Health Care's Thin Threads | Casey's Last Word

One thing is obvious about the health care law recently upheld, mainly, by the U.S. Supreme Court: It will have unintended consequences.

Anything as vast and complex as a health care system for a country the size of the United States can’t be entirely predictable.

But the same can be said of the current system.

Let me tell you the story of John Guest and Chris Yanas. Some long-time San Antonians will remember them.

For years John was head of the Bexar County Hospital District, now known as University Health System.

He would later lead the much larger Harris County Hospital District.

Chris was John’s director of governmental relations.

After several years in Houston, and a clash with some of the politicians, John moved to Austin in 2007 to head up Teaching Hospitals of Texas, a trade association with 19 members, including Bexar County’s University Health System.

Chris joined him shortly after, which was John’s good fortune.

After heading hospital districts with thousands of employees, he now had a staff of three plus himself.

Two of them already had health insurance, leaving only Chris and John looking for a group policy.

“Candidly, there weren’t many companies interested in selling us a group policy,” Guest told me two years ago when I wrote a column about his situation.

“They were very interested in selling individual policies, which are outrageously expensive.”

What’s more, if they had screened Guest for an individual policy, he probably would have been turned down.

While he was “relatively healthy,” he had been diagnosed five years earlier with Type 2 diabetes, the sort of pre-existing condition that can make an insurance company run the other way.

But one of the association’s members, the highly respected Scott & White Memorial Hospital of Temple, has an insurance company and agreed to insure Guest and Yanas as a group of two, for a premium of about $1,200 a month each.

Problem solved. But what if Yanas left the association?

Guest would seek applicants, and some would not need the association to provide health insurance.

They might think saving this expense would make them more attractive as candidates.

Here’s the weirdness: Guest would have to be a saint to hire such a person, no matter how sparkling his or her credentials.

It would leave him without group insurance and any individual policy he would get would likely be very unattractive.

Having spent most his career leading major hospitals that served the uninsured, his own health insurance hung by a very thin thread.

Guest retired in February, and Yanas is now the interim president of Teaching Hospitals of Texas while a search is performed for Guest’s successor.

She said Scott & White has creatively kept her insured by considering another staffer as eligible for insurance and therefore forming a group of two, even though he chooses not to buy a policy.

But that staffer turned 65 last month and may retire soon.

So Chris Yanas is earnestly hoping that the candidate selected to be the new director of the Teaching Hospitals of Texas does not already have health insurance.