Life on the Edge—without Insurance
By: Source: AARP Bulletin Today Date Posted: 2004-06-18 11:53:00-04:00
Widowed at 50, Hazel Greathouse had health insurance through her husband's employer for three years after his death. But when her group coverage ended in 1996, she didn't buy a private individual policy because it was expensive—and besides, she'd always been healthy.
Six months later she was diagnosed with breast cancer and two years after that, lung cancer. When her medical bills hit $60,000 she sold her home to start paying her debts.
Today, at 59, she takes expensive cancer drugs and faces six more years of paying medical bills on her own before she gets Medicare.
Greathouse is one of more than 5,000 people who responded to an AARP Bulletin "Sound Off" questionnaire (July/August 2001). The survey asked readers without medical insurance to tell us how they're getting by, how they're coping with their health care needs.
Americans ages 50 to 64 are particularly vulnerable when uninsured because they're at greater risk than younger people for chronic illnesses such as cancer, heart disease and diabetes but are not yet eligible for Medicare (which covers people age 65 and older).
Nearly 39 million Americans are uninsured, reports the U.S. Census Bureau. More than 5 million of them are—like Greathouse—between the ages of 50 and 64. But that number doesn't reflect the loss of jobs (and health benefits) during the current recession, especially since Sept. 11.
More than 529,000 laid-off workers lost medical coverage in the first three months after the terrorist attacks, pushing up the total to more than 911,000 by the end of 2001, finds Families USA, a consumer group based in Washington.
JUST ONE OF THE HURDLES
"The newly uninsured get the spotlight in tough economic times because so many people lose benefits along with their jobs," says Gerry Smolka, a policy analyst at AARP.
| Hazel Greathouse goes through her medical bills. Photo by Ed Lallo |
"But keeping coverage in an employer's health plan is just one of the hurdles to staying insured," she adds. "If you've had a dramatic drop in income, you might not be able to afford insurance. And if you have an ongoing medical problem, you may have a hard time finding a private individual policy that will cover it."
As the Bulletin learned from its readers, being uninsured can lead to financial hardship and increased medical risk.
From 5,169 replies to our poll, we drew a sample of 1,130 for closer analysis. While the Bulletin survey is by no means scientific, we believe the results are meaningful. The findings reveal a range of attitudes and experiences, from those who'd lost everything they had ever owned paying off medical debts to those who canceled their insurance because the coverage wasn't worth the cost.
"A COMMODITY, PURE AND SIMPLE"
Many Sound Off respondents echoed the comments of Ursula Webster, 48, of Peoria, Ill.: "Our age bracket, 45-65, is the most underserved as far as health care is concerned. Just about everybody [our] age has some sort of medical history, and insurance companies will conveniently deny paying for care because of 'pre-existing conditions.'
"Why should I pay $3,000 to $4,000 a year [on premiums] with high deductibles," she asks, "if I still end up paying for all my medical expenses out of pocket?"
Many respondents previously had insurance but lost it or gave it up. Some said the rates—ranging from $400 a month for a healthy individual to $8,000 per quarter for a couple with medical problems—were way beyond their means.
"Lack of affordable health insurance proves to me beyond doubt that we do not live in the wealthiest country in the world—or the most compassionate," says Jean E. Schultz, 44, of Marquette, Mich. "Health care in our country is a commodity, pure and simple."
HARDSHIPS AND HEARTACHE
The Bulletin asked readers to tell what they've sacrificed—financially and emotionally—while trying to meet their health care needs.
Almost 9 out of 10 respondents said they or family members have not consulted a doctor when needed. Eight out of 10 have forgone necessary treatments or prescription drugs.
Nearly 9 percent declared bankruptcy due to medical debts. Almost half have paid rent, mortgage or utility bills late, and nearly two out of three have cut back on food.
Considering such hardships, it's not surprising that 87 percent of the sample reported experiencing emotional strain because of being uninsured.
In Statesboro, Ga., Della Boyd, 57, is ignoring a potentially cancerous lump in her breast. She doesn't even want to know if it's malignant because she can't afford treatment. She and her husband have exhausted their savings and sold the land on which their mobile home sits. "You end up losing everything you have worked for, plus your self-respect," she says.
Why are so many Americans uninsured? Losing insurance along with a job is just one of many reasons, the Bulletin survey shows.
Some respondents never had employer-based health insurance in the first place. Some are self-employed; others work for employers that don't offer benefits.
Other respondents used to have coverage through their jobs and took early retirement, expecting to have insurance for life. But the cost to those retirees skyrocketed while their pensions did not. Some respondents left jobs with benefits to care for parents in failing health. Others were widowed or divorced, and their coverage went with the spouse.
Some paid for private insurance until the costs began to outweigh the benefits; then they dropped it.
Some had longstanding policies they rarely used—until a major illness prompted the insurance company to hike the premiums to levels they couldn't afford.
"I've given up on insurance companies," says Randall Parmelee, 59, of Joseph, Ore. "They only want the young [and the] healthy. … The older, less healthy become baggage."
A few respondents, though, say they neither want nor need insurance because it's not worth the cost—and what's more, they expect to stay well.
Nora L. Ingram's only "insurance" is to live as healthfully as she can. She and her son produce their own food on a West Virginia farm, get plenty of exercise in the garden and barnyard, rarely use antibiotics and maintain a rich social and spiritual life. Some say she's lucky to have good genes, but at 64, she attributes her "continuing ability to heal" mainly to her lifestyle.
"THE QUEEN OF COPING"
People like Ingram are not the norm. Most respondents who ever had insurance wish they still did. And yet, even as they struggle, some are proving remarkably resourceful and resilient. (See Strategies for the Uninsured.)
A North Carolinian, now 63, says she left a good job with benefits several years ago and moved back home to care for her invalid mother. These days, she participates in medical research projects to get free health screenings such as blood tests and EKGs. When she needed surgery last year, she explained her circumstances to a compassionate doctor, who responded by cutting his fees.
"I feel like the Queen of Coping," she says. "I simply refuse to give up."
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