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Even Insured Patients Struggle as Health Care Costs Rise

January 5, 2009 at 6:35 PM EDT
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As health insurance premiums and deductibles rise, even patients with health insurance are finding it difficult to keep up with escalating costs. Betty Ann Bowser reports on the challenges facing the "underinsured" in Nashville, Tenn.

JIM LEHRER: Now, the first of three stories on health care challenges facing President-elect Obama and the new Congress.

Tonight, NewsHour health correspondent Betty Ann Bowser reports from Nashville on how the recession is affecting personal choices. Our Health Unit is a partnership with the Robert Wood Johnson Foundation.

BETTY ANN BOWSER, NewsHour Correspondent: These days in the honky-tonk bars that line the main street of the nation’s country music capital, good tips are hard to come by. Like most cities, Nashville is trying to make it through difficult times.

MUSICIAN: Times are tough all over, and we know some of you can only afford to tip us 20…

BETTY ANN BOWSER: Everything costs more, including health care. Doctors here at the city’s Baptist Hospital are seeing dramatic evidence of what happens when health care costs continue to rise in an economic downturn.

In the past few months, there’s been a 40 percent increase in the number of patients who’ve cancelled appointments with the hospital’s cardiology practice, many of whom are insured.

CEO Charlie Powell says these are people who have serious heart conditions.

CHARLIE POWELL, CEO, St. Thomas Heart Baptist Hospital: The longer you put off preventive care, the more likely you are to end up in the emergency room and come much closer to a situation where death could be the result of a serious cardiac condition.

BETTY ANN BOWSER: So these people are literally flirting with death?

CHARLIE POWELL: Absolutely. What we’re now seeing is those people with insurance making these decisions, as well.

Health care costs rise rapidly

BETTY ANN BOWSER: Even people with health insurance are struggling to pay for care.

Nationwide, the rise in annual premiums is outpacing average wage increases. According to a September 2008 Kaiser Family Foundation report, the average employee contribution for family health coverage increased 117 percent over the past eight years. Out-of-pocket costs for deductibles, co-payments for medications, and fees for physician and hospital visits are also higher.

And an October tracking poll by Kaiser found nearly half of Americans surveyed said someone in their household was either delaying needed care, forgoing a recommended test or treatment, not filling prescriptions, cutting pills or skipping doses in the past year because of the price tag.

Dr. Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation -- which funds the NewsHour's Health Unit -- says hard times can negatively impact more than people's pocket books.

RISA LAVIZZO-MOUREY, President, Robert Wood Johnson Foundation: They are taking actions that sometimes is bad for their health. They're making choices when they have to choose between the rent or a health care service. That means they will not get a prescription filled or not go back to see the doctor for the follow-up visit or defer an operation that they think they can defer.

BETTY ANN BOWSER: That's precisely the draconian decision Heather and Allen Orozco recently had to make. The parents of three young children, Heather needs surgery to have her gallbladder removed. Allen has a chronic inflammatory bowel condition called Crohn's disease, which recently triggered a rare, dangerous asthmatic condition.

The Nashville, Tennessee, couple didn't have enough money to get medical treatment for both problems, so they chose to take care of Allen's.

HEATHER OROZCO: He was our concern. It wasn't me. I mean, his issue could have gotten much more severe, and it was at a point where, you know, he couldn't even play with the kids. He couldn't even sleep.

Many are delaying treatment

BETTY ANN BOWSER: The Orozcos pay $800 a month for their employer-based coverage through Allen's job. But after a $1,500 per person deductible, it only covers 80 percent for most surgical procedures and diagnostic tests. And they couldn't afford their share of both her surgery and treatment for his lung infection.

HEATHER OROZCO: Eight hundred dollars is a huge amount of money for us every month. We're on one income. I'm in school, and Allen's our sole provider right now, and it's very difficult. We're on a very limited budget.

BETTY ANN BOWSER: Allen works for a mortgage company that has cut bonuses and raises because business is down.

ALLEN OROZCO: It's absolutely frustrating, but to have to sit there and think, "Let's see, should I take care of my wife's gallbladder that bothers her every day, or do I need to take care of my asthma? Can I do my best to suck it up a little longer?"

HEATHER OROZCO: It's gotten to the point where at least two to three times a week I'm so nauseous I wake up in the middle of the night and I'm extremely nauseated. And, you know, I have to get up in the morning. I have to go to class. I have the kids to get ready for school.

BETTY ANN BOWSER: Dr. Leah Patton is the Orozco's primary care physician.

DR. LEAH PATTON, Nashville Medical Group: I worry about her and many, many, many others.

BETTY ANN BOWSER: Every day she has patients who are putting off seeing her...

DR. LEAH PATTON: That one's a little bit infected.

BETTY ANN BOWSER: ... because of a $10 or $20 co-pay required by their insurance.

PATIENT: I can feel it. I can feel a lump.

BETTY ANN BOWSER: Some patients also have co-pays on each of their prescription drugs that can exceed $100 each.

DR. LEAH PATTON: There's always a way around it.

Preventive care saves money

BETTY ANN BOWSER: So even when people have insurance, the out-of-pocket expenses can add up quickly.

PATIENT: I think it's right around $60 per month. So if you have samples, that would be great.

DR. LEAH PATTON: I have people calling me saying, "I can't get into see you, but my lungs sound terrible, and I have a fever of 104. I can't afford the co-pay."

I had a lady that I saw last week diagnosed with diabetes and hypertension four years ago that wasn't able to afford her medicines and came in with a painful right eye. It turned out to be glaucoma.

I ended up keeping her in the hospital for seven days because she had to have emergency surgery on her eye. And it ended up costing what I think four years of therapy may have saved us.

When I let her go from the hospital, I had given her some medicines. And I saw her a week later, and she hadn't been able to buy anything, so we were back at square one.

BETTY ANN BOWSER: When people with chronic conditions skip their medications and put off routine care, they frequently wind up in the emergency room. By the time they get here, they're usually sicker, which means the cost of their care is much more expensive than it would have been in a doctor's office.

Vanderbilt University health policy analyst David Osborn.

DAVID OSBORN, Vanderbilt University Medical Center: We see patients in our emergency room, and it costs five or six times what it does to see them in a primary care physician's office. So we save money in the short term, but it ends up costing us money and having worse health outcomes for individuals.

DR. JOHN GIBSON, Nashville Medical Group: Are you able to hold a fork in your hand?

PATIENT: I'm able to eat with my right hand.

BETTY ANN BOWSER: Dr. John Gibson has been a primary care physician for 30 years. Now, for the first time in his career, he's seeing insured patients refusing routine preventative screenings.

DR. JOHN GIBSON: We recommend screening colonoscopies to everyone over the age of 50. A lot of insurance companies say, "Well you know, we'll cover it, but you pay the first $1,000." Well, they'll say, "You know, I'm not going to do that. I can't afford to give up $1,000 now. That's just something I can -- I'll have to live without."

Now, is that immediately jeopardizing their health? Well, it is if we miss a possible colon cancer. I think that makes sense.

Low premiums, high deductibles

BETTY ANN BOWSER: Analyst Osborn says more and more Americans have been signing up for insurance plans that keep the monthly premiums low in return for very high deductibles, anywhere from $2,000 to $5,000, and that contributes to the problem.

DAVID OSBORN: They may have signed up for the plan when they weren't sick and felt like nothing was going to happen to them, but then now something does happen or they start to have some symptoms, and now they don't have a $1,000 deductible the way they did five years ago. Now they've got a $5,000 deductible.

That's a real difference for a lot of people. They don't have the money in the bank to pay for it. And so for some the reality is they skip the care they need, try to just tough it out, and see if they can go as long as possible without going in to see a doctor or get to the E.R.

BETTY ANN BOWSER: The E.R. is where Heather Orozco has wound up several times in the past year, because she's put off the surgery she needs, and husband Allen is skipping pills.

HEATHER OROZCO: Because of the Crohn's disease, he has to take 15 pills a day, and he's also on additional medication, and the additional medication he'll go a couple of days between, if he can.

ALLEN OROZCO: I'll stretch it out. I am kind of Russian roulette, you know, playing there a little bit.

BETTY ANN BOWSER: Recently, Allen suffered a major health setback that involved some diagnostic tests that weren't completely covered by insurance, so now they're facing a whole new round of bills, and Heather still needs surgery.