|
The Hidden Costs of Healthcare Today
|
|
Rayana, Terry, Joshua and Matthew Ratliff
Pikeville, Kentucky
"What few tests I did have during my pregnancy brought such a financial burden that seven days after the delivery we walked into a lawyer's office to file bankruptcy," said Rayana. "Medically it is just a nightmare. I feel abandoned and betrayed by the system I supported. We're swimming. We're not moving upstream, we're swimming. Inadequate health insurance for us is a greater burden than no insurance at all."
Rayana Ratliff and her family are still trying to recover financially from the financial costs associated with the birth of her son Matthew a little over two years ago. Only an attorney's tardiness in filing required paperwork and the inheritance that came to her family after her in-laws died in a tragic fire kept her out of bankruptcy. What remains of the hospital bill, $9,000, has been turned over to a collection agency and additional out-of-pocket medical expenses incurred by the family sometimes just get added to the total, because they can't afford to pay.
And the Ratliffs have insurance.
When Rayana became pregnant at age 39, her age and diabetic condition contributed to a very complicated pregnancy. Although her doctors recommended an amniocentesis, her insurance said it was not necessary. Desperate to give her son the best chance at life, she went to the local Medicaid office to ask for help but was told she did not qualify. She and her husband were startled to learn that if they got a divorce, which would cost about $500, she would qualify for assistance. Rayana went home in tears and told her husband she would be willing to take that drastic step, but he would not hear of it.
Rayana went through stress tests once a week, and then twice a week before Matthew was born. At his birth, he had bleeding on the brain, jaundice, low blood sugar and heart murmurs. Today her child is a relatively healthy two year old, but he still receives regular check ups for his heart and follow-up procedures to make sure the bleeding on the brain does not return.
While holding off the bill collectors, the Ratliff family has gotten some relief through negotiations with the physicians and hospital over the size of their bill. Rayana believes it was only her part time work with health care billing that made her familiar enough with the system to know that this was possible.
Kim Little
Austin, Texas
"Congress passed a federal law to try to help, but it didn't work for me," said Kim. "I worry about what will happen when my husband's insurance expires. My life is at stake and the treatment that is working for me is not provided by my employer's plan. We still have steep out of pocket expenses, but if my husband's insurance policy had not been there after I got cancer, my family would be facing complete financial ruin."
A Texas state employee, Kim Little is a leukemia survivor. When she was diagnosed in 1996, her doctors gave her a 20% chance of a cure. She beat the odds, but in the process discovered significant gaps in the health care marketplace.
While facing this life-threatening illness, she also faced a critical decision on health plans as a new employee for the State of Texas. The state health plan only offered its employees an HMO-style plan, which would not pay for her to seek treatment with specialists at a Houston hospital. Even with those limitations she couldn't use the state health plan for a year because her cancer was a pre-existing condition, and Texas has an exemption from the Health Insurance Portability and Accountability Act.
Kim stayed with her husband's plan, but when his company laid him off, this safe refuge turned into a short term solution. The Little family's COBRA insurance runs out in May, four months before her chemotherapy regimen is over. Because the state plan will not let her continue to see the doctors who have been treating her, the Little family, which has already paid considerable out-of-pocket costs for her treatment, will be faced with a choice of quitting a successful treatment that has worked for Kim or paying the entire cost themselves.
Donna Donovan & Ken Thornley
Glastonbury, Connecticut
"During the past several years, my husband and I have learned first hand what it means to be 'under-insured," said Donna. "Our sense of security has been shattered by what happened to our insurance after Ken was diagnosed with cancer. As we saw our savings being depleted and realized we were trapped, we were frightened of being wiped out. Our premiums climbed from $230 per month to more than $1,200 per month or $14,500 a year. When added to out-of-pocket medical expenses not covered by insurance, we were left spending almost 25 percent of our income for health care."
Donna Donovan, a self-employed freelance writer, is married to Ken Thornley, who at 53 unexpectedly lost his job in the publishing industry after 23 years with the company. Their family budget was hit hard by the job loss, but Ken's diagnosis with a rare form of sinus cavity cancer nearly did them in.
The only symptom Ken ever had was a runny nose. They went to an ear nose and throat specialist who decided to look for polyps and later did a cat scan which found the problem. The cancer had spread beyond the sinus cavity into the facial bones and tissue and part of the upper palate. Donna was grateful that in the hands of a skilled surgeon Ken came through the surgery, if not intact, at least alive.
They searched in vain for over a year for another health care plan which would take them on to relieve the bills they were getting with Donna's plan. Until he qualified for disability insurance, their family budget had thousands and thousands of dollars in unexpected medical costs and Donna lived in fear of anything happening to her which would leave her unable to work the 60 to 80 hour weeks that had become typical as they tried to stay afloat.
Donna believes that Band-Aid solutions will not fix a health care system which is sick at its core.
Brian, Kate and Zachary Stenz
Columbus, Ohio
"We have been told that we can anticipate medical expenses up to or in excess of one hundred thousand dollars annually depending on the number of bleeding episodes he experiences," said Kate. "Today, hemophilia is a manageable condition, however the treatments necessary for this can be very expensive. Zach needs to be able to play, walk, run and do everything he can to learn and grown like every other child. We do not want to have to deny him any opportunities because we are worried about the limit on his insurance and affording the medications that clot his blood."
Brian and Kate Stenz, a young couple from Ohio's state capital, have a young baby who is the light of their lives. Zachary, who is 16 months old, is a happy well-adjusted child, but he is battling hemophilia. Hemophilia is an illness that makes the falls, bumps and accidents children routinely experience a nightmare for parents. The drug regime necessary to treat bleeding episodes that come with this blood clotting disorder is an expensive one, but one on which his survival depends. The medication alone costs $3,000 a week. His family estimates the health expenses incurred by young Zach in his first months of life have been over $300,000. The National Hemophilia Association estimates that annual costs for hemophilia are $100,000 a year. At this rate, Zachary is expected to max out of the lifetime cap on his health insurance before he reaches 10 years old.
For many health policies, including Zach's, lifetime caps were set at the $1 million range in the 1970s and have not been adjusted since. In the 1970s, the estimated price for the medication Zach uses would have been ten cents a unit. Today, the same drug costs $1 a unit. The price tag on drugs has gone up tenfold, but the lifetime caps on insurance policies are holding steady, putting families like the Stenzs in an impossible bind.
Jane A. Zanca
Decatur, Georgia
"American workers have learned through observation, if not participation, that jobs and health benefits are tenuous things," said Jane. "It took a century of tug of war with employers to establish the workers' benefits that corporate greed has reduced to ashes in less than a decade."
The Zanca family has been witness to the trends insured consumers face when insurance companies trim individuals and families de facto by increasing premiums. When Jane Zanca became unemployed last year, her monthly premium shot up 12-fold. This was an increase she could ill afford when she had no income.
Jane tried to get a cheaper independent policy from the HMO that had provided her care under the employer's benefit plan she had participated in for seven years but both her and her son were denied coverage, based on diagnoses they had been treating all those years.
As community services and even SSI and social security benefits dry up, families like the Zancas are finding themselves increasingly responsible for personal as well as financial aspects of health care for family members who are ill or disabled.
Dan McCarthy
Redlands, California
"All I've got is my house," said Dan. "There is no way to get a loan against it because I can't work. But if they ever do call me, I would take that risk. I would be so eager to say, 'Let's do it.' I can't wait to get into a new life again after all this time. It would be very hard to sit and wait on another kidney transplant list. I feel someone in my insurance company has made an arbitrary and unfair decision."
For someone who has been on hemodialysis waiting for a kidney transplant for two years, Dan McCarthy's doctors give him a pretty good bill of health, but his kidney problems have put his life on hold. As a former letter carrier, this 43 year-old Californian is medically retired and lives on an annual income of less than $18,000 from monthly social security and pension benefits. He has slowly been climbing the waiting list for a kidney at his local hospital and he was pleased with both his transplant team and his medical insurance carrier until the letter arrived. The letter informed him that, as of January 1st, he had a change in benefits.
For Dan that change means his insurance will only pick up the first $50,000 of his kidney transplant if he gets it at the hospital where he tops the waiting list. This would be okay if he can go on the operating room table secure in the knowledge that there won't be complications. But there are never any guarantees. If he gets the transplant at another hospital, further away from home, the insurance carrier will cover the entire cost. The rub is that this new hospital will require him to wait up to six months to be placed on their list to be eligible for a transplant. If he gets the call from the hospital (where he is now registered for a kidney transplant) that there is a kidney waiting for him, and there are complications during the procedure, the bills could climb to $75,000 or more, according to his doctors. These excess charges over what his insurance will cover would throw him into financial turmoil.
Mike Mareno
Brooklyn, New York
(Not featured on videotape; will entertain interview requests.)
"Today I couldn't afford to go get my chemotherapy treatment," said Mike. "It has literally come down to a choice between medicine and food. My credit rating is shot, and I'm really concerned about that too. I'll get through this, but it will be really difficult to build my credit back from this with all the bill collectors at my door. I think I'm typical of a lot of consumers who don't know the limits of their insurance plans. Until I had a belly ache and got my cancer diagnosis, I had no idea what the insurance paid for and what bills I'd be stuck with."
Like many consumers, Mike Mareno, never took a good look at the health plan he was signed up with until he needed it. He was employed at a salary of $30,000 a year with health benefits, and one day had a belly ache. He went in to visit a doctor and was diagnosed with colon cancer. It was a stable tumor that was not aggressive. He had surgery to remove the tumor, and has been on a chemotherapy regiment since October. He quickly found that the co-pays needed for his treatment and medication were costing him upwards to $90 a week and on a $500 weekly wage he was feeling the pinch.
His financial situation grew darker when his employer terminated him in the middle of his treatment. Since getting fired, he has had to rely on COBRA insurance and an $800 monthly unemployment benefit to survive.
The COBRA insurance costs him $260.50 per month and the co-pays necessary for his medication and treatment on top of that expense has him completely tapped out.
