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Inadequate Health Care
Small Business Owner Struggles With Health Care Costs
Since 1988 Doug Mayol has owned and operated a small business in downtown Springfield that sells cards, gifts, and other novelties. But being a self-insured businessman, the rising costs of health care can really take a toll on profits. Luckily his only employee is over 65 and qualifies for Medicare. She also receives spousal benefits from her late husband. If this were not the situation, Doug is unsure if he would be able to provide health benefits. In terms of his own insurance, Mayol has a pre-existing condition and fears the real possibility of becoming uninsured.
In 1980 Doug was diagnosed with a congenital heart valve defect. This has caused no symptoms but without regular health care, additional problems could result. Like most Americans his health care premiums have risen over the years- but recently it’s been shockingly dramatic. He explains, “In 2001 my insurance was $200 a month, then up to $400 in 2005. The next year I turned 50 and the rate shot to $750 a month! I chose a ‘lesser provider network’ and a higher deductible to bring it back down to $650. Last year it jumped to $1037 a month! I brought that down to $888 by taking the highest deductible they would allow, at $2500.” And these numbers will only continue to rise.
Because of his high deductible, Mayol has begun a Health Savings Account. He comments, “Originally I thought this would be a great thing, but setting aside $200 a month, on top of the $888 I pay for my premium every month is darn near impossible. Health Savings Accounts are not the saving grace of healthcare, of course, unless you are rich.” Ironically, Doug isn’t even a costly patient. With his high deductible, the insurance doesn’t even pay out as Mayol has never made a claim for illness or injury, except for routine primary care. Yet more affordable insurance carriers reject him due to his pre-existing condition (the possibility of high expenditures in the future, like surgery). This locks him into a quandary of little to no choice when it comes to insurance, and he does need the security of accessible primary care services. Due to his congenital murmur, antibiotics are needed before undergoing even a simple procedure like dental work. A cardiologist should be seen periodically but Doug has avoided this in worry of more red flags to be added to his health record. It’s sad that even those with coverage are beginning to delay care due to costs and the way insurance is structured. “I’m soon to be one of the uninsured because I can’t afford my insurance,” he laments, and it’s still 13 years before he qualifies for Medicare!
The real issue here is that health insurance companies have been able to pick and choose who they will cover. We all pay premiums while healthy and only needing minimal care, then as we get sick or cross an age bracket independent of health status, we are stiffed with skyrocketing premiums or phased out of our insurance altogether. Is negotiating for higher deductibles and less coverage in the future for all of us? Doug is living the American dream as a small business owner and yet he is suffering for making this choice. In September 2006, he told a group of Springfield residents at an Educational Forum put on by the Health Care Justice Campaign's Springfield committee that he would soon have to choose between keeping his shop’s doors open and paying his insurance premiums. If our country wants to keep small businesses as the backbone of our economy, the government better find a real solution to guarantee Doug the security of having quality health care he can both use and afford.
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