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Pre-existing Condition Part II. Fear and Loathing in the Nation’s Capitol

Merging your company with another can be a nightmare. And I was living one.

Sure, on paper it made sense. After downsizing our office to put us back in the black, it was easier to reclaim our standing in the marketplace through acquisition than trusting a slow, incremental-growth strategy. But, a merger-gone-wrong had been what started our troubles in the beginning, so I had little enthusiasm for another. I advocated for going it alone.

But it wasn’t my company and there were few other jobs out in the marketplace, so I acquiesced to our New York patrons and chose to make it work. My office was folded into a new firm, which was to operate as a separate stand-alone company. Given that our newly acquired partners were on an earn-out, I would no longer be in charge.

It wasn’t the best of circumstances but I had lived through worse. I made only one stipulation; due to my experience with another small, independent company, I insisted that the folks in our office have the option to keep their retirement and health insurance with the parent company in New York. They agreed and with the stroke of pen, I had a new boss and worked for a new company. We packed up our desks, moved into their space and began the process of integrating our business.

To make a long story short, it didn’t work. We had different business models, different management styles and different approaches to the marketplace. And, as happens in these types of cases, the internal politics grew uglier as the situation deteriorated.

Unfortunately, I was the guy caught in the middle. The management of the new venture treated me as an outsider – potentially, even a spy for the parent company – while the folks in New York were suspicious of my up-front opposition and worried about my commitment to the project. It was a no-win situation.

It didn’t take me long to realize just how vulnerable I was. I was a convenient foil for everyone to blame as the merger struggled forward. It was like I had the word “scapegoat” stamped on my forehead. One misstep and I was out of a job.

And I could not afford to lose it. I had a wife, three kids, a dog and a mortgage. I had to work. In truth, I wanted the merger to succeed. It had to succeed.

Then I found out I had Rheumatoid Arthritis.

I had gone out for a run around the block with my oldest son to work off some of my extra weight. As a former athlete, I was shocked when I couldn’t keep up with him. I pushed it, trying to chase him down, but nothing I could do would close the gap. I came home stunned. My son was only ten years old.

Other problems surfaced. After my ninety-minute, morning commute into town, I had trouble getting out of my car and walking to the elevator. On a business trip, I couldn’t lift my suit bag out of the trunk of my car. I thought I had slipped a disk. That summer, I couldn’t push myself out of a beach chair. It was as if I had turned ninety over night.

For those who don’t know it, RA is a horrible, painful, autoimmune disease that slowly disfigures and cripples those it afflicts. RA sends the immune system into overdrive until it attacks and destroys the joints of the body itself. There is no cure.

I found a doctor who told me what was wrong and was given the standard treatment for the disease: a regular dose of methotrexate (a cancer drug) and an anti-inflammatory in an effort to slow the progress of the disease.

It didn’t work. My body ignored the benefits of most of the drugs they gave me (and we ran through a number). My doctor said I should contact a patient group and perhaps get some counseling. My body felt like it was rusting. My movements started to slow. I had trouble with simple things like turning a doorknob, climbing the stairs and even walking across a room.

I was thirty-eight, felt ninety and was scared out of my mind. How much longer would I be able to work? How would I pay for my kids’ education? How would I pay the mortgage, the medical bills, our day-to-day expenses?

But, for the moment, I couldn’t focus on the bigger questions.  I had more immediate concerns.  I had to keep this job. I knew what a pre-existing condition meant and was suddenly stuck with the knowledge I would always have one.

I chose to keep the illness a secret.  I refused to tell anyone at work. I didn’t dare trust them. It would be too easy to isolate me – leave me out of new business meetings, or take away my direct reports – all in the name of being “compassionate about my suffering.”

It wasn’t being paranoid. It was being realistic. I couldn’t afford a gap in coverage. If I lost my job I would be uninsurable unless I found an employer large enough to wave the restriction – and one magnanimous enough ignore the implications of my disease.

I was stuck. So, I suffered in silence, steeled myself against the pain every time I shook someone’s hand or opened a heavy door. I made an art out of “sauntering” to disguise the slowness of my walk.

As to the merger, I had to find a way to de-escalate my vulnerability. There is an old business saying, “Keep your head down and let the elephants fight.” It became my mantra for the next two years. I took myself out of the role of middleman by suggesting that the folks in New York deal directly with our new partners. I kept away from the firm politics, kept my clients happy and kept the business coming in.

It took two years, but my luck finally turned. The five-year earn out was up and the folks in New York had come to see the merger for what it was. They jettisoned the acquisition of their own accord and asked me to retake the lead of the Washington office.

I had outlived the merger. And because I had kept my health insurance with the parent company, I did not have to reapply for coverage after the acquisition failed.

I was also fortunate that new medicines were discovered to treat and manage RA. Wonderful drugs like Enbrel and Humira gave me a new lease on life. I was like the Tin Man after Dorothy applied the oil. It was a miracle of modern medicine, albeit an expensive one as it cost an additional $1,500/month. But compared to a wheel chair it was not much of a choice at all.

I worked for the same company for twenty-five years. Now, there are several reasons for such loyalty. I was challenged often and made pretty steady progress up the corporate ladder (the above situation excepted). I liked the people I worked with and trusted their skills. But, I’d be lying if I didn’t admit to being afraid of losing my insurance. As long as I was employed where I was employed, I’d be safe.

Many years after the merger, I left the company and struck out on my own with a couple of clients. I was able to skirt the pre-existing condition issue by keeping my company’s insurance through COBRA. And due to a change in the law under the Clinton Administration, I was able to keep my COBRA past its one-year limitation – as long as I agreed to pay both the company’s share of the bill and mine. It was incredibly expensive, but with a family still dependent on me, it was the only option I had.

After nearly a quarter century with a pre-existing condition hanging over my head, the issue became moot under the Affordable Care Act (ACA). I finally was able to purchase insurance in the open market. It was a huge relief – a stunning relief.   Free at last!

When I let go of my COBRA-created insurance plan, I received a notice advising me that that once the plan ended, it was gone; I wouldn’t be able to get it back. But, I was confident that Congress wouldn’t take back a program they had extended to all Americans, especially, since it is so much like the benefit they receive under their federal employee health insurance.

Now, of course, I’m beginning to have some doubts. Will I be able to continue my coverage if Congress and the President repeal the ACA as promised?  It hasn’t gone unnoticed that I have to “reapply” for my insurance every year in the open market.

They have vowed to replace ACA with a better plan. The question I have is, “Better for whom?” Believe me. It’s not a paranoid question; it’s a realistic one.

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Pre-existing Condition – Part I

In October of 1982 I was all of twenty-seven years old and living a good life. I was two years into my marriage; my wife was six months pregnant; I had a good job with an up and coming public affairs firm in town and we had just bought a townhouse in the suburbs where we lived with a one-year-old puppy named Sophie.

My wife worked on Capitol Hill. Her boss, unfortunately, had just lost his reelection bid in a tough Republican primary, but since my wife had expressed a desire to be a stay-at-home mom, we took his loss as a sign and redid our budget using just my salary. We had enough – just enough – for us to make ends meet.

My wife’s pregnancy had been a bit challenging due to an undiagnosed bout with gestational diabetes. But thanks to the help of a specialist from NIH and a competent nutritionist, she was able to severely restrict her diet and get her sugar levels under control. Her health rebounded. All was good and the future looked bright.

That is, until November.

It started one day with a dunning notice from my wife’s doctor saying that our health insurance company had rejected his invoice. I assured him it was a misunderstanding and that I would take care of it. My firm had great health insurance coverage; it was one of the bigger perks used to recruit new employees. When I called the insurance company, however, I was told my company had failed to maintain its insurance premiums for the past several months and had been dropped from coverage.

There had to be some mistake. I called upstairs to the CFO and was told he would have to check it out. The next morning, I was summoned to an emergency meeting of our senior managers and told that the firm was going out of business. There would be no year-end bonus, no severance and no further salary distribution. Our doors were closing and the bank had frozen all the company’s assets. We were asked to continue to work for our clients in the hopes that a white knight investor might buy up the company’s debt and save all our jobs.

That, of course, didn’t happen.

So, let me recap. My wife and I had both just lost our jobs. She was seven months into a difficult pregnancy and we were no longer covered by our health insurance. Oh, and on top of that, we were likely just months away from losing our home.

That’s when I first learned the term, “pre-existing condition.” I called every insurance agent in town begging to find coverage. Although every one of them seemed reasonable they all gave me the same answer. Regardless of whose fault it was, my wife’s pregnancy was now uninsurable. Even if I were to get a new job, the pregnancy itself was “pre-existing” and wouldn’t be covered under the new policy.

I started to panic. We had enough saved to cover the cost of the delivery, but if there was a problem – if she needed a C-section or there was a complication with the baby – we had no means to cover the additional cost. We were – to put it mildly – screwed. I told my wife I would figure something out, but I knew in my heart there was little I could do.

I started using one credit card to pay as many bills as I could in an effort to horde cash. I kept the second one clear so I could pay off the first one when its bill came due at the end of the month.   I figured I could rinse and repeat for one more month, but only had two months to find another job.

And it takes time to find a job. I updated my resume and set up lunches with anyone who could help me. News hadn’t yet gotten out about the firm’s closing and I knew enough not to share how financially vulnerable I was. Employers can smell desperation in a job interview. I would have to bluff my way through this crisis.

And then, an amazing thing happened. I got a call from my wife’s chief of staff.

It turns out that Members of Congress hold their jobs until the new congress is seated. My wife’s boss – and therefore my wife – had a job through January 4th of the New Year. And because Members of Congress and their staff participate in the Federal Employee Health Care Program, she was eligible for coverage during the up-coming “open season.”

“How does that help?” I asked. “She has a pre-existing condition.”

I was told that the pool of federal employees is so large, the health insurance companies wave the pre-existing condition clause as a means to compete for customers.

So, even though my wife would be employed for only four days in the New Year, she was eligible for coverage under the federal employees’ open season. The coverage would only last a month, but all the plans offered a month-long grace period. Our baby was due at the end of January. Even if we delivered late, we would be covered.

As it turns out, my oldest was born by C-section on January 25th after a grueling and difficult delivery. Although exhausted, the mother and baby were fine. I too, counted myself lucky in that I found a job in January. Although saddled with three months worth of debt, I was happy to keep the roof over our heads.

In the years that followed, the U.S. health care system would be fiercely debated on Capitol Hill by both the left and the right. Hyperbole was rampant as each side tried to position itself as “holier than thou” alternately calling for universal coverage and keeping the government from stepping between patients and their doctors.

In all these debates, I was frustrated by the fact that Members of Congress never had a true picture of what our health care was like. They never had to worry about their health care coverage. For them it was always an abstract problem not a personal one. They had great coverage under a great plan. I didn’t begrudge them for that; I envied them.

But, for me, my problems with pre-existing conditions were only just beginning.

Next up: Pre-existing Condition – Part II.


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