"A lot of people have no idea how scary it is to have no health insurance," said Walter Price.
"When you don't have insurance, you're suddenly right there on the edge. If I have a bad accident or need a major operation, a week in the hospital could wipe out everything I own. Even if I managed to keep my home, I'd be a pauper. A hospital won't hesitate for a New York second to put a lien on everything you own."
Price, a former Republican legislator from Charleston, serves on the state Housing Development Fund board. At age 54, he has no insurance. His premiums rose abruptly to $886 a month after he had surgery for a gallbladder condition and kidney stones.
He had to drop his policy. "I simply couldn't afford it anymore," he said.
"I never for a minute thought I'd be in this situation," Price said. "Middle-class people don't think they have a problem, but many are a capricious boss' decision away from the free clinic. This is stuff that could happen to people who live in nice homes in South Hills."
One in four working-age West Virginians — nearly 300,000 — had no health insurance for all or part of 2001, according to a WVU survey. More than 60 percent of them are employed.
"I don't know why people aren't out demonstrating in the streets," Price said. "Don't they know what's happening? Don't they understand what their position is?"
Five years from now, if health-care costs don't slow down, 60,000 more West Virginians will have no insurance, Mountain State Blue Cross/Blue Shield predicts. Many simply will no longer be able to afford it.
If that happens, the "one in four" will become one in three.
By 2008, a family health insurance policy may cost at least $18,000 in West Virginia, said Greg Smith, CEO of Mountain State Blue Cross/Blue Shield. People who buy their own insurance would have to pay every dollar. Employees could expect to pay a large chunk.
"How many people in West Virginia can possibly afford that kind of premium?" Smith asked. "And what business can afford it?"
Not many. The per capita income in West Virginia is $23,688.
And Mountain State Blue Cross/Blue Shield's prices are some of the state's lowest.
"The price of all health insurance will roughly double in the next five years if the cost of health care keeps going up like it has been," said Fred Holliday. "It's straightforward math."
Holliday should know. He analyzes insurance rates for the West Virginia Insurance Commission. "This affects everybody," he said.
Last year, national health care spending grew four times faster than the national economy grew. The ripple effects in people's lives are enormous:
Why is this happening? So many things contribute to insurance bills, Holliday said. But the rising cost of health care in the United States is the big one.
Two of the nation's most prestigious health-care experts laid out the big picture
in the May/June issue of Health Affairs in an article called "It's the Prices, Stupid: Why the United States is So Different from Other Countries" (www.healthaf
Health care in the United States costs more than twice as much per person as it does in other developed countries, according to the Organization for Economic Cooperation and Development.
"It's that one thing out there that can destroy us all financially," said WVEA's Haney. "People don't believe there's a national crisis, but it's a monster, and it's going to eat us all alive — you, me, and our grandchildren — if we don't do something about it now."
People who administer health-care programs have seen this dragon coming for years.
"People just don't realize how vulnerable we are in this country," said Renate Pore, director of the Governor's Cabinet on Children and Families. "So many people are one accident, one job loss, one rate hike, or one disease away from being priced out of the market."
"Insurance used to be the thing that stood between people and huge health-care bills," said Sharon Carte, Director of the Children's Health Insurance Program. "Now insurance itself is another huge bill. Or it's just unaffordable. And if you don't have it these days, every day you get up and risk financial disaster."
'I try not to think about what could happen'
Joan and Vern DeLung of Mossy, Fayette County, know firsthand what these people are talking about. Without health insurance, if one of them has an accident, medical bills could wipe out their savings, their home and the rest of what they own.
They insure their 16-year-old son for $256 a month because they make too much to qualify for the Children's Health Insurance Program. They can't afford to insure themselves, too.
Vern DeLung, 41, a veteran electrician, has severe joint pain, but can't afford the medicine that would give him relief. "I live on Tylenol and ibuprofen," he said. "Some days, I hurt from my nose to my toes.
"I try not to think about what could happen. When I think about the future, I think about getting up and going to work."
For 20 years, he has helped wire buildings all over Southern West Virginia, including the Tamarack arts and crafts center. Now he drives 260 miles, round trip, to Greenbrier East High School every workday. Some days, he works on his hands and knees for hours or contorts his body to work in cramped areas. "I ache every day," he said. "That's how it is."
Like many uninsured people, he doesn't always get the medical care he needs. A few years ago, he got a staph infection on his leg. His doctor told him he might lose his leg if he didn't go in the hospital. "We didn't have the money for that," he said. He kept going to work and checked with the doctor every other day.
'Something working people could afford'
A sizable chunk of the West Virginia middle class now has no health insurance. Almost half of uninsured working-age West Virginians make at least $20,000 a year. More than a quarter earn at least $30,000. And nearly 10 percent make at least $40,000.
The WVU Institute for Health Policy Research assembled those figures for its 2002-03 study, "Health Insurance in West Virginia." Before it was published, nobody really knew how many uninsured people there were in the state.
Working-age people have no real safety net. If a couple makes more than $20,000, they aren't eligible for the free clinic. Medicare pays part of the bills for people 65 and older. And the Children's Health Insurance Program is a bright spot in the state's insurance picture.
"We've done a great job of insuring low-income children through the Children's Insurance Program," said Pore, the governor's cabinet director. Nationally, 13 percent of children are uninsured. Less than 7 percent of West Virginia's children are uninsured, thanks to a strong statewide sign-up effort.
"This is something West Virginia can be truly proud of," Pore said. "Now if we could just do the same for adults."
But the demand for CHIP threatens to swamp it. The Legislative Auditor's Office warns that the program could run $20 million short by 2007.
"We should take care of the children first," said Joan DeLung. "But it would be great if they could offer something working people could afford to buy."
Five days a week, DeLung provides home care for a 97-year-old woman. She sees firsthand the risks and expense of old age. "I sometimes think 'That's going to be me someday,' and then I put the thought away. I try hard not to think about it."