When illness strikes
Jenny Scherf found her husband, Mark, writhing in agony last April.
"I came downstairs and he was lying on the floor, screaming in pain," she said.
(Jonathan Miano/Staff Photographer)
(Liz Wilkinson Allen/Staff Photographer)
PHOTO GALLERY
• Health care examined
• About this series
• Factbox: The underinsured
• Even insured take sides on health care reform
• Photos: Health care examined
As the health care debate rages in Washington, we asked for your thoughts about this controversial issue. The response was overwhelming. Hundreds of you wrote, e-mailed or went online to share your feelings. This series addresses the issues you’re most passionate about.
• Sunday: When illness strikes
Even those with insurance aren’t protected from financial and emotional disaster.
• Monday: Don’t take my money
Many taxpayers don’t trust the government to fix the problem; nor do they want to bear the burden of those uninsured.
• Tuesday: Speaking of uninsured
Those who can’t afford health insurance want more options than disability or welfare.
• Wednesday: Fire the lawyers
Some are convinced tort reform could go far in fixing our health care woes.
• Thursday: Your suggestions
So how do you really feel? We look at more of your concerns.
• More and more middle-class wage earners are becoming underinsured.
• Most rapid growth occurred among adults in households earning between $40,000 and $60,000 annually.
• Older adults ages 50-64 are the most likely to be underinsured. From 2003 to 2007, the number of underinsured in this group rose from 11 percent to 18 percent, a 60 percent jump.
Source: Commonwealth Fund
Mark's back was acting up, so Jenny took him to the emergency room for treatment. The trip cost the couple $1,400. And even though they pay for private insurance, not one dime will be paid by their carrier because Mark's back problems are considered a pre-existing condition.
The Scherfs of Joliet are not alone in their struggles with rising premiums and out-of-pocket health care costs. An estimated 25 million adults were underinsured in 2007, according to a study by the New York-based Commonwealth Fund. The number jumped 60 percent from 16 million in 2003.
The group defines people as underinsured if they spent 10 percent of more of their income (or 5 percent if they were low-income) on out-of-pocket medical expenses, or if they had deductibles that equaled 5 percent or more of their income.
The underinsured wind up going without needed care, they don't see a doctor when they're sick and they forego filling prescriptions, according to the study's authors.
It's one of the problems health care reform advocates want to see tackled by proposed health care bills in Congress. The Sherfs are hoping something happens quickly while they can still afford to pay their private insurance premium.
'Really struggling'
Kevin and Michelle Oliver ran into problems when it took two years for their small son to be diagnosed with epilepsy. Even though Kevin has insurance through his job, the medical bills have consumed them and thrown their lives into financial chaos.
They moved out of their Plainfield house in March and put it up for sale. Offers have come in, but all have expired while the couple waits for the bank to process the paperwork, said Michele, who now lives with her family in a Naperville apartment.
The couple missed two car payments, and Kevin's car was repossessed. The lender, looking to collect the remaining due, along with fees and penalties that more than doubled the balance, froze their checking account.
Said Michelle, "We are trying to make ends meet like a lot of Americans today, but are really struggling."
'Never been in that position'
When Mark Scherf was laid off from his job with a builder three years ago, he decided to pursue his dream. The 39-year-old man opened West Side Music in Joliet two years ago, but that meant he and Jenny would have to buy insurance on their own, which they did.
Because Mark had back problems in the past, the insurance company made him sign a lifetime rider agreeing that the company would not pay for any back treatments. Jenny had to sign a three-year waiver for her carpal tunnel syndrome.
The Scherfs, who have two children ages 4 and 7, pay $7,500 a year for the insurance. Their policy does not include wellness coverage for the kids.
"We pay more for (insurance) than we do for groceries, as sad as that sounds," Jenny said.
Now Mark has been diagnosed with arthritis in his back, and the couple will have to pay for treatment out of pocket. Fortunately, the hospital where Mark received emergency treatment in April reduced the $1,400 ER bill as part of a charity program.
"I've never been in that position before," Jenny said. "I don't like doing that. I know who's picking up the cost — everybody else."
The Scherfs have had other insurance problems. Their carrier wouldn't pay for a test Jenny, 43, needed as part of her physical to be a school bus driver. She finally called U.S. Rep. Debbie Halvorson for help. Halvorson's aides intervened, and the test was finally approved. But the insurance company required two other tests first. Jenny's out-of-pocket expenses totaled $700 to keep her part-time bus driving job.
The Scherfs are now wondering how much their premium will increase when they renew their policy in February.
"The most we can do to help ourselves out is raise the deductible," Jenny said.
Public option
Commonwealth Fund Vice President Sara Collins testified earlier this month before a House subcommittee that more and more middle-class wage earners are becoming underinsured. The most rapid growth occurred among adults in households earning between $40,000 and $60,000 annually, she said in a copy of her testimony provided by the Commonwealth Fund (www.commonwealthfund.org).
Also, older adults ages 50-64 are the most likely to be underinsured. From 2003 to 2007, the number of underinsured in this group rose from 11 percent to 18 percent, a 60 percent jump.
Collins urged Congress to act on health care reform. She spoke in favor of HR 3200, a health care reform bill that includes a public option. That bill would go a long way toward reforming the individual and small-group insurance markets that feature high premiums and high administrative costs. The plan would ensure coverage for people regardless of age, health or pre-existing conditions, she said.
Costs out of whack
Cherilyn Murer, president and CEO of the Joliet-based Murer Group, a health care consulting company, said in addition to passing health care reform, Congress needs to get at the root of the problem. The amount of money it costs to provide some health care services is out of whack with what is charged.
"We have to have greater transparency as to what things really cost and what are people being charged," Murer said.
Also, insurance companies also shouldn't be allowed to play a "gotcha" game when they deny claims based on technicalities.
"People are frightened," Murer said of the need for comprehensive reform. "No one should go bankrupt because of medical bills in a country as wealthy as the United States — that's an absolute."
Growing concerns
Mark Scherf said he's hoping for a solution to come out of Washington, D.C., that would be more like those available in some European countries.
"We need to get over this fear of socialism they keep throwing around," he said. "Just because you have these programs, it doesn't mean you're government is socialist."
Something needs to be done to help people who are self-employed and own businesses, he added.
"The goal for any business is to expand and grow," he said.
But because of the high cost of insurance, Mark said he can't afford to hire full-time employees and provide them with insurance.
In the meantime, Mark said he and his wife will do everything they can to keep their music shop going and the insurance premiums paid.
"We're not deadbeats," Mark said. "We're trying to live the American dream here. We work hard to pay our bills, keep a roof over our own heads, feed our family and provide a service to the community."
