Ramona couple have earful to tell Congress about health care

A Ramona couple passionate about health care reform are among three dozen people from across the country who have been chosen by Consumers Union to go to Washington, D.C., and present their views before members of Congress.

And when it comes to health insurance, Reynaldo and Janet Hernandez really know what they are talking about.

“I have a unique perspective because I spent 40 years selling all types of insurance,” Reynaldo said. “And actually I didn’t sell much health insurance because I didn’t feel like I was helping my customers. As an insider, I saw some of the industry’s dirty, little secrets firsthand. There was this attitude of not ‘how do we cover this sickness,’ but ‘how do we get out of paying for it.’ ”

But in all their years of selling insurance, what the Hernandezes never foresaw was that there would come a day when even they would not be able to afford health insurance.

“As you get older, the premiums go up every year and co-pays change,” Reynaldo said. “Every year we would strip the policy down, figuring it was better to have something, rather than nothing. But in late 2007, we were already paying $1,300 a month and we saw it going over $1,500. With co-pays, we would be paying $20,000 a year for health insurance. Who can afford that?”

So the Hernandezes did the unthinkable to them. They canceled their health insurance and went uncovered from October 2007 to July 2008.

“It was the scariest time of my life,” Reynaldo said. “I’ve always played by the book. First I was covered by my parents’ insurance, then by the Air Force and then by myself when I got out and started the agency.”

It was a big relief when Reynaldo turned 65 and qualified for Medicare. “I never thought I’d be so happy about turning 65,” he said.

And since Janet still does not qualify for Medicare, they have purchased insurance for her, but it is costing them $600 a month for an individual health plan.

“Add in co-pays and deductibles, and we’re paying close to $900 month,” Reynaldo said. ”We can’t keep that up with three years to go before she qualifies for Medicare. So what do we do? Are we going to be one of those couples who fall through the cracks?”

During their months without insurance, the Hernandezes purposely avoided addressing some health issues Janet had.

“That could have been dangerous—fortunately it wasn’t—but we knew that if we went to a doctor, we would have to disclose that when we tried to get her covered,” Reynaldo said. “And the industry is so insidious that if they even suspect that you knew about a preexisting condition and didn’t disclose it, they can cancel your insurance.”

The Hernandez’ story came to light when Consumers Union “put out a call” through their magazine, Consumer Reports, asking readers “to tell us about their challenges of getting affordable, high quality health care,” said Michael McCauley, media director for Consumers Union. “We got 5,000 submissions, but we thought that the Hernandez’ story was compelling because here was a couple who had worked in the industry and never thought that later in life they wouldn’t be able to afford health coverage.”

With the debate on health care reform heating up in Washington, Consumers Union decided to sponsor a “lobby day” and chose 35 people to go to the nation’s capital and meet their representatives.

“We want to be sure that the stories of the problems people are experiencing are front and center when health care reform is addressed in the coming weeks,” McCauley said.

And Reynaldo has stories to tell not only about himself, but about others, as well. He is especially concerned about a lifelong friend who is dying of cancer, but is being hounded to pay medical bills, even though he has insurance.

“When you’re fighting for your life, you shouldn’t be worrying about money,” Reynaldo said. “The last time my friend came out of the hospital, he called me and was very upset because they were trying to get him to pay more than $150 a day for his stay. And they wanted $1,000 because they had to take him by ambulance to another location. I told him we could have hired a limo and dancing girls for that!”

And Reynaldo remembers that he had elderly customers who were forced into bankruptcy because they were using credit cards to buy their medication. “They maxed out their cards, couldn’t even make the monthly payments and had to file bankruptcy.”

Having studied the health care systems of other countries, he has concluded that “this is the only country on the planet where people can go bankrupt from health care costs. That’s unheard of anywhere else.”

And don’t expect Reynaldo to sugarcoat his opinions when speaking to the nation’s legislators.

“Too often our politicians live in this fantasy world, and they don’t understand what is going on in the lowlands,” he said. “I have stories that will curl their hair, things that I have seen over the years. This industry needs to be regulated and it should be nonprofit. Where does it make sense to make a profit out of people’s illnesses? As Americans, we have a right to education, and, if we get in trouble with the law, we have the right to an attorney. Why don’t we have a right to health care?”

Although Reynaldo said that he has always been an advocate for his customers, he had to tone it down when he still had his insurance agency.

“If you make too much trouble when you’re working for a company, you’ll be looking for another job,” he said. “But now that I’m semi-retired and have turned the agency over to the kids, I can say whatever I want without fear of retribution.”

And Reynaldo can certainly be counted on to give lawmakers an earful.