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The Tragedy of the Underinsured

Just 21 months into my mother’s cancer treatment, she had reached her medical insurance policy’s cap for chemotherapy — $100,000. As if dealing with cancer were not enough, she now had to deal with the reality that our health care system had left her financially exposed.

Lost in our daily debates on health care reform is the devastating impact our current system has on people like my mom.

She, like 25 million others, was underinsured. They, along with the 46 million uninsured, are forced into a high-stakes game with their lives. Many of these people have jobs yet are left out of our system. Along with other disparities in health care, our employer-based system also discriminates. Where you work matters greatly.

Mom was self-employed and, like more than 5% of the country, was forced to purchase medical insurance as an individual on the open market. These policies are typically more expensive, provide less coverage and don’t receive the federal tax subsidy given to employer-based plans.

Seemingly overnight, my mother, 56 at the time, was faced with chemotherapy, surgery, more chemotherapy and radiation. She soon became nauseated and physically weak. Being self-employed meant that when she did not work, she did not get paid. Her income fell, and her business struggled just as tens of thousands of dollars of bills began to pile up.

All of the physical, emotional and spiritual angst she was feeling was compounded by the complexity of her insurance policy, which was written by the Mid-West National Life Insurance Co. of Tennessee.

Mom’s insurance had odd provisions. For example, she had a $1,000 limit per day on radiological scans and chemotherapy. When she needed a CT scan of her chest, abdomen and pelvis, she had to spread those out over three days when they could have all been done in one appointment.

Her policy also had bizarre limits on what drugs could be given on a single day, which resulted in multiple visits to her oncologist. These limits, along with the $100,000 lifetime caps on radiological scans and chemotherapy, made her care far more convoluted. Treatments were often delayed or changed, depending on her coverage.

A growing problem

The underinsured are more likely to go without medical care because of cost, including skipping tests or treatments and not filling prescriptions. Compounding the problem is that fewer employers are even providing coverage for their employees. In 2008, 63% of employers offered health insurance compared with 69% in 2000.