Photo by Saverio Truglia
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Uninsured in America
By Jonathan Cohn, July & August 2007
These people thought their health insurance was safe. Are you at risk?
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You've heard the statistics: 45 million Americans—almost one sixth of the U.S. population—live without health insurance. You’ve probably also heard the myths: that the uninsured don’t work (false: 78 percent are employed), are illegal immigrants (false: 80 percent are U.S. citizens), and freeload off the government (false: just 18 percent receive health care at a reduced rate). What you probably haven’t heard is how easily this could happen to you. Since 2000 the number of uninsured Americans has grown by 5 million. Education, hard work, and money don’t always guarantee access to affordable health care. These people learned that the hard way.
THE CATCH The chronically ill must choose between treatment and a job
Yajaira Cruz In 2000 the Philadelphia mother of four learned she needed surgery to fix a leak in her aortic valve, plus follow-up care totaling hundreds of dollars each month. It was a Catch-22. Insurance to pay for the treatments came from Yajaira’s demanding job as a nursing assistant, but the longer she worked, the sicker she got. Eventually Yajaira, 34, found a position with greater flexibility—but no insurance. Strapped for cash, she turned to the government. Unfortunately she earned too much to qualify for Pennsylvania’s assistance programs. Exhausted, Yajaira continued working as many hours as she could, while her medical bills emptied the family’s pocketbook. Finally, the Cruzes were forced to declare bankruptcy. Yajaira remains uninsured today. She does what she can to stay healthy, but she’s also skipping recommended medical care because of the cost. She’s overdue for a cardiologist appointment and a stress test. The most ironic aspect of Yajaira’s situation is that she’s not allowed to get angry about it: stress exacerbates her illness. “I can’t get upset over things that can’t be changed,” she says. “Because then I’d be doing myself in.”
THE CATCH The uninsured are vulnerable to scam artists
Janice Ramsey Soon after switching insurance carriers, Janice was unexpectedly diagnosed with diabetes in 2001. Her biggest problem wasn’t the disease. It was her insurance company. It claimed she’d withheld a preexisting condition on her application and promptly canceled her policy. Janice, 62, scrambled to find insurance, but her illness made her an undesirable candidate. She had almost given up when she heard of a company called American Benefit Plans. American Benefit looked top-notch: its glossy brochures promised access to the area’s best hospitals and doctors for a reasonable price. Janice was granted coverage, and she gratefully began scheduling procedures she couldn’t have afforded on her own.
But a few months later the Ramseys started getting calls from billing departments about outstanding charges for Janice’s care—charges American Benefit told her it had paid. That’s when officials from the Florida Department of Insurance broke the bad news: American Benefit was a bogus company—one of many that had duped at least 500,000 policyholders by 2003. Janice’s insurance was a scam.
During the time that Janice was “insured,” she racked up $20,000 in medical debt, which sullied her perfect credit rating. Though she now has legitimate insurance (through a professional association), she is still haunted by her ordeal. What bothers her most isn’t the loss of money but the loss of dignity: “It’s embarrassing. I don’t like not being able to take care of myself.”
THE CATCH For many retirees even good coverage can vanish
Clinton Baldwin After putting in 32 years working as a meatpacker for the John Morrell company in Sioux Falls, South Dakota, Clinton, 72, became eligible for retirement—including insurance that, he was told, would follow him the rest of his life. But it didn’t. Ten years into Clinton’s retirement, the company announced it was revoking its promise—a decision becoming increasingly common. In 1988 two thirds of large companies offered retiree insurance. By 2005 the percentage was down to one third.
After Morrell dropped its bomb, Clinton tried to apply for insurance as an individual but struck out. He had a history of heart trouble that made him a high risk. Shortly after losing coverage, Clinton had a heart attack and found himself owing $50,000 in medical bills. He raised the money the only way he could think of: he sold his house.
Clinton now lives in a mobile home. He tries not to complain; his porch has a gorgeous view of farmland. And now he’s eligible for Medicare, which he calls “a godsend.” Still, he fears that many more retirees will go through what he did: “People are going to have to get back to the dirty ’30s before they wake up.”
THE CATCH The fine print caps payment for the seriously ill
Terri and Michael King Michael, 36, an officer with the Las Vegas Police Department, and Terri, 46, were overjoyed when their son, Matthew, was born in 2004. Sadly, Matthew had a disorder called pulmonary atresia, which required an immediate artery transplant. The Kings felt lucky to have insurance—until they learned their policy carried several fine-print restrictions regarding cost and types of services covered. They worked with a lawyer to fight some of those limits. Others were not negotiable, including a lifetime cap of $2 million per person. By the summer of 2006, Matthew’s medical needs put him within $100,000 of that limit.
The Kings were terrified and began to put off recommended procedures for Matthew. One night he ran a fever of 103 degrees, dangerous given his medical history. The Kings set out for the emergency room, but on the way there, they began to worry: could they afford the bill? They turned back—and Matthew developed a serious infection. He later recovered, but Terri and Michael remain angry that they’ve spent so much of the past two years panicking over dwindling insurance. “We did everything we were supposed to,” says Terri. “We just wanted care for our son.”
Jonathan Cohn's new book is Sick: The Untold Story of America's Health Care Crisis (HarperCollins).
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