As healthcare reform turns one, the under-insured still wait for change

Health insurance

Tess Vigeland: The heath care reform law recently marked its first birthday. Most of its big changes don't go into effect until it turns four -- in 2014. Until then, millions of Americans continue to go without health insurance coverage.

Sarah Varney caught up with three people navigating the system here in California. First, a woman who works as a massage therapist and finds herself priced out of the insurance market.

Cindy Lundy: My name is Cindy Lundy. I'm 48 years old in May and I live in Hayward, Calif.

I've checked into it and if I can find an affordable monthly payment, typically the deductible is astronomical, to the point where you couldn't afford to go to the doctor. It's too much. The last time I had health insurance was 2004 when I worked for Club Sport.

It makes you feel like you're not valued, like you're less than, like you're not a whole or complete person.

I had one health issue that really scared me quite a bit. I was sitting on my couch and I felt like the room was spinning. I had lost my eyesight completely in the right eye for about 45 minutes. And when I finally got it back, my head hurt so bad. And since I had no health insurance, I never had it checked out. When I talked about it later with a couple of different physicians, they talked to me about that it could've been a really small stroke.

I go to a clinic for people such as myself who are self employed or just don't have the resources to purchase health insurance. It's Access Health in Pleasanton here. So I've been able to go there, make appointments for routine wellness check ups and they've caught certain things like uncontrolled blood pressure that was actually at a very critical point. And they have been a godsend in my life. Without them, I don't know where I would've been.

One change already in effect is that you can't be denied coverage because of a pre-existing condition. The law set aside $5 billion for so-called "high risk pools." Here's someone in the deep end of one of those pools.

Brian McCarthy: My name is Brian McCarthy. I'm 27 years old and I'm currently a student at Sacramento City College in Sacramento, Calif. About five years ago, I jumped off a galloping horse, my sister's horse. I know nothing about horses. And the impact when I landed, caused the blood vessels in the talus bone in my ankle to be damaged. The bone started to die within my ankle and this caused a lot of pain.

I had a series of surgeries, and at the time, I was insured under my mom's state insurance, Blue Cross. And then when I turned 25, I was uninsurable by them. So, I kinda lost hope during that period. I'm in my 20s and I'd like to be able to be more active.

And then I heard about the PCIP insurance program, part of the new Obama health care plan. So I jumped on it, because I had been denied by both Blue Cross and Kaiser as uninsurable due to pre-existing condition. And I happened to be the 187th person that got on this new insurance plan and was able to get the surgery I needed.

It's just as good as any PPO, it is a PPO. There's a large list of providers I can choose from. The coverage is very comprehensive. It does not include dental or vision, but I'm able to get regular checks with my doctor, I'm able to get good coverage prescriptions and it covered my surgery. And it's $200 a month with a max out-of-pocket $2,500 a year.

Everywhere I go to use the card at the pharmacy or the doctor's office, it's always the first one they've ever seen. They've never seen it before. So they usually want to check it, they want to see the card and sometimes they want to make a call 'cause they've never seen it and they're not sure how to do it. But then they quickly realize it's like any other PPO and they deal with it accordingly.

Another option is catastrophic insurance. It comes with a high deductible -- sometimes thousands of dollars. You pay for routine care. That's what Paul Martin and Patti Kozlovsky chose to do. But even the bare minimum is not cheap.

He's 50. She's 49. They're both independent contractors. He's in film and she's in information technology. And they've opted for an insurance plan that has a $10,000 deductible.

Paul Martin : We started in like 2002 with like regular insurance, and then around 2005-2006, it got really expensive.

Right now, between the two of us, we're paying between the two of us $450 and $303, so it's coming up to about $750 for the two of us. We, over the years, I have high blood pressure and high cholesterol. So I take two medicines and I couldn't even tell you when I started that, so we have pre-existing conditions. So it's not like we can shop around.

There's always a delay before you just jump in the car and see your doctor. You figure out what's this going to cost and what do I think it is and should I worry about it. But cost is absolutely the top concern. What's this going to cost me if I do it?

So I would love to be able to see what something is going to cost and if it's going to cost more because you're going to a specialist, you're going to someone who is the top of whatever they do, at least you know that.

Right now I feel completely helpless. If they want to raise my rates, what can I do? I have two choices: Pay it or don't.

You've got your budget and you know how much you can spend each month, and when something like insurance goes up, you've got nothing to show for it. It's not like you get better insurance. You look at your budget and say, OK, we're going to have to cut something else out.

And so, we really do think about should we drop it all together? Twenty grand a year, put it in the bank. It's a gamble and it's a big gamble. So $20,000 a year of our income goes to something that I hope I never have to use, which again doesn't make a lot of sense to me.

Vigeland: That was Paul Martin of Sonoma, Calif.

Our health care stories were produced by Sarah Varney of station KQED in San Francisco.

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lost my job a year ago due to illness, i am on long term disability through the company.been paying cobra subsidized through the government. but for some reason that is going away in august. so i wont be able to afford my health care. i applied to medicaid in ohio, due to my bringing home 1345.00 per month and my expenses are so much more. i am very ill with several chronic illnesses and am on appeal with social security disability. I was turned down for private insurance due to pre existing conditions. i have no way to get to my doctors and pay for my meds without insurance. i could really die. no one cares and no one will help me. what do i do?

I am an insurance broker who is trying to help several clients obtain affordable health insurance. Brian McCarthy's experience with the PCIP program sounds the most promising...that is until you read the fine print.

This could be a great option to assist many people who can't obtain or afford coverage due to pre-existing conditions. However, one can only qualify for this new health coverage option "if you have been uninsured for at least six months, you have a pre-existing condition, AND you have been denied coverage (or offered insurance without coverage of the pre-existing condition) by a private insurance company."

That's quite a few hoops one must jump through. It's great for the uninsured with pre-existing conditions but not so great for the others it leaves out. Another unintended consequence of a well-intentioned law.

I am 49, recently divorced mom with 2 part-time jobs, both of which do not offer any insurance. One of those is in a school. As a matter of fact, I've had my hours cut 2 times in the past 3 yrs so that they would not be obligated to offer me health insurance. My income of 1,400 before taxes, does not qualify me for Medicaid, I make too much money according to their guidelines. I am considered to be in the working poor class of people here in Michigan. I have no pre-existing conditions, but have heard NOTHING about Michigan's plan.
By the way, Michigan's unemployment rate was around 15%, so getting a full-time job with benefits @ my age is highly unlikely at this point as competition is fiercely competitive & I have 2 degrees. I probably could not afford a premium anyway. My car insurance company just charged me for medical coverage when they found out that I did not have health insurance - an extra $500.00 for a 6 month premium. Before the divorce in 2009 I did have health coverage through my spouse. My Family Practice Physician who has seen me since 2002 has worked with me to prescribe generic prescriptions & even offer very low priced office visits, as well as to let me pay when I am able. Blue Cross also rules the roost here. For a Non-Profit company, how can they make BILLIONS of dollars every year & get away with it? I too have heard no advertisement for the new Health care plan.

The thing that popped out to me when hearing this was that the deductables are going up. My partner recently received a bill for over $700 for her routine blood work in treatment of her chronic conditions. After calling around to the various parties, she has realized that her employer approved a change that makes her routine lab work charge to her deductable; something that was not true in previous years. Now she is faced with the fact that she is paying for medical insurance that doesn't cover the normal expenses of monitoring her medical treatment. Without bloodwork she cannot get presecriptions for the drugs which her plan allows her to obtain with a small co-pay. She may be forced to choose between paying her bills and medical care-something insurance is supposed to be an aid to. It might make just as much sense to opt out of her plan and pay out of pocket, because the cost would be deductable and about the same.
If this is the face of universal health care, its not pretty.

As I listened to this story, I really had to wonder how the people you interviewed were able to get such great deals. Sad to say, but I found their stories almost laughable.

I live in Ohio, where Anthem Blue Cross rules the roost. I am 58, and a writer (i.e., No employer to help in footing the bills). I have a couple pre-existing conditions, though nothing that costs my insurer anything more than a very slight break on prescriptions. Even so, my insurance premium jumped by 39% last year - to nearly $900 a month, plus a $2,500 deductible - all of which I have to pay. When I called them about it, I was informed that I never should have been accepted into their insurance pool in the fist place, seeing as one of those pre-existing conditions was breast cancer.

Premiums for this next year haven't been announced yet, but I dread to imagine what their increase will be. I can't afford what I am paying now. Even more, I can't think of going without. Why don't you include people like me in your stories on the true costs of coverage, and the impacts those costs have? There are far more of us than you might imagine.

Let us take an example of Texas. The "Wise Medical Insurance" is quite popular in Arizona. It provides so many offers for the low income people.

I work in the country club industry and I feel fortunate to have kept the same position for 18 years without any layoffs. My wife is studying medical transcription and not working steadily.
Obviously, I don't make a ton of money but I contribute to our workplace sponsored health plan and exceed by 2% their 3% contributiuon to my 401k. (still not a ton of money)
Of course, being 64, I've had access to my 401k for a few emergencies and it's helped a lot. However, at about $1000 a month I couldn't come close to affording coverage for my wife, so we've been paying cash for her services. Even with emergencies the yearly cost is still way cheaper than a plan.
My questions are:
Is the new national health care plan going to cost me as much, or(horrors) even more?
I read that the new Health care plan is accepting enrollments. How come there's no advertising pitch from the medical insurers? Are they holding back for "repeal" or are they as in the dark as me?

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