Underinsured struggle to keep up with bills; uninsured seek clinic care or play the odds

The underinsured are continuing their struggle to keep up with piling medical bills, and are seeking care at federally funded clinics in greater-than-ever numbers, but some choose to remain uninsured.

NPR/Kaiser Health News: "Between them, Jim and Martha Martin work five part-time jobs. Yet they still struggle every day with medical debts. The burden warps nearly every aspect of their lives. On a typical day Jim and Martha are up before dawn. That's when they talk about necessary stuff. 'We're both working so many jobs, about the only time we sit down together is at breakfast,' Martha says. Jim adds: 'There's not much time when I'm not at work.'" Despite their hard work -- which tallies a "modest income — about $45,000 a year" — the medical bills add up. "Jim and Martha struggle all the time to figure out how to keep up" (Knox, 9/28).

Kaiser Health News also explains the symptoms of the underinsured: "In some cases, people who are underinsured have coverage through employer-sponsored plans; they have high out-of-pocket expenses or skimpy benefits. In other cases, consumers have bought coverage on the individual market that covers only catastrophic costs. Some polices might feature high deductibles and co-payments, as well as exemptions for specific conditions or expensive treatments, or limit annual and lifetime benefits" (Gold, 9/28).

Meanwhile, The Seattle Times reports on how difficult being uninsured can be when a serious health issue arises -- profiling a woman who owns a jewelry store in Seattle's famed Pike Place Market, but can't afford to pay her own medical bills. "Susan Sauls has liver and lung cancer. … Without income, she can't pay for her medical treatments because she's uninsured. As a small-business owner who makes $22,000 to $28,000 a year, her income is too high for her to qualify for any government health plan but too little for her to afford private coverage. … According to a survey done for the Market in 2007, 39 percent of people working there were uninsured — a rate about three times higher than the state's general population. And as the national debate on health care persists, these small-business owners say they don't have to look far to see examples of the current health-care system's deficiencies" (Federis, 9/28).

Many people are turning to federally funded health clinics for their care. Around the nation, a surge of patients is on track to make the centers handle more than 20 million patients this year, up two million from a year ago, The Wall Street Journal reports. "The centers are addressing in a smaller way two issues that also underlie Mr. Obama's health-care proposals: lack of access to care and high costs. The uninsured often need pay only $20 or so for an appointment with a center doctor. The no-frills centers receive block federal grants for much of their funds and pay medical staff a fixed salary, so they have little incentive to jack up costs with unnecessary care. Still, they're no panacea. Many centers have long waiting lists, and they offer only basic services. Uninsured people who need heart surgery or an MRI still must rely on charity care from a hospital, their own savings or other means. Any attempt to provide more comprehensive care at centers would require significant federal money at a time of concern over spiraling budget deficits" (Favole, 9/28).

And some people continue to not carry insurance, despite Congress' insistence that nearly everyone will soon be required to carry it, The Associated Press reports. "Researchers at the Kaiser Family Foundation, which studies the uninsured, said most are young, generally healthy adults who are self-employed or in relatively low-wage jobs that do not offer insurance coverage and don't pay enough for workers to afford individual policies. … All the health care plans that have emerged from the Democratic-controlled Congress would require everyone to have insurance, the way drivers in nearly every state must purchase auto insurance. Proponents say that by bringing everyone into the system, medical risk is spread over a broader population, bringing costs down" (Fouhy, 9/28).

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This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.