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Thursday, March 12, 2009

Health Care Crisis: One Reporter's Up-Close Story on the Underinsured

Time Magazine runs a moving story by reporter Karen Tumulty about what she learned when her brother was diagnosed with severe kidney disease and suddenly learned that his health care coverage was not what he thought.  She discusses her difficulties in figuring out why his short-term health insurance failed to provide coverage for his condition and how many people may not realize that they will not have coverage when they need it.  She writes,   

The unforeseen was exactly what turned up when Pat went in for a physical on Nov. 30, 2007, his first in five years. . . .  That's when Pat, who is now 54, learned that his kidneys were failing.

The diagnosis was only the first shock. The second came a few weeks later, in an Aug. 5 letter from Pat's health-insurance company. For six years — since losing the last job he had that provided medical coverage — Pat had been faithfully paying premiums to Assurant Health, buying a series of six-month medical policies, one after the other, always hoping he would soon find a job that would include health coverage. Until that happened, "unexpected illnesses and accidents happen every day, and the resulting medical bills can be disastrous," Assurant's website warned. "Safeguard your financial future with Short Term Medical temporary insurance. It provides the peace of mind and health care access you need at a price you can afford."

Kidney failure would seem to be one of those disastrous "unexpected illnesses" that Pat thought he was insuring himself against. But apparently he was wrong. When my mother, panicked, called to tell me that the insurance company was refusing to pay Pat's claims, I told her not to worry; bureaucratic mix-up, I assumed. I said I'd take care of it, bringing to bear my 15 years of experience covering health policy, sitting through endless congressional hearings on the subject and even moderating a presidential candidates' forum on the issue.  Confident of my abilities to sort this out or at least find the right person to fix the problem, I made some calls to the company. I got nowhere. That's when I realized that the national crisis I'd written so much about had just hit home. . . .

The Underinsured
. . . .  But Pat represents the shadow problem facing an additional 25 million people who spend more than 10% of their income on out-of-pocket medical costs. They are the underinsured, who may be all the more vulnerable because, until a health catastrophe hits, they're often blind to the danger they're in. In a 2005 Harvard University study of more than 1,700 bankruptcies across the country, researchers found that medical problems were behind half of them — and three-quarters of those bankrupt people actually had health insurance. As Elizabeth Warren, a Harvard Law professor who helped conduct the study, wrote in the Washington Post, "Nobody's safe ... A comfortable middle-class lifestyle? Good education? Decent job? No safeguards there. Most of the medically bankrupt were middle-class homeowners who had been to college and had responsible jobs — until illness struck."

Ms. Tumulty was also featured on Fresh Air earlier this week and a podcast of the story can be found here.

http://lawprofessors.typepad.com/healthlawprof_blog/2009/03/health-care-cri.html

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