Health : High Cost of Victory : Cancer Survivors Beat One Enemy, Only to Be Haunted by Problems With Insurance

Leaving Columbia Pictures after 27 years, Joseph Abruscato anticipated no problems converting his company health insurance to an individual policy.

So the stocky, plain-spoken Tarzana man, 51, was shocked when he started his own business in 1983 and the insurer raised the coverage for himself, his wife and his son from $17 a month to $514.

Abruscato’s dismay grew as the monthly rates increased to $845 in 1985, $1,350 in 1986 and $2,000 in 1987. Even when his son, Robert, died in 1988 at age 22, after hitting his head and drowning in a bathtub, Abruscato paid $1,220 a month for five months. The policies carried deductibles of $1,000 or $1,500.

Abruscato’s rates increased because he converted to an individual policy and because his son had developed bone cancer in his right leg at age 12. Surgery and chemotherapy cured the disease, according to doctors, but a metal prosthesis inserted from Robert’s thigh to below his knee developed frequent infections requiring costly operations.

Anxiety Over Insurance

Abruscato is among thousands of Americans, including many professionals on fast career tracks, who overcome the trauma of cancer in themselves or a family member only to face the additional anxiety of seeking insurance.

To find coverage, they often stay in jobs they no longer want or take positions that do not interest them.

Abruscato took a different course to obtain his insurance needs. Last year, he sued Prudential Insurance, alleging that the company raised his rates unconscionably in an effort to get rid of a high-risk customer. A Prudential attorney in Woodland Hills refused comment, but the suit was settled out of court for a figure believed to be about $100,000.

Abruscato believes that the settlement provided a measure of justice, but he isn’t sure others in his situation will be as lucky.

“I’m fortunate enough and intelligent enough to be in the position where I can spend time to fight these things,” he said recently in the softly lit Sherman Oaks office where he now advises television syndicators. “If I was, say, a blue-collar worker who does not have an office with phones, or a secretary, or if I was not in a circle of attorneys, I could not do this.

“One of (my) sadnesses is that people who really need the help do not have the time or the ability to get it.”

Cancer Statistics

Statistics aren’t available on the number of cancer patients or former patients who have trouble getting insurance, but the American Cancer Society reports that more than 5 million Americans have a history of cancer. They include 3 million who were diagnosed five or more years ago, most of whom can be considered cured.

Another 405,000 diagnosed this year will live five years or more. That’s an increase of 67,000 from the 1960s, due largely to rising survival rates in Hodgkin’s disease, acute lymphocytic leukemia in children, ovarian and testicular cancer and other diseases.

For these survivors, many insurance companies either refuse coverage of the disease or increase rates prohibitively.

Susan Nessim, founder of Cancervive, a Los Angeles group that provides support for cancer survivors, said her organization recently sent a questionnaire to 3,000 people.

“To over 90%, insurance was the No. 1 issue that they were concerned about in getting on with their lives,” Nessim said. “A lot of times people will take jobs that they are overqualified or inappropriate for just to get the group insurance policy. They are also afraid to leave or go on to other things because they are afraid to lose the policy.”

Selma R. Shimmel, founder of Vital Options, a Studio City psychological and support group for young adults with cancer, says that she sees someone every day who is worried about his health insurance.

“First you win the battle of the disease,” said Shimmel, 34, who developed breast cancer six years ago. “After that you may not be equipped to wage another war against the system for insurance.

“What worries me about that is the ongoing, low-grade stress that goes with battling the system. Once you get past the disease, you want to liberate yourself. But you can’t be free when there are little strings tying you down.”

David Solie, president of a Woodland Hills consulting firm for life and health insurance agencies, said that cancer patients pay high rates because insurers must rely on actuarial tables rather than physicians’ opinions that patients are cured.

“Give me 100 women who have had the same breast tumor and the same medical advice that they have recovered and 100 women who have not had a breast tumor and let’s watch them for the next 20 years,” Solie said.

“Are they going to have the same utilization of health-care resources? The answer is no. Out of the 100 who have had cancer, a certain percentage are going to develop another breast tumor.

“In the present approach to cancer, especially radiation and chemotherapy, we are in some degree undergoing controlled poisoning of the body to destroy the cancer without destroying the patient. It’s hard to predict in terms of bone marrow and the immune system what the long-term consequences are going to be.

“From a clinical point of view we’ve said to the woman, ‘You’ve waged a good battle and we won.’ From an actuarial point of view, we know that this person is more likely to have more problems.”

Brent Barnhart, associate counsel for the Assn. of California Life Insurance Cos. in Sacramento, said it is not only cancer patients who are having trouble getting reasonable coverage.

‘In Serious Disarray’

“The whole health insurance system is in serious disarray,” he said. “Even if you take a very healthy person without serious indication of illness, it’s not that easy to get good coverage at an affordable price.

“There is decent coverage available to large groups. But they too see year after year that their cost of providing that coverage is increasing at a rate far in excess of the consumer price index and the coverages they provide are decreasing. Furthermore, the employee share of payment for going to the doctor is far above what it was three or four years ago.

“There are many reasons for this increase in cost. We have an aging population, and older people require more care. And medical technology makes wonderful things available. We are able to sustain lives of people who would have died a few years ago. But this technology is very expensive. Figuring out how to pay the costs of this technology is the ultimate problem we face.”

Escalating fees for doctors services, hospital rooms and laboratory tests also contribute to rising insurance rates, said Arnold Freiman, president of Partners Financial Group Inc., an employee benefits consulting firm in Petaluma, Calif.

To defray these costs for cancer patients and more than 5 million uninsured Californians under the age of 65, state Sen. Alan Robbins (D-Van Nuys) and Assemblyman Phillip Isenberg (D-Sacramento) have introduced catastrophic health insurance bills in the Legislature.

Expanding Business’s Role

Meanwhile, Assembly Speaker Willie Brown (D-San Francisco) and Assemblyman Burt Margolin (D-Los Angeles) have authored bills that would expand the role of business in providing health insurance.

Reform can’t come too soon for many local survivors.

Rhory Kadish, 41, whose breast cancer was diagnosed in June, 1988, owns My Mother’s Knish, a Westlake Village bakery. Surrounded by freezers, refrigerators and ovens in a long room, she and her sister, Amy, wrap layers of paper-thin dough around potato fillings sold throughout Los Angeles.

Although she has experienced no recurrence of her disease since her surgery last year, Employers Health Insurance company raised the business policy, which covers Kadish and her sister, from approximately $432 a month to $1,150 last February. Kadish got the rate reduced to $856, but only by increasing her deductible from $250 to $1,000.

While working 60 hours a week at the bakery, the former teacher has begun tutoring reading part time to help pay for the more costly premiums.

“When I first got the bill for $1,150, I thought ‘I must have not paid this bill last month,’ ” Kadish said recently as she walked the bakery’s concrete floor near posters of Barbra Streisand and framed pictures of former Dodgers Ron Cey and Don Sutton and other customers.

“I realize I have also had claims for back pain. But I feel like ‘What is insurance for’ (if you can’t get covered at regular rates). There are people who never use their insurance and pay premiums all the time. Shouldn’t they balance me out?

It’s ‘Outrageous’

“I can’t drop the insurance. I still need chemotherapy, which costs about $1,500 per month. I’m going to have reconstructive surgery. I understand they are entitled to more money. I just think this amount is outrageous. . . .

“I try not to think about it. I try to live one day at a time. (But) I get nervous and anxious and wonder what am I going to do if it comes time that I can’t afford it? How would I survive? I’ve always felt there were choices in life and this is real sticky for me. I feel like I don’t have any.”

Chuck Lane, assistant vice president of public relations for Employers Health in Milwaukee, said that in situations such as Kadish’s, the insurance company adjusts premiums rather than terminates policies. He said the judgment is “based on prognosis of medical conditions and reasonably anticipated utilization of benefits.”

Maxine Flader of Beverly Hills received similar rate increases after her breast cancer was diagnosed in 1982. She considered dropping her company for another, but an agent warned that no one would accept her. Flader called several insurance agents and found out how accurate the advice was.

Monthly rates of less than $200 for herself and her two children in 1982 increased to $1,103 with a $500 deductible by 1985. Flader now pays $818 per month with a $5,000 deductible for herself alone. Flader, who declined to name her insurer, has shown no trace of the disease in seven years.

While survivors may get discouraged seeking insurance the conventional way, Freiman, the Petaluma consultant, advises that there may be alternatives.

“For someone who can work,” Freiman said, “you go to a place that offers health-care benefits. You may have to ask the employer to switch to a company that does not ask individual underwriting questions.

No Questions

“If you work six months or a year for a business with 20 or more employees and can’t carry on, then the law protects you for 18 more months.

“You can also form your own business. If you can get two or more employees, one plan I know will ask no individual underwriting questions.

“And many associations--trade groups or religious groups for example--have guaranteed issue plans with open enrollment.

“And if I’m desperately ill and middle class or lower middle class, there’s nothing wrong with using Medi-Cal until catastrophic health care is signed.”

Nessim, the founder of Cancervive, took another approach in getting insurance for her organization.

“I got down on my knees and appealed to an old school friend whose father runs an insurance agency and who lost his sister and mother to cancer and was sensitive to this issue.

“What’s important is that people who are most devastated by insurance discrimination are people who are young like I was when I had cancer, and they do not have a work history or a spouse who has a great insurance policy that they can get on to.

“So many of us fall through the cracks. We don’t realize until we go out and try to get insurance that we can’t get it.”