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.
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Here’s more from Just Care:
- One in four insured Americans go without care, struggle to pay high deductibles
- Why mixing Medicare with commercial insurance is not the health reform we need
- Ten ways Medicare Advantage plans differ from traditional Medicare
- For Americans, Medicare for all means continuity of care and far less disruption than the status quo
- Congressman Larson introduces the Social Security 2100 Act