When I moved to Portland from Brooklyn, I hardly gave a thought to finding an affordable health insurance plan. Assuming that Oregon, like New York, would have a range of options for its legions of freelancers, I’d grown nonchalant about my situation: self-employed and the unlucky possessor of a chronic but manageable autoimmune disease.

For a writer living in New York state, there were plenty of reasonably priced plans, among them the Freelancers Union and Healthy NY, a state-run program for people who don’t quite qualify for Medicaid. Sure, I’d heard of backward places like Mississippi that still allowed insurance companies to reject you for having a “pre-existing medical condition”—but naively assumed that green, progressive Oregon took care of its medically challenged citizens, especially those contributing to its much ballyhooed creative economy.

The truth is, if you’re self-employed, or run a small business, and have a pre-existing condition (and who doesn’t?), the Beaver State’s pickings are pretty slim. That’s largely because in Oregon, “medical underwriting”—during which insurance companies cherry-pick healthier customers—is alive and well, so insurers still deny coverage to those who come to them with ailments. (Comparatively, New York is nirvana: it’s one of five states with so-called “guaranteed-issue” laws that mandate insurance companies cover anybody regardless of health status.)

Of course, Portland in particular has an enormous number of freelancers of all sorts: 73,816 self-employed workers, according to the Census Bureau’s 2009 American Community Survey. That’s 7 percent of the employed population. Just walk into Crema Coffee and Bakery, or the Fresh Pot, or one of the city’s other Wi-Fi-enabled coffee shops, any day of the week and you’ll see us hammering away at our laptops or hosting ad hoc business meetings.

To those of you employed with full benefits, the multitude of insurance-deprived freelancers deserve more than your sympathy.

To those of you employed with full benefits, the multitude of insurance-deprived freelancers deserve more than your sympathy, according to Laura Etherton, a health care advocate at the consumer advocacy organization Oregon State Public Interest Research Group (OSPIRG). Very small businesses, of which freelancers are an important part, “are the sector of our economy that has traditionally gotten us out of the recession—it’s nimble and entrepreneurial,” she notes. “The last thing we want to be doing as a state is hampering that sector with high insurance costs. It’s exactly the wrong way to stimulate the economy.”

Yet this is precisely what Oregon is doing by not providing affordable health insurance options. And unless the current state Legislature takes dramatic action, the situation could persist until last year’s federal package of health reforms finally takes effect (if it does) … in 2014.

The only plan I can find here that would cover my pre-existing condition costs more than half my rent—a reality that may force me, even though I’m employed, to take a job I don’t want just so I don’t become one of the 51 million Americans who are uninsured.

“You hate to have people making decisions about how they will make a living be dependent on getting health coverage,” Etherton says. “It holds back people from becoming self-employed—and doing their life’s work.”

FOR FREELANCERS LIKE ME, there are three options: I can pay a lot; I can pay a little less for a lot less care; or I can move.

My search for some kind of health insurance comparable to the $320 I paid each month for my Healthy NY Aetna plan (with no deductible and $20 co-pays) became a wild goose chase. And whether looking to the Oregon Health Plan or so-called “catastrophic coverage” insurance, either my modestly middle-class income or my pre-existing condition led me mostly to dead ends.

Nancy Metcalf, senior program editor at Consumer Reports Health, hears stories like mine all the time, only worse, via her “Ask Nancy” column at consumerreports.org/health. 

“What really needs to happen for you is that it needs to be 2014,” Metcalf tells me.

That’s when the new Patient Protection and Affordable Care Act, jeeringly called “ObamaCare” by conservative pundits, will eventually force insurance companies to cover everyone, pre-existing conditions or not. They have had to cover sick children since September; adults, however, have to wait until January 1, 2014—three long years away.

In the interim, Oregon, like many other states, received federal money for high-risk patients, also known as the Federal Medical Insurance Pool. But before you get too excited, as I did, know this: in order to qualify, you need to have gone without health insurance for six months or more and been denied coverage based on medical underwriting criteria, or have one of 75 medical conditions (see page 63). That means, if you’ve moved here from somewhere else where you had prior insurance, tough luck. Or if, like a lot of people, you lost your job and now your COBRA—the government-mandated continuation of your group health
coverage from a former job, which usually lasts 18 months—is running out, tough luck, too.

Bottom line: until the new federal health legislation fully kicks in, Metcalf says, “which state you live in matters way more than you think it does.”

For freelancers, she says, Massachusetts is mecca, or at least the future.

MASSACHUSETTS basically has “what everyone in the country is going to have in 2014. And they’ve had it for four years,” Metcalf says. Indeed, Obama’s Affordable Care Act was shaped in large part by the experience of Massachusetts, where everyone who can afford health insurance is required to buy it and no one can be denied coverage for having a pre-existing condition. When you enroll for insurance online via Massachusetts’s health insurance exchange, called the Health Connector, you aren’t even asked any questions about your health history. The Connector, regulated by the state, is a competitive marketplace where private insurance companies present their plans side by side in a standardized format so consumers and employers can compare apples to apples.

If you buy insurance via the Connector and your income is below $32,508 (300 percent of the federal poverty level for an individual) you get subsidies on premium costs, and if your income is half that you can get a plan with no monthly premium. Granted, Massachusetts’s health reform has its flaws—namely a shortage of primary-care doctors and specialists, but also spiraling costs. However, at the end of the day, the state has the highest rate of coverage in the nation: 97.3 percent of the population is insured. Because the costs are spread out over a larger group of people, premiums (if you’re one of the people paying them) are actually reasonable: they start at $39 a month.