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What 'House of Cards' gets wrong about health insurance

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Beltway Confidential,Opinion,Philip Klein,Health Care,House of Cards

It's become a bit of a game in Washington to poke fun at what the Netflix hit television show “House of Cards” gets wrong about politics, journalism, and geography in the nation's capital. In the first episode of the second season, the show also got health insurance wrong.

In one of the subplots of the episode, an ex-employee of an environmental organization run by Claire Underwood (wife of protagonist House Majority Whip Frank Underwood), complains that her health insurance has been cut off.

The former employee, Gillian Cole, had been fired and subsequently launched an employment lawsuit against Underwood. She is pregnant and desperate for medication.

“Blue Cross said my insurance was cancelled,” Cole tells Underwood, explaining that, “The severance package gave me health coverage for up to a year.”

When Underwood suggests that she take it up with the insurance company, Cole informs her that, “They said it was terminated. They can’t reinstate it without the employer’s approval.”

Evidently, “House of Cards” takes place in an alternate universe in which COBRA continuation coverage (short for the Consolidated Omnibus Budget Reconciliation Act) does not exist. Ever since the law passed in 1986, workers have to be offered continuous health insurance for 18 months after leaving a job either voluntarily or involuntarily.

This isn’t something that is terminated by the insurer subject to the approval of the employer, nor is it contingent on negotiating a severance package.

The COBRA law does contain some loopholes. For instance, it applies to employers with more than 20 workers. But early in season 1, when Underwood fires 19 employees, it’s described as being “half the staff” of the organization and the organization later hires new people as part of an international expansion.

In the District of Columbia, where the organization is located, there is a separate “mini-COBRA” law that applies to businesses with fewer than 20 employees, offering at least three months of continuation coverage.

Also in the episode, Underwood tells Cole that she signed a consent form. But it’s unclear what that consent form would be.

As explained on the U.S. Department of Labor website, COBRA law requires employers to notify insurers within 30 days if a worker is terminated and the ex-worker has to be sent notice within two weeks asking them whether or not they want to maintain the coverage. “The individual then has 60 days to decide whether to elect COBRA continuation coverage,” the Labor Department website says. “The person has 45 days after electing coverage to pay the initial premium.”

So, to lose coverage, Cole would have had to receive an offer of continuous health insurance in the mail and either actively decline to accept the insurance, neglect to send back the form for two months, or accept the insurance while failing to pay for it for six weeks.

In theory, that’s possible. But it makes less sense in the context of the character. Cole, we are told in the first season, was a valedictorian at Stanford University who had been offered a high-paying job at Google, but turned it down to build a successful nonprofit that helps bring water to developing countries. She was aggressively recruited by Underwood. And she’s no pushover. She was fired for defying Underwood and then launched a lawsuit.

It’s pretty hard to believe that she would have neglected to pay attention to the details of her health insurance given that she’s highly educated, incredibly competent and has the wherewithal to hire lawyers to launch a lawsuit against her ex-employer. This is especially true given that she’s pregnant and, we are led to believe, in desperate need of a medication that could mean life or death for her baby.

“There’s medication I need that I can’t get unless it goes through my HMO,” she says.

Which is another thing that doesn't quite ring true. A survey by America's Health Insurance Plans found that in 2010 just 23 percent of employees working at firms with fewer than 50 workers were enrolled in HMOs, as the recent trend has been toward more-flexible PPOs. I'm skeptical that Cole would have had an HMO as a heavily-recruited senior employee of a prominent non-profit.

Even if she lost her health insurance coverage, there’s no reason why she couldn’t get her medication unless it went through her HMO. She could always pay out of pocket for her prescription drugs, find a new job to get coverage, or pursue many other options that would be available to a highly educated individual with resources whose services are in demand.

The only positive thing that can be said for show’s treatment of health insurance is that it isn’t, by a long shot, the most ridiculous thing that happens in “House of Cards,” or even in this episode.

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