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Waiting for Medicare: Uninsured 59-64 year olds hope their health holds up

This article first appeared in the St. Louis Beacon, March 27, 2012 - Early retirement, layoffs and loss of health insurance have become part of a rude awakening for many baby boomers during the economic downturn. Getting by with fewer or no health benefits is especially problematic for a generation nearing a life stage when routine medical checkups and preventive care are proven shields against some serious illnesses associated with aging.

It’s still a golden age for most area residents. Those who are able to retire are doing so in generally good health, often with enough disposable income and insurance to cover medical bills. But for the uninsured 12 percent, as well as those who are underinsured, life isn’t what they expected. When people lack health benefits, they are more likely to ignore a lump under their skin out of fear it’s a symptom of a disease requiring costly treatment. Likewise, they may learn to tolerate joint pains, poor hearing, diminished vision and other mild-to-chronic health conditions.

One common remark among the underinsured and uninsured nearing retirement is the hope that their conditions won’t incapacitate them before they become eligible for Medicare, the federal health insurance program guaranteed to anyone 65 or older.

Census data show that roughly 47,000 Missourians between the ages of 59 and 64, representing 12 percent of the state’s residents in that age group, were uninsured between 2008 and 2010. The Beacon interviewed some to find out how they are coping while they wait for Medicare.

Peace in the world, that’s what we ask To heal the world, we’ve made our task With help from all the angels here among us They may look just like you and me No wings or halo you can see Perhaps you’ll hear them singing Hallelujah Hallelujah, Hallelujah, Hallelujah, Hallelujah 

— One verse of Leslie Kaplan's lyrics to Leonard Cohen's "Hallelujah"

One is Leslie Caplan of Olivette. On some days, she finds herself humming the lyrics to one of her songs, "Hallelujah," as she gets through another day without adequate health insurance. That song, she says, is “about taking care of each other and so it’s very much about health care.”

Caplan came to learn about the world of the uninsured following a divorce. She previously was insured through her husband’s job at a corporation.

“I’ve been self-employed, so health insurance is an issue. I’ll be 64 in June, and I won’t get Medicare for another year.” She adds that she feels blessed that she has had no serious illnesses, save for what she thinks might have been a misdiagnosis for Crohn’s disease in 2000. In addition to “having experienced no real Crohn’s attack in 12 years, I’m in perfect health, have never had a hospitalization, never had a surgery. Nothing.”

Yet she says she cannot get affordable health insurance because she’s been labeled as having “a pre-existing condition” because of the Crohn’s. Even so, she feels lucky “because if I had Crohn’s disease without insurance, it would be an unmitigated disaster.”

In the meantime, she says she’s among those who simply put off preventive care. “They wait until it’s an emergency, then they go to the emergency room. That has become their doctor’s office, and we’re all paying for that because hospitals aren’t treating people for free."

She says many of the state’s 47,000 uninsured people in their 60s “are victims, but they don’t want to talk about it because they feel a lot of shame that they cannot take care of themselves.”

But in the view of Jennifer Bersdale, director of advocacy and communications for Central Reform Congregation, the real shame is that no system exists to help people get affordable health insurance.

“This is especially horrible when someone has worked all of their lives and paid into (their employer's health insurance and/or the Social Security) system and are trying to take care of their health. They end up sicker than they would have been if they had had insurance to get preventive and ongoing care.”

But time runs out on some who yearn for the time when they become eligible for Medicare for access to doctors and prescription drugs. One widely mentioned local case is that of the late Robert Douglas, a diabetic who worked as a clerk at the St. Louis Post-Dispatch for 40 years. His daughter, Erica Douglas, says her dad retired with a $360 monthly pension but couldn't afford to cover a health insurance premium of $580 a month with the pension. At times, Douglas, 59, reportedly got insulin from others because he could not afford to buy it at a pharmacy.

After Douglas was rejected for both private insurance and Medicaid, Erica said she took him to health clinics where he sometimes got medicine "that made him sick because he wasn't getting continuous care from one doctor like he did when he had insurance."

Her eyes watered a little as she said, "My father was afraid he was going to die bcause he couldn't get the health care he needed. And, unfortunately, his fears were right."

On Dec. 16, his family found Douglas' body on the kitchen floor of his home. 

In some ways, his profile fits those in an American Association for Retired People profile issued in February. It covered a slightly broader group of older uninsured people than those in the 60-64 age category. The survey targeted people in the 50-to-64 age group. Missouri has about 12 percent of residents in that category, compared to 14.7 percent in Illinois. By contrast, only 4.1 percent of Massachusetts residents fell into that category, the lowest percentage of any state. This low rate is probably due to Massachusetts having adopted health reforms similar to those in the Affordable Care Act, including a mandate that residents buy insurance.

The AARP explains why many older adults will be glad to qualify for Medicare:

• Health insurance coverage continues to decline across the nation, with the number of uninsured adults between age 50 and 64 rising to 8.9 million in 2010, from 3.7 million in 2000. In 2010, 138,000 Missouri residents and 316,000 Illinois residents, age 50-64, were uninsured.

• Although roughly three in five uninsured Americans aged 50 to 64 are employed, many are ineligible for employer health plans or work for employers who do not offer coverage.

• Because most states, including Missouri, allow insurers to charge higher premiums based on age and health, those in the 50-64 age group have difficulty affording insurance coverage.

Pointing to the number waiting for Medicare, U.S. Rep. Russ Carnahan, D-St. Louis, recalled the days when health reform included talk about expanding the health insurance for older adults and the disabled.

“Early on in the health-care debate, one of the ideas actually was to lower the eligibility age for Medicare,” he said. “But that’s not really the way the health-care bill developed.”

He adds that the law included provisions that can and will benefit the those too young for Medicare. These include new state-run health insurance pools to accommodate some residents with pre-existing conditions and no lifetime limits on coverage by private insurers. In addition, he mentions the general benefits, such as those that extend coverage to children with pre-existing conditions and allow young adults to remain on their parents’ plans until age 26.

“No question about it, the recession hammered the country and a lot of individuals and families in a way that we haven’t seen in a generation," Carnahan said. "One of the biggest drivers of costs and hardships in this country has been health-care costs. It has been the No. 1 reason for people filing personal bankruptcy. That’s just wrong, and that's why this new health law, (for which) we’re celebrating the second anniversary, is so important.”

Ray Koziatek, 63, of Ballwin has had his share of problems getting and keeping insurance following a layoff in 2010 at a plumbing distributing company. With that layoff went his health insurance. He has since found health insurance through a company that offers month to month benefits at a cost of $245 a month, plus a one-time $100 fee for signing him up. The downside, he says, is that he, rather than the insurance company, files the claims when he visits a doctor or gets other care.

“I haven’t had to go through it yet, so I don’t know how much of a hassle it will be,” Koziatek says.

His biggest disappointment, however, involved his efforts to get health insurance from major companies. He suffers from a sleep condition and takes high blood pressure medicine. He says he explained his conditions up front, but the major insurers asked him to fill out applications online.

“It took about four hours (to complete the application,) digging up information, making sure I’d tell them when I began taking something. When they ask and you tell them you have this or that, they should tell you right away that you don’t qualify. Instead they make you go through filling out applications. Then in 15 seconds they tell you that you don’t qualify. That kind of rubbed me the wrong way. They should be more upfront about what isn’t covered.”

Many in the 59-64 age group are without health insurance due to layoffs, but the case of Bernadette Grongborg, 64, of Festus, is different. She resigned from her job because of family obligations before she became eligible to collect retirement benefits.

“I thought I’d be able to get insurance. I thought it would not be a problem. But I was shocked by all the rejections that I got. If you are laid off from your job and you are in this age group, you are going to have something to keep you from getting insurance.”

It’s enough to make her wish Congress had expanded Medicare to reach the  uninsured younger than 65. She ended up with a high deductible catastrophic policy that she says costs nearly $400 a month but doesn’t cover much.

“I will tell you that I’m insured, but it won’t cover anything happening to me. I had three premium increases in a year.” She says the reasons for the increases include aging “or the fact that I didn’t die.”

She jokes about praying that “somebody hits me with their truck, then their insurance might cover my medical bills because if anything else happens to me, I’m going to be pretty much up a creek financially.” In these times, she empathizes with the “hundreds and hundreds of people who work when they are sick and tired and longer than they should so that they can have health insurance.”

As for herself, she turns 65 in August, making her eligible for Medicare.

"And I can’t wait.”

Robert Joiner has carved a niche in providing informed reporting about a range of medical issues. He won a Dennis A. Hunt Journalism Award for the Beacon’s "Worlds Apart" series on health-care disparities. His journalism experience includes working at the St. Louis American and the St. Louis Post-Dispatch, where he was a beat reporter, wire editor, editorial writer, columnist, and member of the Washington bureau.