Springfield, April 2007

Current Stories:

Risky Business

David’s health savings account is simply not enough to cover the medical costs of his chronic condition

Deanna Graham

Deanna is paying a lot into her high deductible insurance plan, but not getting much in return.

Maureen Craig

Mental health benefits can vary widely, limiting employment opportunities for those with pre-existing conditions such as clinical depression.

The Phantom Illness

Susan Orr cannot obtain insurance on the individual market because of a bureaucratic error that is frustratingly difficult to correct.

Beth Najberg and the Self-Insured

For self-employed workers, premiums are becoming increasingly more difficult to manage

Covered Just in Time

For Brenda Rueff's granddaughter, the All Kids program arrived just in the nick of time.

Second-Class Health Care

Connie Sue believes she was given substandard care because of her HMO's cap on referrals.

Survivor

Mickey Trznadel is a survivor who not only battled cancer but also waged a full-on war with his health insurance company to maintain affordable coverage.

Sue Smith

Sue firmly believes that she was fired because her health problems made her a costly employee.

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Health Care Headaches - Featured Story

Susan Staskowski

Young adults aged 19 to 29 are now the largest and fastest growing segment of the US population without health insurance.

Teary-eyed parents often kiss their sons and daughters goodbye when they leave home in pursuit of a full-time profession or maybe to attend graduate school. With a college degree under their child’s belt, many parents confidently await their child’s bright future. In reality, this might be a time to start worrying about their well-being.

As a full-time law student, Susan Staskowski and her husband Gregory survive on a very limited budget. Susan works as a research assistant September through May and could be covered by the university’s health insurance. However, that benefit would cost $1000 per year. Graduate students, even those working for the university, are not given health insurance as part of their university enrollment or employment. Since Susan is married, she is fortunate enough to rely on her husband’s health benefits throughout her studies. Until now.

Early June of 2006, Gregory was unexpectedly laid-off from work. He was offered COBRA, a temporary continuation of health coverage at group rates. Although meant to be a goodwill gesture, COBRA payments are significantly higher than employer-sponsored insurance because the employer no longer pays a portion of the premium. Gregory and Susan feverishly tried to whittle down expenses. But no way did they have an extra $1,000 a month for COBRA! That added cost could deplete every penny of their meager savings and possibly topple the young couple into future debt.

Not so surprisingly, the Staskowski’s are not alone. Young adults aged 19 to 29 are now the largest and fastest growing segment of the US population without health insurance. A staggering 13.7 million young adults lacked coverage in 2004 according to a study by the Commonwealth Fund. That is an increase of 2.5 million since 2000!

Although young adults are generally a healthy group, being uninsured puts up barriers to care when needed, or puts them at risk for high out of pocket costs should a severe sickness or injury happen. This age group is far more likely to get pregnant, have injury-related illnesses, and be at-risk for HIV and other STDs than most other age categories. Access to medical care would greatly benefit this group, and perhaps the parents from whom Susan very nearly had to ask for financial help.

Ironically, less than a month after the Staskowski’s decision to forgo COBRA insurance, Susan hurt her wrist in a rollerblading accident. The injury was painful but there was no bleeding. Of course, their first instinct was to visit the emergency room, but that was quickly ruled out, being too much of a financial risk. “It’s just a sprain, not a big deal, and most injuries heal themselves,” Susan thought, and played tough, only to realize two weeks later the pain never subsided.

“What do people do in these situations?” Susan thought. Out came the heavy phone book (which was difficult to manipulate one-handed) as she probed for low-cost care. Surprisingly, most places were either hesitant to quote prices or didn’t have that information readily available and needed to research the rates and call her back. Consumer-driven health care suggests that individuals should “shop around” but few people have success in this. The task is not only “daunting” and “intimidating” as Susan would explain it, but it’s wildly impractical as most health care decisions are made under emergency conditions and emotional stress. Susan’s husband Gregory was really amazed by her strength. “Normal people would have just gone to the first place they found,” he said.

After calling six places, Susan found a clinic that cost $75 to take the x-ray and $70 to read it. The emergency room would have wanted more than twice that, which is why she did not go there. The x-ray revealed a fracture, and she was referred to another clinic that wanted an additional $350 to 500 for specialty care. On a student’s budget, Susan panicked. “I was terrified that my wrist would heal badly because I couldn’t afford to get treatment, and it (the use of her wrist) would be a problem for the rest of my life,” said Susan. As her anxiety grew ever higher, again out came the phone book, and with some probing Staskowski found an orthopedic specialist for $180, roughly half the original price.

Three hundred twenty-five dollars and two and a half weeks after her rollerblading accident, Susan’s wrist is finally set with a splint. Looking back at this long stressful ordeal, Susan wishes there was more transparency within the medical field. There is no easy side-by-side comparison of quality and cost for clinics within a city. Young adults, like Susan, who move in and out of school and jobs throughout their 20s, are put in a bad situation without the tools to navigate through the system. How can we all become savvy health care shoppers in a medical marketplace that hinders cost and quality comparisons?