When it comes to health coverage, one really is the loneliest number

If you’re fortunate enough to have health insurance through your job you’ve probably been spared the overwhelming costs, unreasonable conditions and frequent indignities of obtaining and paying for an individual health care coverage. But take it from those who have—or have tried—it’s a brutal, expensive and demoralizing way to live.

The Cover America Tour has crossed ten states so far and we’ve heard this same stories about individual health care in virtually every city, town, or country road we have stopped.

There was Gary (right), a technology consultant in Milford, Massachusetts whose spiraling insurance premiums get him less coverage each year. He needs equipment upgrades to keep his business going, but the high monthly insurance costs don’t allow room in the budget for any extras.

There was Peter, a t-shirt shop owner in Carbondale, PA who declined care for his amputated thumb because he can’t possibly afford an individual insurance policy. Sacrificing his thumb seemed like a better option than losing his home and business from medical bills to reattach it.

There was Marty in Ohio, a former veterinarian of 30 years who is burning through the savings she meticulously put aside for years for her retirement just so she can pay her ever-escalating insurance premiums and oppressive deductibles.

If the prices aren’t enough to scare you away from buying insurance on your own, the lack of consumer protections just might.

This week Families USA released a report, Failing Grades, which details the inadequate and inconsistent protections each state offers to people who have to purchase insurance on their own. The report found that safeguarding consumers is the exception—not the norm—in most states, and that attempting to buy individual insurance can leave you vulnerable to rejection for something as minor as cold sores, ridiculous premium hikes, and the abrupt cancellation of your policy without any recourse.

Last week in Pittsburgh, PA we heard about the egregious stunts pulled by an insurance company on one of its individual policy holder. When Tina called to update her policy with her married name, she decided to ask—just to be absolutely sure—whether she had maternity coverage. The agent said yes, giving Tina some comfort as she and her husband set about starting a family. Five months into her pregnancy the insurance company denied all maternity coverage.

It’s no wonder our recent investigative report found that those with individual coverage were more likely to have complaints about their coverage, pay higher premiums and deductibles, and postpone care due to high costs than those on employer plans.

If you find yourself out on your own for insurance, check out our tips for buying individual insurance for guidance on researching before you buy. But be forewarned: With few consumer protections and debilitating costs, the individual market is no place for the weak-stomached. With pre-existing conditions though, they probably won’t insure you anyway.

—Meagen Bohne, Campaign Organizer

Visit Cover America Tour to see more videos of the people we're talking to across America and to share your own health care story.

Comments

[E. Daniel Follett]

I had an HMO policy for my self & family,it was 1994,I had a DVT (clot)in my left leg,treated in hospital 4 days & sent home.Put on coumadin for 6 mo.and never was told another thing.Dr. said "Your a truck driver clots are common in that line of work."Late Aug.2001 I felt bloated and sick,had not lost any weight but my wife noticed I had made 2 turns to the west coast (from Wi.) and not eaten more than a nibble of the food she always sent.Went to Dr.at our HMO, he said "Must be a ulcer." & gave me some type of antacid.I made one more lap to the west coast and back.By labor day week-end I was to sick to get out of bed,went back to Dr. 3 more times in the following week,each time I came home with a different med. and guess of what my problem was.Finally on 9-10-01 they checked my blood work and said "You need to go to the hosp.for a real work up,your labs are bad news" At this time I was really sick and decieded to go to the VA hosp. in Milwaukee Wi. on the advice of my Dr. who said "You need a place with lots of resources to figure this out fast." The VA Docs looked at me one min. and said you are having acute liver failure and told my wife "It's to late he's not going to make it more than two or three days."The date was 9-11-01.Three days later I had not died yet and they(the VA Docs) had been going over my med records my wife had gotten from our HMO and discovered that in 1994 when I had the DVT the HMO Docs found that I had a condition called "Anti-phospholipid anti-body syndrom"(APL)and had never informed me of it or the fact that any one with with APL,thats had a clot needs to be on life long anti-coagulants (coumadin ect.)because of the very certain to follow clots.I had been lucky for 7 years but my luck ran out.The VA Docs found that both (you only have 2) hepatic veins were clotted shut with no hope of reopening. It was called Budd chiari syndrom,no one lives through it.Five days later I was not dead,and the Docs went looking for why and found that I had a very small third hepatic vein.I was still going to die but it would take a little longer.The Docs deceided to take a chance on opening the vein up with angio-plasti to allow enough blood to flow to keep me alive.I was going to die anyway,so it was opened up way beyond what was a safe margin to push it.It needed to carry enough flow to be of any use in this case.Well the vein did not rip and it's been re-opened seven times since 2001,and every time I have it done I do not know if I'll live or die 5 to 7 days later if it rips.Toxic death from liver failure is a bad way to go.This did not have to happen to me if I had been treated correctly from 1994 on.The treatment was well known but the HMO had deceided it would be better to get rid of me by raising our rates.I did not take the hint because all the other ins. co. I called wanted just as much $ because of the clot in 1994.Due to this disaster we lost our trucking co. and almost my life.In most states what the HMO did would be a felony but in Wi. the laws are written by the big money ins.lobby. Wi.had a $400,000.00 punitive damage limet on med. malpractice at the time and only two law firms in the whole state doing med. cases.I called them both,they both said the same thing,"Your case is a classic slam dunk but costs us twice as much as we can recover in this state,sorry" They also said after looking at my med records "The HMO did it by the numbers and you were going to cost them to much so they treated you with a vascular surgon that was a contractor from out side the HMO,then in six mo. when treatment stopped,the contractor was let go ,all med info was given to your primary doc,& six weeks later they gave you a new primary doc to complete the hard to follow trail of smoke and mirrors.Welcome to Wi.There is no help for the injured people in this state.The VA had me at 100% disabled w/non-service connected pension benefits check every mo. My wife went back school got a new degree,now shes back to work,VA pension was stopped because of her income and I am still waiting for Social sec. to give me a hearing after two turn downs.I filed the first time in 2001.Every Dr. I have said I can not go back to work,S.S. thinks I'll die sooner than later so blow it off & he'll go away! Well we have two kids,11 & 12 now and we are not able to make ends meet on one income. I am worth more to the family dead and I ask my self "Where is the justice in this country when these crooks in the ins. industry can take your money,withhold simple cheap treatment that you'll die without,walk away leaving your life destroyed and then the same government that paid me a 100% disabled military pension has another hand that withholds the S.S.insurance benefits that I paid for?" Also we do not have a choice on paying for S.S. or not,it's just a scam forced on us that will not pay out when you most need them.My family has suffered enough & I wish only for fair treatment.

[Kate M.]

I hope that our elected officials pay close attention to this tour. The esclating cost of individual insurance in this country is devastating to working families. It has certainly hit my family hard. Two years ago my father-in-law suffered a back injury which resulted in the loss of his job. He found himself too young to qualify for Medicare, too "rich" to qualify for Medicaid and too poor to purchase his own insurance. Now, he struggles to pay for day-to-day expenses and has burned through his entire retirement savings.

I applaud your efforts and sincerely hope that your tour yields some real change! It is LONG overdue!!!!!

[Scott Gifford]

Hi Dave,

A few thoughts.

Although the costs to employers providing health care are certainly high, the costs to individuals are much higher. Employer-provided group health care policies have special regulations and cannot take into account the health of members; they are also paid with pre-tax dollars. Purchasing most individual policies requires an extensive health evaluation, and applicants who are in less than perfect health are routinely declined (I was declined for a minor health condition that is completely treated with a $10/mo prescription). If you make any errors on the application, you can have your policy cancelled later. The plans are much more expensive, and are paid by the individual out of post-tax dollars. $600/mo pre-tax for a family would be a bargain for an individual policy.

The tricky part about individual policies is that most healthy people don't buy them, so the insurance companies typically pay out quite a bit on the policies that are purchased, making them very expensive. Group health care helps make up for that, because companies provide health care to all employees, both those in good health and those prone to illness. Most of these employees are relatively healthy, and so the insurer can afford to charge much less for the policies.

Individual health care would be better in some ways, but those problems needs to be solved first, and they are hard problems, both economically and politically.

It's also worthwhile to keep in mind that the traditional reason that employers have provided insurance to their employees is because employees who are well cared-for and have well cared-for families are likely to be more productive, because they are spending less time sick or dealing with health problems and more time working. If employers punt all health coverage to individuals, and their employees decide to purchase no health coverage or inadequate health coverage, they could end up with less productive employees.

Finally, I assume you know this but for others that may be reading: while it may be tempting to hire only single employees because they are cheaper to insure, it is against the law to take family status into account while hiring.

[Dave]

The idea that having health care through your employer somehow shields you from costs is absurd. I am an employer. To cover a single employee costs us $305/month (we pay over 80% of that). An employee +1 (their spouse) plan costs us $588 (we pay 75%, the employee pays 25%). The family plan costs us just over $900/month (we pay 65%).

So yes, if you only focus on the cost of health insurance, the employee does get a decent plan at a more affordable then if s/he were on their own.

But obviously, there are other considerations to the employer. If we're paying $250, $450, or $600 extra per employee per month (depending on the plan) we're obviously cutting other benefits. Also, from the employer's perspective, it's much more economical to hire a single employee than an employee who requires a family plan, since the family plan costs us an extra $3600 per year.

Another obvious question to as is, "what does employment have to do with individual health?"

Why don't I get my life insurance, home owner's insurance or auto insurance through my employer? The answer of course, lies in politics. If employers were out of the health care business, the overall costs would be astronomically cheaper through the simple economics of supply and demand.