Bulletin E-Edition:
more photosBenjamin Lindner, right, owner Redmond’s Nutshell Enterprises, shakes hands Thursday with Sen. Ron Wyden, D-Ore., before testifying at the Senate Special Committee on Aging’s hearing “Scrambling for Health Insurance Coverage: Health Security for People in Late Middle Age.” Beside him is witness Mike Roach, of Portland.
Lisa Nipp for The Bulletin
A Redmond patient takes case to D.C.
Business owner with a painful condition testifies on Wyden health coverage bill
By Keith Chu / The Bulletin
Published: April 04. 2008 4:00AM PSTWASHINGTON — Benjamin Lindner suffers from psoriatic arthritis. His wife, Leslie, has cancer. Together, they’ve wrangled with their insurance company for years over the drugs and treatments covered under their policy.
And yet, Lindner, of Redmond, says he’s thankful.
Because even though the couple pays more than $21,000 a year in health care costs, the Lindners are insured through Nutshell Enterprises, the small business they own in Redmond.
“We are thankful that we’re able to purchase insurance at all, at any price,” Lindner, 54, said.
“If we don’t have this policy, we have nothing.”
For middle-aged Americans like Lindner, increasing health care costs and trouble keeping coverage in the last decade before they qualify for Medicare are problems that have worsened in recent years, according to experts who testified with Lindner before the U.S. Senate Special Committee on Aging on Thursday. Because of that, some older workers stay in jobs solely to for health insurance, they said.
The hearing, chaired by Sen. Ron Wyden, D-Ore., examined heath care challenges facing middle-aged Americans and promoted Wyden’s health insurance reform bill, the Healthy Americans Act.
Expensive treatments
Lindner’s arthritis is similar to the more common form, rheumatoid arthritis, but is related to psoriasis, a condition causing itchy red lesions on his skin.
The psoriasis itself, “is not that big a deal,” he said.
The arthritis is worse: “That causes stiffness and swelling of joints, and I felt bad,” he said.
Medication reduced his symptoms, he said. But a few years ago, Lindner found the drug he had been using was causing liver damage. His doctor recommended a new drug, Enbrel, which costs from $10,000 to $25,000 per year.
Lindner’s insurance company said it would not cover his new, more expensive medication.
“I went round and round with them for probably six months,” Lindner said.
After six months, an appeals board eventually approved his request, but it was immediately overruled by the company’s chief medical officer, Lindner said.
Lindner declined to name the company, because he fears being punished by his insurer, he said.
Eventually, Lindner was able to get the medicine, but only by participating in a pharmaceutical company trial of the drug — in Seattle. That meant a six-hour drive every three weeks for about a year
When that drug stopped being effective, Lindner switched to another that was nearly as expensive, but this time his insurer approved his treatment.
In the fall, Lindner’s wife suffered her own insurance ordeal, after the company said it would not pay for an MRI her doctor ordered, after diagnosing her with kidney failure. The Lindners paid the cost out of their own pocket, although the insurer eventually decided to pay for the procedure, Lindner said.
Insurers that deny payment for treatments are trying to steer patients to the most cost-effective treatments, said Robert Zirkelbach, spokesman for America’s Health Insurance Plans, which represents the insurance industry.
“What the science shows about what works, that determines what the health plans will pay for,” Zirkelbach said.
Because the family’s insurance is tied to their business — Nutshell develops industrial land, among other pursuits — Nutshell now represents not just an income, but a lifeline.
“We can’t stop having the business in order to do something else or take a job or retire,” Lindner said. “I guess you could say I’m one of those few people who are looking forward to retirement so I can get on Medicare.”
Affordable coverage
Two-thirds of U.S. residents, aged 55 to 64, worry they won’t be able to pay their medical costs in the future, according to a survey by the Commonwealth Fund.
That group is less likely to receive health insurance from an employer than younger workers. Older workers have more health problems and spend twice as much on health care out of pocket, compared to people aged 35 to 54, according to Jeanne Lambrew, a professor at the University of Texas, who testified Thursday.
Combined, those factors create, “the spectacle of hundreds of thousands of Americans between the ages of 55 and 64 years old scrambling to obtain quality, affordable health coverage in the strongest and richest country on earth,” said Wyden, in his opening statement Thursday.
His answer is a bill that would provide universal health insurance, in part by severing the link between employment and insurance.
“If they are working for an employer, they are often one rate hike away from losing even the limited health coverage they may have,” Wyden said.
As a remedy, Wyden’s proposed a sweeping plan to overhaul the U.S. health insurance system. In brief, the plan would make individuals responsible for buying insurance, rather than employers. To make that feasible, Wyden’s plan would require that businesses pay employees the cash value of their insurance benefit. Companies who don’t pay insurance would have to pay into a government plan, to help subsidize the uninsured.
Wyden, with backing from the high-profile health care consulting firm The Lewin Group, says his plan would insure all Americans for the same amount of money the country currently spends on health care.
And by de-linking insurance from employment, people like Lindner would not be tied to their small business, or a job of any kind, solely to hold onto their insurance benefits. Under Wyden’s plan, insurance would follow the individual, regardless of their job.
Wyden has gathered 14 co-sponsors — including seven Republicans — for his bill, although the Senate is unlikely to take up such sweeping legislation during an election year.
Lindner was unfamiliar with Wyden’s bill before this week, but after the hearing Thursday, he said the concept makes sense. Like Wyden, Lindner said he thinks the health insurance system needs to be shaken up, to remove the incentive for insurers to deny coverage for older Americans and to prevent costs of the uninsured from being pushed onto paying patients.
But ultimately, despite his trials, Lindner said he’s still glad he’s with his insurance company.
“I’m happy I’m alive. I’m happy my wife’s alive, and she would be dead, if not for the treatment she’s had,” Lindner said. “I belly ache about the insurance companies, but the alternative is pretty crummy.”
Keith Chu can be reached at 202-662-7456 or at kchu@bendbulletin.com.
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