Posts Tagged 'Health insurance'

Navigating Transitions: What We Never Learned in School

Change is the one constant in life. And yet, we are often surprised when it comes. Parents reward us for mastering routines of hygiene and self-discipline. Our educational system grooms us for progressive levels of security, reinforcing the belief that skill mastery yields the predictable comforts of a settled life. As we age, we are measured by our gains, not our losses, our stability, not our vulnerability.

That’s why so many people are devastated when the temple of their familiar world is shaken through unemployment, divorce, disease, death, and similar forces of upheaval.  We believe in change as long as the wheel of fortune spins in our favor. When change defies our expectations with unpleasant results, a lifetime of conditioning can become suspect, unleashing the dark designs of our imaginations.

Throughout the centuries, philosophers, theologians, and psychologists have attempted to illuminate the nature of change, from the ancient hexagrams of the I Ching ( the Chinese Book of Change) to the stages of loss identified in the last century by Elisabeth Kübler-Ross, M.D., who describes a non-linear progression through denial, sadness, anger, bargaining, and acceptance. One of my favorite frameworks, however, was written by a little-known English professor whose last name is practically synonymous with change – William Bridges.

In his 1980s groundbreaking book “Transitions,” Bridges maps out the cycle of change into three discrete stages that is at once counter-intuitive and overly simplistic. According to Bridges, every transition begins with an ending and ends with a beginning. In between endings and beginning is a discomfiting neutral zone that most people would rather avoid but is essential for personal growth.

Why begin with the end? Writes Bridges: “Divorces, deaths, job changes, moves, illnesses, and many lesser events disengage us from the contexts in which we have known ourselves. They break up the old cue system that served to reinforce our roles and pattern our behavior.”

Within the rubric of “endings,” he identifies five fundamental tasks one must master in order to successfully move to the next chapter. They are disengagement (separation from the familiar), dismantling (letting of what is no longer needed), disenchantment (discovering that certain things no longer make sense), disidentification (reevaluating one’s identity) and disorientation (a vague sense of losing touch with one’s reality).

Once endings are complete, people progress to an uncomfortable but growth-filled neutral zone which Bridges describes as “an empty in-between time when…everything feels as though it’s up for grabs and you don’t quite know who you are or how you’re supposed to behave.”

Most people would prefer to skip this stage. However, by attempting to leapfrog past the neutral zone, they may miss important insights and gifts, putting them at risk of poor decision-making in the future. Bridges explains that, not unlike the concept of meditation or the Sabbath, “only by returning to the formlessness of primal energy that renewal can take place. We need it just the way an apple tree needs the cold of winter.”

As the neutral zone is discomfiting, beginnings can be anti-climatic. Usually, there are no bells, whistles, or red carpets, just a “faint intimation of something different, a new theme in the music, and a strange fragrance on the breeze.” Although some individuals may feel invigorated by beginnings, often it takes time to become adjusted to a new identity or situation. Even a beginning considered positive by societal standards – like getting married, having a child, or getting promoted – can be extremely stressful as those affected become attuned to an unfamiliar landscape.

Although no one can escape life’s inevitable transitions, people’s coping styles vary depending on a variety of factors from biology to their family of origin. Talking to a trusted friend or mental health professional can be helpful if you or someone you know shows signs of depression and anxiety. Reflecting on Bridges’ framework, however, may help demystify transitions so they don’t seem quite so scary or overwhelming. Liberated from our fears, we can dance courageously with the unknown, mining important life lessons from every little step.

Stay tuned for information on my “Coping with Transitions” workshop at the JCC in Manhattan this winter.


The Eleventh Commandment: Thou Shalt Have Health Insurance

The Difference Between a Comedy and a Tragedy Depends on How You Define It

Growing up, the first commandment in my family was “thou shalt have health insurance.” This sacred precept was invoked whenever I became itchy at a job or felt the urge to strike out on my own. “Consider what would happen if, God forbid, you got into an accident,” my parents would say. “We would have to sell the house.”

My instincts towards financial self-preservation guided many a decision in my dual career as a clinical social worker and professional writer.  Lest I sacrifice my benefits, I often remained at jobs well after they lost their luster. I was horrified by statistics on the uninsured and perplexed by self-employed friends – mostly holistic health practitioners – who seemed unfazed by their insurance-free existence, as if health coverage was a perk akin to joining a fitness club.

My parents’ admonishment haunted me last March, when I learned that the grant funding my position at a large philanthropic organization would expire at the end June, in the dead of summer, in a recession. In other words, I was about to be unemployed.

Although I yearned to be liberated from the 9 to 5 grind to pursue other career aspirations, like expanding my psychotherapy practice, the prospect of dedicating a large sum of unreliable freelance income to pay for Cobra – on top of school loans and other expenses – made me wonder whether it was I, and not my parents, who would end up homeless, unable to pay the rent on my modest Manhattan studio apartment.

I explored other options. I didn’t have enough documented freelance hours to qualify for health coverage under the Freelancers Union. I could sign up with Atlantis and similar insurance companies that cater to the self-employed. But, as a healthy middle-aged single woman, I would probably pay at least 10 times more than my current monthly contribution for far less coverage. Financially and ideologically, this troubled me.

Granted, I knew the Obama administration had passed a generous 65 percent subsidy on healthcare insurance premiums as part of the American Recovery and Reinvestment Act of 2009. The Cobra reduction, which had been extended several times to addressing rising unemployment, was due to expire May 31, a month before my scheduled departure. The Senate had approved an extension through the end of the 2010. But it remained to be seen whether the House, which needed to ratify changes in the Senate’s legislation, would follow suit.

With the subsidy, I would pay $210 instead $600 a month for 15 months, amounting to nearly $6,000 in savings. I would also retain my current level of coverage without having to change doctors.

Faced with an absurd no-win situation, I opted to ignore it and hope for the best. I reassured my colleagues, “They’ll extend it. How could they not?” This strategy worked until the last week in May. The expiration date was approaching with no extension in sight.

On Monday, May 22, I raised the subject with the managing director of my department. She had invited me out for lunch to apologize about my situation and see if she could help. I explained my quandary, and she offered to lay me off a month early so I could qualify for the subsidy. I posted a status update on Facebook. “So it boils down to this: whether or not I have a job next Tuesday depends on Congress. Go figure?” A friend replied, “Oh dear, oh dear. You’re screwed.”

Yet I was reluctant forfeit a month’s salary if an extension was imminent. Seeking guidance, I consulted an attorney with the New York Legal Assistance Group (NYLAG), a pro-bono firm which offers consultations on unemployment compensation and related matters. The attorney advised me to call my Congressman.

Since I live on the Upper West Side of Manhattan, my Congressman is Charles B. Rangel, chair of the House Ways and Means Committee, which sponsored the aforementioned legislation. I called his office for regular updates. Was the bill coming to the floor this week? Most likely but not guaranteed, a young aide explained. Would it pass? Probably, since it had sailed through the Senate. But there were no guarantees.

Although I am a registered Democrat and I voted for Obama, I regard politics with the same disaffection I reserve for football – I am vaguely aware that there are two teams who seek the destruction of their opponents, using muscle and intimidation to score points and and galvanize fans. Generally speaking, I root for the home team.

But this time, it was the 11th hour, and the score would determine whether I would say goodbye to my five-year job at the end of the week, or in another month. On the morning of the last day of eligibility for the extension, there was still no decision. I felt like an actual football — just an object in the game of politics, with my future being punted back and forth.

I checked the online news at frequent intervals, proving the old adage about watched pots. I called the aide at Congressman Rangel’s office, who referred me to Washington, where the resident expert on healthcare was in a meeting, presumably about the legislation.

At 4 p.m., there was still no news. My colleagues in Human Resources advised me to leave and call them after the Memorial Day holiday to let them know whether I would be coming back. Was this really happening?

I returned home to meet up with a former co-worker who happened to be visiting from Rochester. A year ago, I had comforted her when she lost her job. Now, she stared at me with a worried expression as I scanned the Internet for news of my fate.

And finally it came. Around 6 p.m., I spotted an article on CNN online. I read it aloud. “The final version (of the bill), approved by a 215-204 vote, extended the deadline to file for unemployment benefits through November, but jettisoned sending $24 billion in Medicaid assistance to the states and extending the 65% federal subsidy for COBRA health insurance premiums.” The article went on to explain that Republicans and moderate Democrats had balked at the price tag of the proposed bill.

Suddenly, my mind went blank. “What does ‘jettison’ mean?’ I asked, somewhat embarrassed. We were both professional writers. “I think it means to propel or push forward,” she replied with some reticence. We both really wanted it to mean that. But the conjunction separating “approved” from “jettisoned” suggested otherwise. I handed her an old Random House dictionary.

“Oh, I’m sorry,” she said, locating the entry. “I was wrong. It actually means to discard or throw out.” I looked up at her in disbelief. “I just lost my job,” I said. “Yeah,” she replied, “and you found out in the dictionary.”

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