CALPIRG Members Speak Out on Health Care
December 21st, 2007 Posted by: Dr. Cox
Health care reform is at the top of California’s agenda, and everyone agrees the system is broken. It’s harder to know which problems are the most important, and easy to lose sight of what’s really at stake in the abstract policy debates.That’s why CALPIRG recently conducted an email survey of 575 of our members, to find out what kind of reforms are most important to them, and gather their stories about the health care system.
While largely satisfied with current insurance, 69 percent of participants are insecure about the future of their health insurance. A large majority of the participants – 88 percent – currently have health insurance, and 73 percent say they are either satisfied or very satisfied with the quality of the coverage they have.However, more than two-thirds do not feel secure that good coverage will always be there for them – 33 percent said they were concerned, 36 percent very concerned, about the future of their health insurance.The told us that they worried about getting dropped if they develop health problems, and about what will happen when they – or the family member through whom they obtain coverage – retire.Even for people who already have good health insurance, comprehensive reform is a critical issue.
74 percent thought obtaining health insurance on the individual market was difficult, as well as being confusing to navigate, largely unaffordable, and sometimes unavailable.Twenty one percent of our members bought their coverage as individuals, rather than as part of a group plan – a process 74 percent said was difficult or very difficult.One CALPIRG member who works in the health care field found buying a plan on the individual market “extremely confusing and difficult.”Making the same point, another said choosing a plan was like “trying to compare oranges with apples.” And some lack even this dubious luxury of choice – one member was only offered a single plan by a single insurer, while a second said that due to the difficulty obtaining individual coverage, the only option was the government high-risk pool, which has premiums of over $1,000 per month.Reforms need to bring people into group coverage by opening up eligibility in group purchasing pools, so no-one is forced onto the individual market.
85 percent of those that did not have health insurance cited costs.Most of our members have health insurance, but those who did not overwhelmingly lacked it because they could not afford it.Only 15 percent of members were self-insured or used Health Savings Accounts; the rest simply could not pay the premiums for coverage.County-based care was used by several as a safety net, but one member was forced to sell her property in order to qualify for it and get the breast cancer surgery she needed.Getting more people covered means giving them assistance, since very few people are uninsured as a matter of choice.
25 percent of survey participants had been refused coverage by an insurance company, and 55 percent of survey participants knew someone who couldn’t find an insurance company willing to cover them. A full quarter of our members were denied coverage for having a pre-existing condition.One person who had had bypass surgery found getting insurance impossible; so did another member, self-employed and diagnosed with AIDS.But the rationales insurers used for rejection can verge on the farcical, from citing “short stature” to taking a member to task for the “elective surgery” they underwent to remove a tumor.And even if it had not happened to them, 55 percent of our members know someone rejected by insurance companies, including one member whose acquaintance, an uninsured 60-year-old with a digestive disorder, died last month. Requiring insurance companies to take all comers is a necessary element of reform.
65 percent of survey participants had been surprised by a bill that they thought was covered by their insurance. Health care reform has to contain the skyrocketing costs of health care. Several participants said that they didn’t go to the doctor as often as they’d like in order to control costs – including one who told us that she skipped her yearly mammogram because of high copays. Insurance company refusal to cover certain treatments imposes even more costs on consumers – multiple members had been billed directly by hospitals after their insurers refused to cover emergency services, including one who was charged almost $7,000 for 2 hours in an ER.All told, 65 percent of our members had been surprised by a bill for services they thought their insurance would cover. Preventing providers from billing insured consumers directly will protect them from being surprised by large bills and being forced into debt.
While there are significant differences between the reform proposals put forth by the Governor and the Legislature, there are also significant areas of agreement. These survey results are one more indication that most Californians, even those who are satisfied with their current health insurance, are insecure about the future and need California’s leaders to come together and pass reforms that contain rising costs, expand coverage, and give consumers a fair shake on the market.CALPIRG is a statewide, membership-based organization that stands up to powerful interest, working to win concrete results for Californians’ health and well-beings. With researchers, advocates, organizers and students, we advocate on behalf of consumers and all California’s residents. For more information about this survey, contact Michael Russo, Health Care Advocate and Staff Attorney, at (213)251-3680 x332, or mrusso@calpirg.org.