Bob and Jacki Marsh have been following the twists and turns of the health care reform debate closely. Like most Americans, they want to know: Will health care reform help us?
More specifically: Will health care reform help us finally get divorced?
The California couple separated in 2004, when Jacki moved to Utah to be with her son and granddaughter. But they stayed legally married because Jacki, who suffers from cardiomyopathy, is uninsurable on the private market. Since 1984, she's relied on a series of pacemakers to keep her alive.
Without Bob's insurance, Jacki believes she would have been unable to afford the replacement she needed in February 2009. "It would have been out of pocket, I wouldn't have had the funds," said Jacki, 55. "I would have died."
Jacki will need help soon: In July, Bob turns 65 and will be eligible for Medicare, which won't cover his estranged spouse. She said the cost of her heart medication alone will nearly double.
Jacki might benefit from one of the more immediate provisions of health care reform. In three months, the Department of Health and Human Services is required to set up an "interim high-risk pool" to cover people who are uninsurable due to preexisting conditions. It's not clear how helpful this provision is going to be.
The state of Utah has had its own high-risk pool for years. Like the HRPs in many states, it comes with a six-month "exclusion period" during which Jacki's heart condition would not be covered. But to qualify for health care reform's high risk pool, Jacki has to be uninsured for six months. So that's not much better. And would either program let her continue to travel to California to see the cardiologist who's kept her alive for more than 20 years?
In terms of premiums, it will be up to the health department whether the high-risk pool under the new law will be more generous than existing state pools, which typically charge premiums ranging from 125 percent to 200 percent of the "standard risk rate." In 2010, out-of-pocket costs for an individual policyholder in the pool will be capped at $5,950; a family policy caps costs at $11,900.
The pool will have $5 billion to make up the difference between premiums and costs, and the Treasury Department has the authority to dish out more money if needed -- but at the same time, the health secretary has the authority to stop taking applications to comply with the funding limitation.
Failing the pool, Jacki is looking toward 2014, when the insurance industry will be prohibited from discriminating against people with preexisting conditions. People in the individual market will be able to choose from subsidized policies via "exchanges."
That's right about when Jacki's current pacemaker will need to be replaced. "I'm going to be right at the edge... My next pacemaker will be due at the time -- in theory -- that they can't discriminate against people like me. Reality is I may not be able to afford my medications between now and then. I'm not going to bankrupt my family. If I can't afford it, I just won't take my medications."
Bob and Jacki spoke amicably of each other in separate interviews with HuffPost. ("He's a fine person in his own right and I am in my own right," said Jacki. "The marriage ran its course and it's over.") But, grave health concerns aside, the insurance industry's preexisting discrimination has left the estranged couple in a state of romantic limbo.
"It's been really frustrating because, as you can imagine, trying to move on with your life, trying to explain to people, to potential girlfriends, that you're almost divorced but not quite because of health care -- it's awkward," said Bob, who is the CEO of a media software company.
Jacki said the same thing.
"It affects the people that I date. People my age are looking for 40-year-old women, so that puts me in an age group where it's the 65-year-olds who are interested. I can't marry them because I would bankrupt them. It has an amazing affect on every aspect of my life. There was a gentleman I absolutely loved a few years ago. I can't marry this man. If I married him, then he financially would be responsible for my medical bills."
It's not an uncommon concern. In September, HuffPost reported on how a California couple, bankrupted by medical costs, divorced in order to stay afloat financially. Splitting up indemnified them from each other's possible future debts.
Bob is skeptical that the insurance companies will play along with reform. He noticed Monday's New York Times story about insurance companies preparing to get out of the requirement to cover children with preexisting conditions six months from now. "For me, [our situation] just sort of underscored what I think a lot of people are going through staying in jobs they wouldn't otherwise stay in because they need health insurance. We make these compromises in our lives to maintain what we think is good coverage and then we end up jousting with insurance companies every day."
Said Jacki: "It gets really stupid when you think about the contortions people have to go through to keep health care."