Voices from the trenches
How does the rising cost of health care and health insurance affect you and others you know? Send us your story and point of view. We will forward all letters and e-mails to the state planners who are trying to put together options for uninsured people. Send to: Everybody at Risk, The Charleston Gazette, 1001 Virginia St. E., Charleston, WV 25301. Or e-mail firstname.lastname@example.org. Put "Everybody at Risk" in the subject line of your e-mail message.
With the above points in mind, the Sunday Gazette-Mail invited readers to send us the view from where they sit. As these selected letters show, West Virginians of all stripes are indeed at risk:
My husband retired from Arch Coal in 2000 at the age of 65. A year and a half later, he returned to work because we couldn't afford my and our son's insurance, which was almost $900 monthly.
Now our son is in college, and my husband is 68 years old and not working again. I'm only 45. We can no longer afford insurance for me because of arthritis and our son has no insurance.
I have pain from morning to night because I can't afford the Celebrex they give me for arthritis. I would like to get a job, but I don't think I could hold a job due to the pain.
If my husband and I weren't married, I could get a medical card because of no income. What price do people like us have to pay in order to get the help we need?
I am a 58-year-old, self-employed, uninsured male. I had insurance for approximately 30 years with the same provider. About a year ago, it became financially unmanageable ($840 monthly for a $5,000 deductible), and I had to drop coverage.
Six months later, I was diagnosed with prostate cancer. I am taking radiation treatments, financed by cashing in my retirement funds.
The insurance on my wife and son just increased by $100 monthly. She is currently paying $507 monthly for a $5,000 deductible. It is only a matter of time until the insurance company achieves what they set out to do — eliminate our entire family from coverage.
We have written our senators and congressmen on this issue and only get letters of sympathy. I hope the news media has more influence than the average citizen seems to have.
Paul Flippin Jr.
The legal, medical, and insurance industries have all gotten in bed together, beginning with huge awards by juries maneuvered by clever lawyers. These awards against doctors and hospitals are paid by the insurance company and passed on to the consumer in higher premiums. Hospitals are filled with all sorts of expensive modern testing equipment (which needs to be paid for). This, coupled with the need to protect themselves, tends to cause the hospital and doctors to order an excessive amount of tests, thereby increasing the insurance payment, and around and around it goes.
I have no medical insurance. My small business cannot afford it. The plan to double the premium should result in more people joining me and less money to the insurance companies, less money to the medical and legal professions, and so the ball will unravel.
The system will fix itself because it must. In the meantime, I guess a lot of us will have to die without the aid of doctors or hospitals.
Robert B. Morrison
When I retired roughly two years ago, my PEIA health insurance cost $137 a month. Effective July 2002, that amount raised to $158 per month. I now receive assistance with my insurance and prescription co-pays. It helps, but the alarm is just under the surface.
How do other countries manage to offer their citizens free or low-cost health care? Perhaps looking at their methods would show West Virginia a path to pursue.
Listening to NPR recently, I heard about a health-care plan provided by the state of Utah. Is anyone there familiar with it? Sounded good!
Having retired from state employment (DHHR) after 25 years, I had a firsthand look at people who coped without any type of medical coverage. The last three years I worked, I evaluated recipients for the Medicaid program. Even Medicaid is restrictive in who a policy allows it to cover. There is nothing for the healthy person, regardless if they are working or not.
Day after day, I encountered poor people who lied to get this meager offering from DHHR. And sad to say, some came into the office gravely ill and then would have to be turned away, because they could not meet a spend-down*.
I also have a son who lives with me and could be classified as underemployed. He works in construction, hanging drywall for a private contractor who cannot afford to provide health insurance.
Recently, he enrolled in a program offered by Boone Memorial Hospital for people who have no insurance at all. It is without cost, due to his status as underemployed. It offers no prescription coverage, and he is limited as to where he can go for treatment. Fortunately, he has not had to use it thus far.
In summary, there is no affordable insurance plan in the state of West Virginia for the underemployed. This really makes a good argument for socialized medicine, as they offer in Canada, which I agree with. I would be willing to pay the 15 percent sales tax, as they do, for medical coverage for all.
* Editor's Note: In Medicaid terms, a spend-down is like a deductible. If a person makes too much to be eligible for Medicaid, he or she must run up a certain amount of medical bills to be eligible for help. That amount is the difference between the person's income and the Medicaid eligibility levels.
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.