Tampa, Fla. – First, Jeanne and Randal Wills sold one of their cars. Then they sold some property they needed for retirement.
They have to dig deeper and deeper into their pockets to pay their family health insurance premiums, which cost more than $3,000 a month now after going up 250 percent in six years. They can’t afford the policy, but they can’t afford to drop it.
The couple is trapped in an unaffordable insurance policy because it covers their 19-year-old daughter, who is in college. She has a serious digestive disease and has been through several surgeries.
“My goal is to provide continuous coverage for her at all costs, because if she goes one day without being covered by a major medical health plan, she runs the risk of having every cost related to her disease denied and left uncovered,” Jeanne Wills said. “I can’t pass that on to my child.”
They have appealed three times to Aetna to reduce their rates, but were denied. They complained to the Division of Financial Services, which operates a consumer help line. But DFS says that because the state’s Office of Insurance Regulation approved the rates, it can’t do anything.
OIR actuaries say Aetna’s rates are justified, given the type of policy the Wills have. Aetna spokesman Walt Cherniak said the company loses money on that type of policy but has to offer it, by law, to customers leaving the group plan.
The Wills are on a “conversion” plan, one that is legally available to individuals or families who are losing their group plan and moving to an individual/family plan. Healthy people those who can pass the medical underwriting go to the open market for individual coverage. Those who can’t are stuck with the “conversion” plan, with premium rates calculated in a pool of other unhealthy people relegated to conversion plans.
“These plans are literally plans of last resort for people with no other options,” said Cherniak.
In a written statement, the company said the Wills case illustrates why it has been working since 2005 for meaningful health reform. Companies could stop turning away those with chronic illnesses if all Americans were required to carry coverage, the statement says.
The Wills have been with Aetna since Jeanne Wills’ days as a Pinellas County school teacher. When she quit teaching in 2002 to care for her sick daughter, her family was able to keep their coverage through the federal law known as COBRA, usually limited to 18 months. When it ended, they landed in the conversion plan. Overnight, their rates shot up 39.7 percent, and continued to go up every year since.
The Wills have tried to get insurance from other companies, but no one will take them unless their daughter’s illness is excluded from coverage, they said. They’ve been told this policy is the best deal they can get.
Randal Wills, a real estate lender who had to shut down his business when the market soured, is unemployed. So is his wife. They would be willing to move out of state for work, but they’d have to get new insurance. Their Aetna policy is not portable beyond Florida.
They have thought of putting their daughter on Medicaid, but can’t bring themselves to do it. “It’s such a chasm between having insurance and having Medicaid, just so much that wouldn’t be done for her,” Jeanne Wills said.
When Health News Florida contacted Aetna about the Wills’ case, the insurance company said it would do what it could to see whether there is any way to reduce the family’s rates. “It’s not a good situation for anyone,” company spokesman Cherniak said. “We’re very sympathetic to the challenges they face.”
The Wills aren’t looking for sympathy. They need action. “With these increases,” said Randal Wills, “I don’t know how many more years we can go.”
“We’ve played by all the rules,” said Jeanne Wills. “We’ve done everything right. The system has failed us.”