Jeremy Knox, of Carney, can hardly absorb the bad luck he's had.
Rejected for medical insurance because of liver complications and high blood pressure, he turned to the temporary high risk pool for health coverage in August 2012 and, within the year, lost his home and mechanic and towing business, which were situated on his 40-acre property, to the May tornadoes.
“We're doing what we can,” said Knox, who's so far built back one of the nine metal structures he lost and runs AAA calls for tire changes and U-Haul repairs. He can't start towing again until his company trucks are reinspected.
Knox, his wife, Jessica Miller, and their four boys temporarily are living across the street in the Carney Christian Church.
Dwight Herron, chair of Oklahoma's traditional high risk pool, said he hopes most of his members — who are covered under Blue Cross and Blue Shield at 135 percent of premiums nationwide — will transition to the new marketplace by Jan. 1 for more affordable coverage. But the pool will stay open through March, he said.
“The choices they make will be important, because a considerable number of our members are very unhealthy,” Herron said. “Versus simply opting for the cheapest plan, they'll be using theirs,” he said.
“Everything (about health care reform) has been turned into numbers and politics,” Herron said. “Somewhere in the mix, people have gotten lost. We need to get back to the focus: health insurance for people who really need it.”