I am self-employed in the insurance billing field for several local physicians, so I did extensive homework, comparing plans, before purchasing a health insurance policy. I have seen all kinds of horrors, so I was very careful. I called each plan and asked a lot of questions.
My husband and I are both 32 years old, non-smokers, with no risky behaviors or employment, and a healthy history. In August 2002, we received notice from Golden Rule Insurance Company that our insurance premium would be raising substantially. To avoid this increase, we chose to raise our deductible to $1,500. In exchange, our premium would stay the same. A few months later, we received another notice that our premium would raise to $448 a month anyway. This is what I am paying now.
In June, I called Golden Rule to change my address. We moved from Nitro to Cross Lanes, 4 whole miles away. Golden Rule told us that our premium would increase an additional $68 a month, to make it $516, because we were moving 4 miles.
I told the representative that I would need to add my infant son to the policy and found I can now expect to pay $647 a month!
I am pregnant with a due date of Dec. 2. I have contacted a couple of insurance companies and was told they would not cover me because the pregnancy is a pre-existing condition. So we are stuck. I (thankfully) make too much to qualify for the Maternal Child Program, which could help with bills.
I will look for an alternative carrier after December. In the meantime, I can't afford $657 per month, and I can't afford to be without insurance. It's getting to the point that we will start making the choice of paying for insurance or eating!
Greg Smith* has delivered a very strong message to everyone in West Virginia. Hopefully, there will be other leaders in this state to heed his warning. He laid it on the table, the root of the problem is greed and the numbers tell the tale. Companies operating in this state cannot afford to absorb the increases and continue to employ the existing work force.
It's a vicious circle, the same players are all going to the same trough. The bottom-line: Most companies are closer to the breaking point than they know or are willing to admit.
The challenge of responsibility to all sectors is on the table. The big question: Do we have leaders in this state willing to take on the challenge?
* Editor's Note: In a previous story in this series, Greg Smith, CEO of Mountain State Blue Cross/Blue Shield, warned that insurance rates in the state would double within five years if health-care costs keep increasing at the rate they have been. He outlined steps he felt should be taken and challenged others to do the same.
My husband and I moved from West Virginia to Texas in 1995 because of a promotion. After one year, his job was phased out, and he found himself without work. Going into debt, we purchased our own business, which after a while, became successful. But we had to have our own insurance. That was manageable, but after five years, I fell down the stairs at work and broke a hip.
When we sold our business and moved back to West Virginia, we discovered that our insurance company did not cover the state we were moving to, so we sought out a new company. In looking at my medical history, they discovered I had elevated blood pressure and osteoporosis and refused my application. We tried a second company and the same thing. I was a high risk, according to them.
I am 62 years old. I consider myself very healthy. I have one or less colds and headaches per year. For almost two years, I have been without adequate insurance. But I have only a small AARP health insurance policy that covers up to $4,000.
After a third bone density test, my bones have improved substantially. I feel it is up to me to stay as healthy as I can. I monitor my own blood pressure. I eat healthy food, walk 2 to 3 miles each day, take a modified yoga class and a stretching and bending class three days a week. I have a deep faith in God and a positive outlook and don't try to dwell on my aches and pains.
I have little faith in the medical system, the insurance companies, or in our government as far as health issues are concerned. I am fortunate in that we can afford the preventative medicine and tests. But if I become ill with cancer, diabetes or any other disabling disease over which I have no control, I am sunk. I would not want to burden my husband with major medical bills.
So I am hanging on until I reach 65, hoping that Medicare will still be in place. A lot can happen in the next three years. But the poor people of West Virginia who are younger than I am, with no insurance, that is very scary. I have no answers, and if I did, it would probably be unconstitutional. I see a lot of young people who don't seem to care about their own health. No exercise, terrible eating habits, smoking too much, driving recklessly. There should be requirements about things over which people do have control. But then we couldn't say we live in a free country.
Things are not going to get better. We all know that. So I wish the Wise administration much luck in trying to insure 150,000 more people within five years. But if they are insured, they should be required to stop smoking, exercise and eat healthy. How do you make somebody do that?
If I were talking with Sen. Jay Rockefeller, I would tell him that I would like to see in place universal health-care coverage, including prescription drug benefits, but privatized to the extent that everyone has a choice among federally regulated health plans. People would also bear financial responsibility compatible with their means. The dollar amount should be lessened for those who maintain a lifestyle free of medically recognized abusive patterns of living, such as tobacco use. Coverage should not be available when the condition results unquestionably from an abusive lifestyle, such as their injury due to drunken driving.
I would remind the powers-that-be that "everybody" is a very diverse group and that no one health insurance plan will fit all. It will take multiple plans. One model with a good track record is the Federal Employee's Health Benefit Plan (FEHBP). It should be expanded and made available, as a choice, for all citizens. Other options are modifications of the Medical Savings Account (MSA plan), under consideration by Congress. Other plans would be needed to assure adequate care for the poverty-stricken.
In every case, there is the individual responsibility to maintain a lifestyle that does not knowingly contribute to the impairment of health. When a person's lifestyle is identified as a risk factor, it should be mandatory that those individuals participate in a health plan/counseling program until the change in lifestyle is established.
James T. Spencer Jr., M.D. (retired)
I was covered by Conseco health insurance for about three years until last year when Conseco ceased doing business in West Virginia. I didn't cancel Conseco. Conseco didn't cancel me. Conseco canceled West Virginia.
During the time I was insured, I was diagnosed with rheumatoid arthritis. As a consequence, I'm unable to buy health insurance now. My insurance agent was able to purchase an emergency type of policy. I pay about $100 a month for a major medical policy, but I'm only allowed to have it for a short term.
Money isn't the obstacle. Accessibility is. I have told four different insurance agents that money isn't a problem. Now imagine telling an insurance agent you don't mind paying a hefty premium. You would think they could find a policy, right? Wrong. None of the agents was able to help me. The head of the consumer division at the state Insurance Commission told me that it was very possible I wouldn't find an insurance company to cover me.
Some of the treatments for rheumatoid arthritis are costly. Aspirin works for some people. I'm not that fortunate and must take two kinds of drugs that cost about $250 each month. I must see a rheumatologist regularly.
My arthritis isn't a self-induced ailment. It not only affects me, it affects my employees. Because nobody wants to write a policy for me, my two employees cannot get group coverage.
I know I'm not the only person in this predicament. I'm willing to pay, but there just doesn't appear to be any coverage available for me in West Virginia.