One in four West Virginians were without health insurance for some part of last year. Insurance prices are rising faster in West Virginia than elsewhere. As state leaders struggle to find answers for the future, the Gazette offers this glimpse of the past.
In 1955, newly married, young Tom Kasey went door to door to collect health insurance premiums. "You'd go to people's homes and collect, like the paperboy," he said. "The milkman, the doctor, the insurance man — all of us came to your house back then.
"Most anybody who wanted health insurance got it. It was like your electric bill or water bill, something you paid without much thought. For about $12 or $20 a month in the '50s, you could have your family insured.
"The wage scale was lower, of course, but as a percentage of income, health care and insurance were a lot more affordable."
When his first child was born in 1956, for instance, his wife's semi-private room cost only $9.50 a day.
He felt good about his job. "You weren't asking people to give up something they needed when you offered them a chance to get health insurance," he said.
"I had one suit, the one I got married in. When we went out to work, we were required to wear a suit coat and white shirt and tie, even if it was 90 degrees outside. So I went to Penney's and bought myself a second suit.
"I had more invitations to come in and eat than I've ever had at any other time in my life. People told me things they wouldn't tell a preacher. It was scary to a shy young man like me. I'd think, 'Lord, I hope I'm giving these people the right advice.'"
Kasey has watched 49 years of changes in American health insurance. At age 71, he still meets with health insurance clients a few days a week at Silverstein, Maddox Wallace & Associates in Charleston. "But premiums are so sky-high now, I don't know how people can afford it," he said.
The average West Virginia family insurance premium is now about $750 per month or $9,000 a year, which is about $3,500 higher than it was in the 1950s. Health-care costs have rolled upward at a double-digit clip for the past three years.
At that rate, the average family premium will cost $18,000 by 2008, in a state where the average 2002 income was $23,000.
Kasey wishes health insurance could go back to "community rating." From the late 1920s through the 1950s, many insurance plans were community rated. Everybody paid the same rate, regardless of their age or health history.
"The idea was that if everyone was in the same pool, nobody would have to pay too much," he said. "The healthy would subsidize the sick, then later in life, they'd be subsidized in turn.
"We've lost that idea," Kasey said. "That's more of a shame than people know. It's all about the bottom line now."
Most insurance plans are experience-rated now, he said. The older and sicker you are, the more you pay. People who work in more dangerous occupations pay more. People who buy individually pay more. People who live in areas such as West Virginia that generate a lot of medical claims pay more.
Given the age and poor health of West Virginians, experience rating is not great for the state, Kasey said. West Virginians as a group pay some of the highest premiums in the nation, according to Mountain State Blue Cross/Blue Shield.
And U.S. rates are the highest in the world, Kasey adds. In the United States, health care costs twice as much as it does in other industrialized countries, according to the Organization for Economic and Community Development (OECD).
Since 2000, Kasey said, many large insurance companies have stopped writing health insurance policies. "They can't get the profit they want now." Companies that still write policies are leaving unprofitable areas like West Virginia.
Earlier this year, the state Insurance Commission said fewer than 10 companies are still writing health insurance policies in the state.
"It's all changing, but most people don't know it yet," Kasey said. "You saw that in the Kroger strike with health care," he said. "It took the company and the employees awhile to come to a common understanding of what the reality is."
He looks around and sees multinational, publicly-traded insurance conglomerates. West Virginia companies creating self-funded insurance plans that escape state regulation. Employees paying huge deductibles and co-pays. His old insurance company has become part of General Electric.
A lot of his clients can't afford prescription drug coverage anymore. "I give them the 800 number of a Canadian pharmacy," he said.