Obamacare was supposed to make our healthcare system friendlier to patients, and in many ways it’s succeeded. But we still have a long way to go.
For almost her entire life, Maria Rogers has been the picture of health.
She’s worked for years as a personal trainer, most recently at the Beverly Hills branch of the Equinox fitness club. In her off hours, she’s competed in long-distance races as a member of the Santa Monica Track Club. She ran the Boston Marathon last year.
In May, however, Rogers was diagnosed with Stage 3 cancer of the abdomen. She underwent surgery at Cedars-Sinai Medical Center and now faces months of chemotherapy.
“My prognosis is good,” Rogers, 49, told me. “They say this is treatable. But it’s rough. My life doesn’t feel like my life anymore. I’m tired all the time. I can’t do anything.”
Obviously she doesn’t need any extra hassles. But that’s not how things have played out.
Rogers’ experience illustrates the challenges we face not just getting affordable healthcare but keeping it while dealing with a life-threatening illness.
After her surgery, she asked Equinox for a three-month leave of absence, which, under federal law, the company was required to grant. Although the paychecks stopped coming, she was assured that her job would be waiting for her.
“They told me not to worry,” Rogers recalled. “They said they’d take care of me.”
She wasn’t strong enough to resume her duties as a trainer as the clock ticked down on her leave. She told Equinox she needed more time off.
The company responded with a notice saying that her health coverage would end Aug. 23 — as permitted by the federal Family and Medical Leave Act, but a decision made at the employer’s discretion.
From any business, that would be a slap in the face. But from a company that describes itself as “a temple of well-being,” that’s a particularly harsh thing to learn.
Jesse Derris, an Equinox spokesman, didn’t challenge any aspect of Rogers’ account but declined to comment in detail for privacy reasons.
“We value Maria and look forward to welcoming her back to Equinox when she is able to return to work,” he said.
Rogers contacted Cedars after Equinox said it was ending her health benefits and asked about her options under Obamacare.
A Cedars rep, she said, informed her that the reform law would allow only limited access to the hospital’s cancer doctors and facilities. A spokesman told me that even though a medical center may be in an insurer’s network, coverage might not apply to all of the hospital’s doctors.
Rogers signed up for COBRA, which guarantees continued coverage from a worker’s former insurer for up to 18 months — but at a significantly higher cost since she’s now paying both her share and much of what Equinox had been paying.
As a result, she said, the roughly $200 a month in healthcare premiums she’d been paying while an Equinox employee more than doubled to about $500 a month under COBRA.
Rogers said her health-club clients have pitched in to help her pay her insurance bills. She’s also receiving state disability payments, but they only go so far.
“I know everything that’s happened with my insurance is legal,” Rogers said. “But it still feels wrong.”
It turns out that, under state law, she had more options than she thought. But many people might not realize that — or have the wherewithal to explore alternatives while undergoing a debilitating treatment such as chemo.
The California Department of Managed Health Care provides for “continuity of care” when people’s healthcare situations change. This could include a doctor no longer being in an insurer’s network or a patient having to switch to a new plan.
Rodger Butler, a spokesman for the state agency, said it’s up to the patient to negotiate with all concerned.
More than half of working Americans receive health insurance through their jobs. Rogers’ situation illustrates the lunacy of such a system.
No other industrialized country links work to coverage in this way. Other developed nations have concluded that the only rational and economically viable way to cover everyone is to establish a single-payer system — Medicare for all, in American terms.
Another option for this country would be to have all Americans shop for insurance from private companies in an Obamacare exchange, rather than receive it through an employer.
If we had either system in place, Rogers wouldn’t have had to worry about continuity of care. Her coverage never would have been in question.
Equinox, for its part, never would have been in the uncomfortable position of yanking health insurance from a sick employee. It wouldn’t have been part of the equation.
The company’s actions may make sense from a financial perspective. But that doesn’t mitigate the stunning heartlessness of its decision.
Equinox, by the way, is a founding sponsor of Cycle for Survival, a nationwide movement to raise funds for rare cancers.
Rogers is upbeat. She says she’ll return as a trainer and will compete once again in races.
Sadly, she’s running an obstacle course to get there.