JustCare

Category: Health insurance

  • Health care costs continue to rise faster than inflation

    Health care costs continue to rise faster than inflation

    Americans want Congress to address out-of-control health care costs; these costs have been Americans’ top policy concern for several years. Until Congress acts, costs likely will continue to rise. Axios reports that in 2018, Americans spent $3.65 trillion on health care, 17.7 percent of the economy. 

    Health care spending grew by 4.6% between 2017 and 2018. It grew even more than in the previous year, when it grew by 4.2%. Both years, higher prices, not an increase in utilization, fueled the increase. According to federal actuaries, corporate health insurers and corporate Medicare plans did not rein in health care prices. 

    Corporate health insurers have an incentive to allow provider rates to increase. The more they pay providers, the more they can charge in premiums. The more they charge in premiums, the more they can profit.

    Higher health care costs in 2018 as well as in 2017 led to a one million person increase in the number of uninsured in each of those years. At the end of 2018, there were 30.7 million uninsured. Health insurance premiums are up, as are deductibles. In 2018, deductibles were $500 higher than a decade earlier, $1,400 as opposed to $900.

    The number of people with corporate health insurance–largely employer-based coverage–dropped a bit in 2018. But, the per capita cost of private health insurance rose by 6.7 percent to $6,199 a person. Hospitals, doctors and pharmaceutical companies were able to secure significantly higher rates from insurers, leading to higher insurance premiums.

    In 2018, total health care costs average around $11,000 per person. About one third of that cost was for hospital care. About one fifth of the cost was for medical care. And, about nine percent was for retail pharmacy costs.

    Medicare and Medicaid, public programs, experienced much slower growth than corporate health insurance, 2 percent and 3.7 percent as compared to 6.7 percent. Corporate Medicare and Medicaid insurers were responsible for increases in these programs’ spending.

    The National Business Group on Health expects that premiums will increase 5 percent for workers and their families in 2o2o. The average cost of workplace coverage will be $15,375, up from $14,642. Employers typically pay about 70 percent of premium costs for individuals and families.

    Workers will be responsible for an average of $4,500 in premiums in 2020. In 2018, the average household spent more than $5,000 on health care, double what they spent on health care 34 years earlier, in 1984.

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  • Traditional Medicare offers better home care benefits than Medicare Advantage

    Traditional Medicare offers better home care benefits than Medicare Advantage

    If you have Medicaid or can afford supplemental coverage to fill gaps in traditional Medicare, here’s another reason to think twice before signing up for a Medicare Advantage plan. Researchers at Brown University’s School of Public Health have found that Medicare Advantage plans do not offer the high quality home health care benefits that traditional Medicare offers. Traditional Medicare home health care services are better, they report in JAMA Network.

    People in traditional Medicare, overall, have access to far higher quality providers than people in Medicare Advantage plans. Last year, researchers at Brown University found that traditional Medicare offers higher quality skilled nursing facility benefits than Medicare Advantage plans. Medicare Advantage plans contract with poorer quality providers.

    Of course, people in good health need not be too concerned about the quality of care their health insurance offers them. But, all of us can be hit by a car, or slip and fall, or otherwise develop a costly condition at any time. So, it’s important to pick a Medicare plan that will meet your needs in the long-term.

    Unfortunately, data about the quality of care in particular Medicare Advantage plans is not available. But, the Brown University researchers found that people with costly health conditions were more likely to leave their Medicare Advantage plans and enroll in traditional Medicare. That’s another sign that Medicare Advantage plans are not meeting people’s needs when they need costly care.

    For their home health care study, the researchers analyzed data from 4.4 million people who received home health care. They could not independently assess the quality of the home health agencies serving people in Medicare Advantage plans. Instead, they determined quality based on star ratings, which can be seriously flawed. They found a “significantly” greater likelihood of getting high-quality care in traditional Medicare than in Medicare Advantage. Consequently, people in Medicare Advantage plans may suffer negative health outcomes.

    The researchers posit that Medicare Advantage plans save money by contracting with lower quality home health care agencies, just as they save money by contracting with lower quality skilled nursing facilities. Unfortunately, the Centers for Medicare and Medicaid Services does not factor in the quality of home health care agencies in a plan’s network when determining a Medicare Advantage plan’s star rating.

    The Kaiser Family Foundation has also looked at the quality of providers in Medicare Advantage plans and found that people in these plans are less likely to be able to use centers of excellence when they have cancer.

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  • Do you need care? Why should your health insurer decide

    Do you need care? Why should your health insurer decide

    In a Washington Post op-ed, William E. Bennett Jr., a gastroenterologist and associate professor of pediatrics at the Indiana University School of Medicine, makes the case that health insurers should not be allowed to practice medicine. They too often deny medically necessary care unless and until your doctor is willing to go through hoops with their medical staff. But, medical staff who work for health insurers have no clue whether you need care.

    Bennett appreciates our need for health insurance. He also recognizes that having health insurance is necessary but not sufficient for our well-being. To get his patients needed medicines and tests, he must request prior authorization from his patients’ insurers, which can needlessly delay their access to care for weeks. And, still, the insurers may deny needed care.

    Only if Bennett appeals to a doctor who works for the insurer and says the right key phrases, will the insurer reverse its denial. Most of the time, the doctor in the employ of the health insurer has little accurate information about the patient; the doctor has never had any contact with the patient. Bennet explains that the insurer’s doctor is unqualified to know whether the treatment or medicine is needed.

    There is nothing beneficial about this process for the doctor or the patient. It does not assure the patient gets the proper treatment. In fact, it keeps many patients from getting needed care. And, it burdens the doctor excessively and unreasonably.

    Bennett experiences the system from the patient’s side as well because his daughter has a serious health condition, and he has had to deal with an insurer that has limited her access to needed treatment. Appealing is a challenging process that requires Bennett to rely on the advocacy of his daughter’s doctors. It takes time and does not always work. In the meantime, his daughter suffers, even though his daughter’s treating physicians all know she would benefit from the treatment.

    In short, when health insurer denials are based on the insurer’s claim of lack of medical necessity, the system breaks down, and the most vulnerable patients are harmed. One study revealed that one health insurer denied claims for emergency visits that met a “prudent layperson” emergency coverage standard in more than 85 percent of cases. Patients can appeal the denials with a high likelihood of success on appeal. But, only a tiny number know they can appeal and have the wherewithal to do so.

    Bennet concludes that health insurers should not be able to decide the care people need: “When an insurance company reflexively denies care and then makes it difficult to appeal that denial, it is making health-care decisions for patients. In other words, insurance officials are practicing medicine without accepting the professional, personal or legal liability that comes with the territory.”

    Here’s more from Just Care:

  • Private health insurers don’t let you budget for your care

    Private health insurers don’t let you budget for your care

    Kaiser Health News reports that people with the wherewithal to shop around for affordable health care can easily end up with bigger bills than they expected. Unlike traditional Medicare, private health insurers don’t let you budget for your care.

    No one should have to shop around to ensure that their health care is affordable. Most people needing care have better things to worry about than whether their insurer, doctor, or hospital will charge them a fair price. Still, private health insurance companies force Americans to shop for care if they want to keep their costs down.

    Kaiser reports that even people with private health insurance who try to budget for their care may not succeed at keeping their costs down. One couple, the Balzer’s, planned a laparoscopic hernia repair operation for after they had had a baby and had met their insurance deductible. Wolfgang Balzer also called the hospital and the doctors for cost estimates.

    Still, the Balzer’s could not get an accurate sense of their costs. The anesthesiologist’s office would not return his phone calls. The hospital’s actual bill was more than 50 percent higher than its estimate. And the surgeon’s bill was more than twice the estimate. With insurance, the Balzer’s owed $2,304.51, $800 more than they expected.

    The Balzer’s challenged their bill, a time-consuming and stressful process. The procedure had gone exactly as expected, and there was no reason the bill should have been higher than estimated. The Balzer’s learned that  neither hospitals nor doctors are required to give accurate estimates of patients’ costs.

    The Kaiser reporter inquired about the Balzer’s charges, and the hospital ended up writing them off, six months after the surgery. That’s the good news. The bad news is that most of us do not have a reporter following up on our health care charges.

    In other countries, where patients must pay a piece of the cost, providers are expected to give them accurate cost estimates. And, people’s out-of-pocket costs are nowhere near as high as they are here. It’s time to fix our broken health care system.

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  • Health care information confuses people

    Health care information confuses people

    The Center for Retirement Research blog focuses on how health care information tends to confuse people more than help them. As a result, many people make poor health care choices.

    In truth, information that we need to make smart health insurance choices is largely unavailable–e.g., whether a particular health plan delivers value and how one health plan ranks vis a vis others. Private health plans rarely provide helpful information on what we will need to pay for our care. And, people don’t know what care they may need. So, people understandably cannot choose health plans that save them money.

    Only older adults and people with disabilities have the choice of traditional Medicare and can guarantee themselves access to the doctors they want to see at predictable costs. But, they need Medicare supplemental insurance, which can be expensive and many older adults are hard-pressed to afford it.

    It’s not clear that people could ever have the health care information they need to make rational choices about private health plans. It might not make a material difference if health plan information were less confusing or better information were available. What would make a big difference? Giving people good affordable private health plan choices, which would require a far more heavily regulated private health insurance system than we have today.

    Putting aside health insurance choices, the evidence suggests that people cannot make good choices about health care products and services. They often mistakenly believe that more expensive health care products–e.g. brand name drugs, not generics–are better. One research experiment published in Science found that “Expensive medications tend to make us feel better, even when they’re no different than cheap generics.” People may react to a treatment differently based purely on the cost of the treatment.

    In fairness, most of us are bombarded with health care information that is virtually impossible to understand and steers us in all kinds of directions that may not be in our interest. We are left to wonder what to believe. It’s therefore not surprising that people often believe that more medical tests are better than fewer tests, even when they may not be. And, they skip care because they mistakenly think they cannot afford it. They may think that a physical or MRI will cost more than it actually does.

    A University of Wisconsin report finds that almost half of people who are on a tight budget skip medical tests and treatments because they don’t think they can afford them. About one in three of them don’t fill a prescription for the same reason. They make these decisions thinking their out-of-pocket costs are higher than they in fact are.

    People also do not understand how their health insurance deductibles and coinsurance work. People with high-deductible health plans do not understand that they need to pay for the cost of their care up to the deductible amount, which is often many thousands of dollars, before their care will be covered.

    It’s time we stopped expecting consumers to act “rationally” when it comes to health care and guarantee everyone affordable access to the care they want and need.

    Here’s more from Just Care:

  • Major problems with Medicare Plan Finder

    Major problems with Medicare Plan Finder

    Not long ago, advocacy groups called out the Centers for Medicare and Medicaid Services (CMS) for misleading the public about Medicare Advantage plans–private insurance plans that offer Medicare benefits–and steering people into them without providing appropriate warnings. Now, the Government Accountability Office (GAO) has issued a report highlighting major problems with the Medicare Plan Finder web site, which is supposed to help people compare Medicare plans.

    People should be able to know when they choose a Medicare plan what their out-of-pocket costs are likely to be and which doctors and hospitals they can use. But, the Medicare Plan Finder cannot provide them with this basic information. People with Medicare understandably struggle to get the information they need from the Medicare Plan Finder.

    Estimates of out-of-pocket costs are incomplete on the Medicare Plan Finder, so people cannot make a meaningful comparison between traditional Medicare and Medicare Advantage. People need to know that their maximum out-of-pocket costs can be as high as $6,700 in a Medicare Advantage plan and far higher if they use out-of-network doctors and hospitals. But, the Medicare Plan Finder does not highlight these costs. It does not make it easy for people to see that if they want to spend time with a family member outside of their community and need care, they may have to pay for all their care out of pocket if they join a Medicare Advantage plan.

    To find out whether the doctors and hospitals you want to use are in a Medicare Advantage plan, call them directly and ask. You can also visit the Medicare Advantage plan’s web site. Always call the plan to confirm. Medicare Advantage plan provider directories are wildly inaccurate. Provider information is not on the Medicare Plan Finder.

    In traditional Medicare, people with supplemental coverage have minimal costs. If they do not have Medicaid or retiree benefits to provide this coverage, they need to buy this “Medigap” coverage. And, they need to know its cost and the specific benefits covered. That information is not available on the Medicare Plan Finder site.

    Note, the Medicare Handbook is also misleading. Call your SHIP (State Health Insurance Assistance Program) for free help choosing a Medicare plan.

    Medicare for All, an improved traditional Medicare, proposed by Senator Bernie Sanders and others, guarantees everyone coverage from virtually all doctors and hospitals, without premiums, deductibles and copays, or the need for supplemental coverage. It would save people money on their health care, without forcing them to give up the choice of doctors and hospitals they most value. As important, it would not force people to try to navigate a sea of rules and constantly changing health plans and guess whether there’s a health plan that may meet their needs. It also would not ration care based on ability to pay.

    If you support Medicare for All, please let Congress know. Sign this petition.

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  • Private insurers are the biggest obstacle to guaranteed affordable health care

    Private insurers are the biggest obstacle to guaranteed affordable health care

    Although not all the Democratic presidential candidates support Medicare for All, most understand that giving people the choice of Medicare but allowing them to keep their private health insurance will not guarantee health care to all or make health care affordable. Only Medicare for All guarantees everyone affordable health care from the private doctors and hospitals they choose to use. Private health insurers are the biggest obstacle to guaranteed affordable health care.

    Over at New York magazine, Josh Barro does not appear to appreciate that the problem with private insurers goes beyond the fact that they are for-profit and do not rein in provider rates or prescription drug prices. It’s that their business interests are at odds with the need of Americans for guaranteed affordable health care. 

    Barro mistakenly believes that if we simply reined in provider rates through federal rate-setting, we could make health care affordable. Unfortunately, high provider rates are only one way that private insurers do not meet our needs. Insurers jeopardize our health care in a number of other ways.

    Private health insurers drive up administrative costs to the tune of as much as $503 billion a year. These administrative costs contribute to both high provider rates and high premiums. With Medicare for All, these administrative costs largely disappear, and we generate enormous administrative savings.

    Yet a third problem with for-profit private insurers is that they are in the business of avoiding risk. To survive financially, private insurers must compete to avoid people with costly conditions. Consequently, our commercial health care system is designed to fail the people who most rely on it.

    Commercial health insurers cannot compete to meet the needs of people with complex conditions. If they did, they would attract too many people in poor health, their premiums would soar, and everyone who was healthy would flock to their competitors. They would go out of business. So, instead, they do their best to avoid enrolling people with costly conditions and to delay and deny care to their enrollees with complex conditions. 

    A fourth problem with commercial health insurers is that they treat their data as proprietary. Most of their data is not available for public scrutiny. So, we cannot measure and report their performance, nor can we drive system improvements.

    The fact that insurers do not appear to “manage care” in ways that serve the public good is a fifth problem. For example, wittingly or unwittingly they colluded with pharmaceutical companies to fill millions of opioid prescriptions. Even if unwittingly, the fact that they covered millions of opioid prescriptions without questioning people’s need for opioids vividly illustrates that they do not manage care appropriately or effectively.

    Thankfully, virtually all Democratic presidential candidates seem to appreciate that for-profit insurers are at the heart of the problem with our health care system. Federal rate-setting alone cannot guarantee access to good affordable health care for all Americans. You need Medicare for All in order for the federal government to bring down exorbitant and irrational hospital and doctor rates, lower administrative costs, eliminate cost-sharing and give people access to the doctors and hospitals they want to use when and where they need to use them. 

    If you support Medicare for all, please let Congress know. Sign this petition.

    Here’s more from Just Care:

  • Can we regulate health insurers to do right by Americans?

    Can we regulate health insurers to do right by Americans?

    As the debate over the future of health care in America rages on, some posit that the solution to controlling costs and guaranteeing health care to all lies with better regulating commercial health insurers. Olga Khazan writes in The Atlantic that if Congress regulated health insurers more aggressively, as European governments do, it could ensure that Americans would not get high medical bills,  How realistic is that?

    Khazan suggests that Americans would be happier with commercial health insurance if they were not faced with so many surprise medical bills. And, Congress could ensure Americans never saw these bills if it regulated health care prices and had strict rules about what insurers covered, as the French and German governments do. Europeans do not get surprise medical bills.
    For example, in Germany, there are different health insurers, but all doctors and hospitals take people’s health insurance, whatever it is. Most people pay nothing for their care. Supplemental insurance picks up any out-of-pocket costs. Copays are small. A tiny fraction of doctors don’t take insurance, but even they must let people know their cost in advance of treatment. No surprises.In France, there are health insurers, but all doctors are in network. Some doctors can charge above the government-negotiated rate. But, private supplemental insurance generally picks up these additional costs. Doctors’ charges must be posted publicly so you can always know what your costs will be before receiving care.

    The German and French systems are not perfect, but most people think of them as being far better than the US health care system. And yet, unlike the United Kingdom or Canada, where health care is government-administered, these countries rely on private health insurers to guarantee health care to their citizens.

    Do these models provide a potential path forward for Americans? Khazan argues that they would put an end to some unexpected medical bills without doing away with the health insurance people don’t seem to want to give up. But, she doesn’t explain how they would address a host of other issues we face with for-profit health insurers in the US, including cost-shifting to people in poor health and wrongful delays and denials of care.

    These practices all make our system unaffordable to many people who need care and too often leave people needing costly care without the care they need. But, it is hard to see how Congress could regulate these behaviors.

    Here’s more from Just Care:
  • Don’t trust your health plan’s provider directory

    Don’t trust your health plan’s provider directory

    Traditional Medicare’s “one size fits all” approach offers a wide choice of doctors and hospitals at a predictable cost, for which you can budget. With commercial insurance, be it through a Medicare Advantage plan, a state health care exchange, or your employer, your choice of doctors and hospitals can be quite limited; and you may not be able to see the doctors you want to see. Beyond that, you can’t trust your health plan’s provider directory to reflect accurately the doctors you can use or the locations at which you can get care.

    If you’re looking to see certain doctors, a plan’s provider directory may list them as part of their network, but the doctors may not be in your health plan. And, if the doctors are in your health plan, they may not be taking new patients from your health plan. Or, the doctors may only be seeing patients from your health plan at a location that is inconvenient for you, which is different from the location listed in the directory. (Here are two tips to help you choose a health plan.)

    To address problems with health plan provider directories and help people make better decisions about their health plans, CMS imposed rules on health plans that became effective in 2016. Both Medicare Advantage plans and plans in the state health exchanges must publish up-to-date provider directories, including which doctors are seeing new patients, their locations, contact information, specialties and hospital affiliations. And, in addition to making them easily accessible, they must keep them updated each month. Three years later, the rules are not working.

    CMS may impose penalties on Medicare Advantage plans up to $25,000 per person enrolled if they violate the rules and up to $100 per enrollee on health plans in the state exchanges. These penalties should deter plans from listing doctors in their directories who have left their plans as much as ten years back, as some have been doing, but they have not. (In November 2014, California levied penalties of $250,000 each on Blue Cross of California and Anthem Blue Cross because 25 percent of the doctors they listed said they did not accept these plans or did not offer services at the listed locations.)

    The Washington Post reports that for the third year in a row a CMS audit found that more than half of the Medicare Advantage plans have at least one deficiency in their provider directories–mistakenly telling people that doctors are in-network when they are not or that they are taking new patients when they are not or that they are seeing patients at particular locations when they are not. Yet, the Trump Administration has chosen not to fine Medicare Advantage plans that violate these rules.

    If CMS were to use its power to impose fines on Medicare Advantage plans, Medicare revenues could be way up. One recent CMS investigation found that the online directories of 54 Medicare Advantage plans had incorrect information on more than 2,500 of the 5,832 doctors listed. 

    Since you can’t trust the provider directory, how can you help ensure you see in-network doctors?

    1. Talk to the staff of the doctors you use to see what plans they are in and whether you will be able to see them in-network.
    2. Keep in mind that three out of ten doctors change their hospital affiliations or practice group each year.
    3. Insurance contracts can be so complex that sometimes staff don’t know what plans the doctors are in. Always call your health plan to double check.
    4. Finally, make sure that whatever plan you join has a stable of good specialists. Even if you’re healthy, you want to know that there are doctors in the plan who will meet your needs if you develop a costly or complex condition. (Indeed not knowing your future health care needs makes it challenging to choose a health plan that’s right for you.)

    Unfortunately, it’s still hard to avoid medical bills from providers who are not in your plan’s network if you are hospitalized. Often the in-network hospital has teams of out-of-network doctors.

    Congress is now looking to address the problem of these “surprise medical bills.” Twenty-five states have already passed laws offering people some protection against these surprise bills.  The best way to protect yourself is to let the hospital know in advance of being admitted that you only want to be treated by in-network doctors.

    To learn more about Medicare Advantage plan networks and provider directories, there’s a September 2015 report by the Government Accountability Office (GAO) critiquing CMS oversight of Medicare Advantage plans to ensure adequate access to care in the wake of United Health terminating contracts with well over 1,000 Medicare Advantage providers in 24 states. Medicare Advantage plans can end contracts with doctors and other providers at any time for any reason. The GAO recommended heightened CMS oversight of Medicare Advantage plans and rules to help patients accurately understand health plan provider networks.

    Here’s more from Just Care:

  • Eve’s story: Commercial health insurance, inhumane choices

    Eve’s story: Commercial health insurance, inhumane choices

    Millions of hard-working Americans with common health conditions struggle every day to stay healthy because they must rely on commercial insurance to cover their care. Deductibles and coinsurance are so high that people must prioritize their families’ health care needs. They are forced to make choices that are inhumane and unconscionable.

    Eve and her husband Errol Meikle are two middle-class Americans in just this predicament, forced to prioritize their families’ medical needs, hoping against hope for Medicare for All. Medicare for All is a health care system that builds on Medicare. It allows people to see most doctors and use most hospitals anywhere in the country. It improves on Medicare, eliminating premiums, deductibles and coinsurance and expanding benefits to include vision, hearing, dental and home and community-based care. Medicare for All recognizes health care as a right and guarantees everyone in America access to the care they need.

    Eve, a registered nurse, and Errol, a customer service rep, live in Florida with their three children, ages 18, 14, and 6. With good jobs and an annual income just over $80,000, they can no longer ensure their family gets health care. And, they have insurance!

    Eve and her daughter, Kylee, 14, have chronic health conditions requiring attention. Eve has ulcerative colitis. Kylee has scoliosis and gastritis.  But, the deductibles and coinsurance required to get all the care they both need have forced the family into medical debt.

    To live as much as possible within their budget, Eve and Errol must choose which health conditions get medical attention. Putting aside total out-of-pocket health care costs, upfront costs just to get into the doctor’s office, are often prohibitive. Because of Kylee’s scoliosis and gastritis, today, the Meikle’s owe thousands of dollars to doctors and hospitals.

    The big bills started coming in January 2016, soon after Eve got health insurance through her job, and the family started to take care of their health issues. They were not able to do so before then.

    When Eve took her daughter, Kylee, for her annual checkup, the doctor said she needed X-rays to determine whether she had scoliosis. The X-rays alone cost several hundred dollars. And, that was only the beginning. Kylee needed to see a specialist.

    Shopping for health care was not helpful. Eve contacted several specialists in her network to try to keep costs down. But, none could tell Eve what the visit would cost. There were different levels of service, ranging in cost from $450 to $850. And, this was just for a consult and review of X-rays. Kylee would need treatment as well.

    Eve knew she needed to get Kylee to the specialist. Scoliosis can become worse over time and cause problems. But, she didn’t end up doing so because in the six months she was expected to wait for the specialist appointment, Kylee developed a new serious condition.  In Eve’s words, Eve “had to let scoliosis go and pray it would not become worse every year.”

    In the summer of 2018, Kylee became so sick that she could not go to school. She had nausea every day and needed to stay in bed. So, Eve made the call that this illness trumped the scoliosis and ended up canceling the appointment with the bone specialist.  She needed to find out what was wrong with Kylee and get her treatment.

    She scheduled appointments for Kylee with two different specialists to figure out what was causing her severe symptoms. While waiting for the appointments, Kylee had to be admitted to the ER. Her symptoms became too severe–nausea, not eating, not sleeping. Eve hoped to get a diagnosis.

    The hospital sent Kylee home with a prescription but without a diagnosis. Eve was told that “hopefully” the specialist could figure out what was wrong with Kylee. By then, Eve had paid $275 upfront, her copay, to walk in to the ER. Then, after they left the ER, the physician and ER bills came in at nearly $2,000, which she was expected to pay by “cash, check or credit card.” Eve’s insurance has a $3,000 individual family member deductible and a family deductible of $10,000 before it begins covering 70 percent of the approved rate for covered services. Eve could not pay the ER bill and let the hospital staff know. She was told to call the hospital and set up a payment plan.

    Eve then took Kylee to the specialist to get a diagnosis and proper treatment. The upfront doctor’s cost for the visit was $200.  The two procedures Kylee needed, the colonoscopy and the EGD, cost $900 more upfront. And, Eve was charged $180 to learn the diagnosis.

    The total cost for Kylee’s procedures was more than $17,000. Eve owed over $5,000 for the coinsurance, 30 percent of the cost. That’s when Kylee was diagnosed with gastritis and given a prescription.

    Eve was told to schedule a follow-up visit for Kylee, so the doctor could check on how Kylee was doing. But Eve chose not to make that visit. It would have cost $163 upfront. Eve could not imagine what the doctor would say that was worth the cost. “All she’s going to say is how’s it going?” In Eve’s view, there was nothing more the doctor could do. There were no other medications to give. With so much medical debt already, Eve had no choice but to gamble with her daughter’s health. Kylee’s gastritis is still not 100 percent better, and she has yet to see a specialist about her scoliosis.

    Meanwhile, Eve has had to put her ulcerative colitis, which she has had for 22 years, on the back burner.  After taking Kylee from one specialist to another, she had maxed out her credit card. But, Eve’s ulcerative colitis has caused her tremendous and continual pain and misery. It makes getting through a 13-hour shift very difficult.

    Eve explained that one way to treat the ulcerative colitis is to keep your life stress-free. She knows that’s not realistic. She has to go to work, and she has little time to rest. She also needs medications. But, it would be too much to pay for the appointment to get the prescription she needs. Moreover, drugs are expensive. “It’s more on top of more on top of more.”

    Eve and her husband are both college educated, with good jobs, and consider themselves to be making good money. Understandably, Eve struggles to understand their financial and health care situation. They don’t live a fancy lifestyle. “No fancy car. No fancy home.” They pay their mortgage and bills. She says, “I’m frugal. I couldn’t be more frugal.” And, she asks “Why am I having to cancel doctors’ appointments for my family and decide which of my illnesses need the most attention and which will be on the back burner until we can afford to take care of them?”

    That’s Eve’s story. With expensive commercial health insurance from her hospital, Eve lives in pain everyday, and she and her daughter have not been able to get all the care they need.  Eve feels penalized for having health insurance. In her words, “It’s not health insurance when you have to pay so much upfront when you need to see the doctor. It’s a coupon. It’s not insuring me for anything.”

    Eve has often talked with her husband about dropping their insurance and paying out of pocket for their care. Without insurance, she says she could get discounted rates. She could pay $200 instead of $800 for a visit.  And, she would keep the $550 monthly insurance premium in her pocket.  She would have $6,600 a year to pay the discounted fees at the doctor’s office. She also knows that in the event of a catastrophic condition, she would be bankrupt without insurance. So, she keeps it.

    Eve’s choice to have health insurance and make tradeoffs with her own and her families’ health care, is not one that should exist in a humane health care system.

    Eve has always believed in universal health care.  She actively lobbies for Medicare for All, speaks about it and participates in conferences. As she puts it, she is “befuddled” by our current commercial health insurance system. “This isn’t working.” She, and the millions of people like her, must make choices that no one should have to make.

    If you support Medicare for all, please sign this petition to Congress.

    Here’s more from Just Care: