Health reform

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

Marketplace Staff Apr 1, 2011
Health reform

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

Marketplace Staff Apr 1, 2011

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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