When health care reform passed, Teresa picked up the phone and immediately began looking into her new options for insurance. Diagnosed with asthma and severe allergies, she has been excluded from the private insurance market since 2002. Health care reform will go a long way in helping Teresa get the care she needs come 2014 by restoring her access to the insurance market and making health insurance more affordable. However, her phone calls also revealed that she is falling through the cracks when it comes to more immediate reforms, such as the establishment of a federally subsidized high-risk pool.

Today, Teresa buys insurance through Illinois’ high-risk pool, the Illinois Comprehensive Health Insurance Program (ICHIP), which provides costly insurance to those with pre-existing conditions who are otherwise excluded from the insurance market. Teresa paid $13,016.55 last year in medical expenses on ICHIP. This number represents a combination of her monthly premiums, prescription costs, co-pays and her $500 deductible. “I spent 80.5% of my small dividend income on medical and dental expenses in 2009!” says Teresa. The high cost of insurance for those with pre-existing conditions is often unmanageable. This year, Teresa finds herself making tough choices about which bills to pay, and which ones to hold off on.

Health care reform will help solve Teresa’s insurance problem in the long run, and she looks forward to accessing a competitive insurance market that cannot deny her coverage for pre-existing conditions. However, when it comes to more immediate needs, Teresa will not be able to access the new federally subsided high-risk pool because she is technically insured already.

The federal government is providing 194 million dollars to Illinois to set up this new high-risk pool and provide subsidies to new enrollees. In order to avoid burning through the new funds, there are certain pre-requisites for joining the high-risk pool, one of them being that you have to have been without insurance for the past six months. “The new health care bill was originally designed to help people who are denied insurance coverage because of pre-existing conditions. That’s me! I should be allowed to enroll in this new high-risk pool!” says Teresa. Reform may not benefit Teresa this year, but in the long run the new measures will save her money and worry.

Dennis runs a small business, Geier Florist, in West Peoria. In 2005 his wife Lisa was diagnosed with breast cancer for which she received surgery, chemotherapy, and radiation. At that time the couple’s annual deductible was $5,000 and their monthly premium $250. However, over the course of the next few years their premium increased nearly three-fold to $705 in January 2008. That same month Dennis was diagnosed with colon cancer.  His treatment consisted of three operations and over a month of hospitalization. Hoping to keep their monthly premium below $800, Dennis changed the annual deductible on the policy to $10,000, however, in 2009 their monthly premium increased again—to $875. This year, literally a week before the Health Care Bill passed, the couple’s monthly premium increased again—to $962. This means that the couple spends nearly $22,000 annually in out-of-pocket expenses for their health insurance. Dennis refers to rising premiums and deductibles as ridiculous.

Dennis and his wife are looking forward to retiring at some point, but the astronomical amount they are spending on health care makes this seem like an impossible dream.

The recently passed health care reform bill, which, beginning in 2014, will require that 80% of monthly premiums go toward health care costs should reduce skyrocketing premium rates. This, along with the fact that insurance companies will no longer be able deny coverage to individuals with preexisting conditions, should foster competition among insurers and provide consumers with more choice when purchasing insurance. Although Dennis supports the Health Care legislation, he feels it does not go far enough; he supports a public option under which all Americans have access to affordable and quality health care.

The Dill Pickle Food Co-op is a small, locally owned and operated cooperative, which offers local and organically grown foods.  For Vinnie Hernandez, the general manager, covering the co-op’s employees is a priority.  However, the experience of finding and establishing insurance for the co-op employees was bureaucratic and time consuming.  Vinnie had trouble finding adequate coverage at a reasonable cost and with premium rates skyrocketing each year, he worried about the future.

Now some of his worries can be put to rest.  The health care bill recently signed by President Obama will allow The Dill Pickle a tax credit worth 35% of their health care costs.  This credit will increase to 50% in 2014.  Also, small businesses will soon be able to ban together to buy insurance as a group through Small Business Health Options Programs.  These measures will help keep Illinois’ small businesses, like the Dill Pickle, strong and their employees healthy.

Dr. Mercedes Martinez is a child and adolescent psychiatrist who has no health insurance.  She works at three different community health centers caring for underserved youth and volunteers her time in the community providing education on mental health topics. These jobs are all part-time and as such she does not qualify for employee-sponsored health insurance.  Her monthly income is just above the maximum allowance to qualify for Medicaid, but she cannot afford to buy health insurance for herself on the individual market because of her high mortgage and student loan payments.  Thankfully, her college-aged children are covered by their father’s insurance and will be able to stay on his insurance through age 26 because of health care reform.  Dr. Martinez has thus far relied on self-diagnosis, community clinics and/or alternative medicine to treat her medical problems.

Dr. Martinez is a part of a growing cohort of doctors, who don’t have health insurance for a number of reasons including, student loan debt and high malpractice fees and choosing to work predominantly with low-income Medicaid and Medicare patients, which provide lower reimbursement rates. Finishing medical school literally hundreds of thousands of dollars in debt, some doctors simply cannot afford to purchase private medical insurance. It is a bitter irony that those working within the medical community can be uninsured.

Dr. Martinez believes that doctors in her position should have more choice when it comes to buying insurance. With the recent health care reform legislation, more funding will be allocated to community centers, and coverage for mental health patients will increase, which will, hopefully, allow hospitals and community centers to employ more doctors such as Dr. Martinez (full or part-time) and provide them with health care benefits. Dr. Martinez would also like to see lower insurance premiums for doctors that work predominantly with Medicaid and Medicare patients.  Moreover, increased competition among insurance companies and new accountability measures will hopefully lower premium rates, making it more economically feasible for doctors to purchase private insurance. Finally, Medicare and Medicaid payments for primary care providers will increase—a policy which will hopefully be extended to include specialty doctors such as Dr. Martinez that continue to dedicate themselves to working in underserved communities.

Teresa Zduncyk of Brookfield is over 50 and has been unemployed for 18 months. With continuing job cuts in the banking industry, it has become increasingly hard for her to find work in her field.

In 2003, Teresa had insurance through her employer. Yet when she required emergency gallbladder surgery, her insurance company refused to pay. Since then, she has been hospitalized twice for atrial fibrillation. Without adequate coverage, her bills are high. Without a job, she struggles to make payments.

Her husband also struggles with the health care system. He was born with anhidrotic ectodermal dysplasia, a condition that weakens the skin, teeth, and hair, and diminishes their functions. In 2006 he was diagnosed with bladder cancer. In the hospital, he contracted pneumonia and developed a large hernia from coughing. As a result, he lost his job as manager of a convenience store. Without consistent work or health coverage, it has been impossible for the Zduncyks to pay for treatment.

Teresa and her husband’s struggles to receive the care they need are indicative of the need for change within our health care system.  We need to hold insurance companies accountable by eliminating discriminatory pre-existing condition clauses and making sure people get the coverage they paid for.

I often see people who are in soul-killing, corporate jobs, who’d love to start their own business, but they don’t dare because they have a child or spouse with medical issues, and they fear medical expenses would bankrupt them. If you are self-employed, insurance companies discriminate against you.  There is no good reason for treating us differently than others, but I have found no good options for insurance as a self-employed person.  At one point, an organization for the self-employed approached us, promising good insurance through a large pool of self-employed individuals.  It sounded great, but when we got to the numbers, it was expensive, bad insurance that didn’t cover much.

People rely on their health for survival. Whether self-employed, beginning a small business, struggling with mental health issues or other preexisting conditions, everyone deserves the peace of mind of knowing they can get the care they need, when they need it, at a cost that won’t bankrupt them.  It is unconscionable that the insurance companies gladly take our premium dollars when people are young and healthy, but when we have the audacity to get older and/or sick, the insurance companies drop us.  I’m really tired of hearing about situations like a client who couldn’t get insurance because she’d had a bout with cancer.  What are they to do?

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Passing legislation would allow people like Steve and his clients to obtain affordable coverage that is currently unattainable due to self-employed status or lack of coverage through an employer. Rather than relying on his wife’s insurance, Steve would have options. Access to preventive care would be increased, underlining a shift in focus towards overall wellness. Those of Steve’s clients denied coverage due to high medical risks would be able to access “catastrophic policies” as a stopgap maneuver until full coverage is made available in a few years. Reform will improve the quality of life of American citizens, and it must happen now.

When Linda’s Blue Cross Blue Shield of IL COBRA coverage ended for her and her husband on December 31, 2008, their premium jumped from $577.00 to $1,036.30 per month. In order to save money, her husband switched from a BCBS of IL group policy to an individual policy that had a $5,000.00 deductible (a policy she first heard about on Oprah). Because her husband was rarely ill, they were not worried about the large deductible and the 20% co-pay. Upon making this change, BCBS of IL never explained to Linda the difference between group and individual insurance, nor did they require a physical exam before approving him.

Linda believed her husband had secure health coverage until his bypass surgery in October 2009. Although the surgery had been pre-approved by BCBS of IL, one week following the surgery, BCBS of IL claimed that her husband had a pre-existing condition and rescinded his policy. BCBS of IL based this decision on the fact that her husband had three high blood pressure readings, even though these readings were the result of taking Mucinex DM (extra strength) – a cough medicine that is known for raising blood pressure.  He had never been treated for, taken medicine for, or had been diagnosed with high blood pressure.

At this point Linda owes medical bills of $208,000, $89,000 of which is about to go into collection.

Of BCBS of IL she says, “You have insurance, you pay for insurance and then you’re not covered…They didn’t check his records before approving his individual policy. They did nothing but take our money…and now they’re sticking us with the bill.”

Although Linda has written to local, state and U.S. senators and representatives, only President Obama expressed genuine concern over her situation. In the end, Linda regrets ever changing her husband’s group insurance to save money with an individual policy.  We need to hold insurance companies accountable.  All Americans deserve the peace of mind of knowing that the health insurance they pay for will take care of them in their time of need.

My name is Mark Kraemer and I am grateful for the excellent health insurance that I have through my employer. Without it we would not be able to afford my daughter Carolyn’s Leukemia medication—Gleevec. Thirty Gleevec pills, which would cost us $5443 out of pocket, only cost us a $40 copay. If not for this insurance, our family would have been bankrupted long ago.

Carolyn, who recently turned 23 and is not a full-time student, would have lost her dependent coverage this year. However, thanks to a new Illinois law, her coverage will extend until she is 26.

Once Carolyn turns 26, we will have to scramble to find alternative coverage. We are trying to cover Carolyn until the patent on Gleevec runs out, which we have heard could happen in 2013. Perhaps lower priced generic versions of Gleevec will also become available once the patent runs out.

We know that Gleevec is obscenely expensive, and our hearts go out to every patient who must wrestle with this problem. We are grateful that Gleevec and later generations of kinase inhibitors are available, but know that certain people who desperately need them could be denied their benefit due to cost.

We realize how lucky we are–Carolyn is still with us and we have avoided bankruptcy. But we are mindful that millions of people in the US don’t have the health insurance benefits we do, and that we are vulnerable to financial ruin should any change occur in my coverage.

This is why we have had such hopes for health insurance reform. The bills currently under discussion in Congress would ban the denial of health care coverage based on preexisting conditions, allow more families to cover their children until they are 26 or 27 and increase competition to keep health care costs down.  We also hope legislation that lowers the cost of prescription medication will be enacted soon.  Health insurance reform is the moral thing to do.

My name is Rich Godwin and I am an entrepreneur.  It is a challenge to open a business and provide health care for my employees, my family and myself.  The costs involved are outrageous. In five years, my family’s health care costs went from $500 a month to $800 to $1100 to $1600 to $2200.  It infuriates me that my insurance costs got to be higher than my mortgage.

The American dream is being compromised because health care costs are eating into small business profits and making it nearly impossible to remain competitive.  We cannot keep allowing costs to spiral like they have.

Dave works freelance, shooting films and stills.  Depending on his earnings, he bought insurance on the individual market or in tougher times, went without.  Luckily, he was insured the day he was diagnosed with colon cancer.

Dave began his chemotherapy treatments and had surgery on August 1st.  Soon afterwards he was back in the field, shooting films in war torn Sarajevo and Serbia with his chemo pump at hand.  He could not afford to take a break and lose a paycheck.

In October, Dave found that none of his medical bills were being covered.  His insurance company was conducting an investigation, looking for preexisting conditions that would allow them to avoid paying the bill.  Dave fought back and eventually the insurance company paid up.  But afterwards, Dave saw his premiums jump 50% and 60% each year.

By 2008, his insurance premiums had increased to $28,000 a year and no other company would take him on.  The total amount he paid to his insurance company exceeded the cost of his cancer treatment.  But without competition and burdened with a preexisting condition, there were no choices.

Our health care system does little to help the sick.  The health care bills under consideration would introduce competition, bring down premium rates and make denying coverage based on a preexisting condition unlawful.