Introduction to My Substack: The Burdens of Health Care Access

Hello! Welcome to my first Substack post!

First, a little about me. I’m a political scientist by training, and have spent the last few years focused on the politics of health insurance in the United States. My forthcoming book, Coverage Denied, examines the ways in which health insurance coverage denials deepen health and economic inequality through the imposition of administrative burdens associated with appealing denials. And if you ever find me in person, I might talk your ear off about ERISA. You’ve been warned.

I spent some time reflecting on the best subject of my first post here, and I can’t think of a better, underdiscussed subject than COBRA, or continuation insurance coverage.

Before you stop reading, let me tell you about why I’m writing on this topic. When I had a month-long gap between a research position at UCLA and a faculty position at Oberlin College, I enrolled in COBRA insurance given my medical history. A couple of days before my coverage was due to expire, I submitted the appropriate paperwork along with the check for about $600, and assumed that things were squared away.

Not so.

During this month-long period, I had about $16,000 in medical expenses (nothing serious, but an IUD replacement, two iron infusions to treat anemia, and a blood test, and the costs added up quickly). I knew that COBRA was backdated so intellectually, I knew that the prescribed care would ultimately be covered.

The problem was that when I logged into MyChart, I saw three medical bills in excess of $5,000 each.

Sweating. Nausea. Heart palpitations. I have never had that kind of money. After all, academia isn’t exactly where we make the big bucks.

It would take six months for the COBRA insurance to get processed after it was discovered that the paperwork was directed to the wrong address, and the insurance company failed to process the revised paperwork despite a dozen phone calls and emails with even more senior people at the insurer.

And then there were the calls from the medical center, which had not been reimbursed for services rendered and understandably sought to rectify that. Despite months of pleading that COBRA was being resolved and would be backdated, there was the looming possibility of being sent to collections for the $16,000, at which point not only would it negatively affect my credit, but it would not be forgiven upon the appropriate paperwork being processed.

There was fear. There was anger. There was frustration. There was a sense of defeat.

And the social scientist in me was well aware that if it was difficult for me — a U.S.-born health policy researcher with a Ph.D. — it must be all the more challenging for vulnerable populations, and for those whose jobs do not offer the luxury of spending hours on hold with an insurance company. And COBRA enrollees tend to be older and have more significant health needs than the broader population, making it all the riskier to have care kept out of reach due to these administrative burdens. Far too little is known about this insurance plan in which millions enroll every year, and I hope to rectify that. For perspective, most of the 26.8 million Americans at risk of losing their employment-based coverage are eligible to remain in that coverage under COBRA. This program was made all the more salient amid the COVID-19 pandemic, in which many lost their employment and with it — thanks to the American health care system’s reliance on tying insurance to employment — lost their health coverage. And this doesn’t even address the burdens of affording COBRA, the exorbitant cost of which is particularly challenging in light of the patient population: those who are newly out of work.

From time to time here, I will reflect on my own experiences navigating the American health care system, which has helped inspire me to write Coverage Denied and other related projects. Mostly, I will highlight the administrative barriers to accessing the health benefits to which individuals are entitled, leaving far too many Americans to have access to benefits on paper but not meaningfully in practice.

I look forward to sharing my findings along the way, and to hearing your thoughts as well.

Thanks for reading.