Cathy Kerns has multiple sclerosis. The drugs she takes are lifesaving, she says, but they cost more than $5,000 a month -- and she must make a 20 percent co-payment. Her specialized physical therapy costs $600 per half-hour -- and she pays 20 percent of that.
``If I call and plead with the insurance company that I need more therapy so I can walk, they say, `Sorry, it isn't in the policy,' '' she says.
``I'm paying more than $30,000 a year out of pocket. I'm running through my savings.''
Kerns, 60, who is retired and lives in Orlando, represents hidden millions in America's healthcare crisis. She has insurance -- but she is underinsured.
In that category she joins a California woman who was bitten by a rattlesnake, ran up a $73,000 hospital bill for medicine and an overnight stay, and learned her insurance would pay only $3,000 of it. And a Miami woman whose policy won't cover her diabetes because it was a preexisting condition.
The underinsured include the working poor whose employers don't provide full coverage, people who lose their jobs and their employer-subsidized insurance, and those who fail to understand the fine print in policy contracts and end up with less coverage than they expected.
25 MILLION
No government agency keeps an official count of the underinsured. A 2007 survey by the Commonwealth Fund, a New York-based nonprofit that studies healthcare issues, estimates 25 million Americans are underinsured, up from 16 million in 2003. It defined ``underinsured'' as those with insurance who pay more than 10 percent of their income on medical expenses.
Underinsurance closely tracks the economy, experts say.
``People often become underinsured because they lose their jobs,'' says Lori Parham, Florida state director for AARP. ``They can't afford to continue the good insurance they had through their employer, so they shop around for cheaper coverage -- policies with low cost, but so many limitations.''
Under the federal law known as COBRA, people who leave their jobs can continue their employer-provided policy for up to 18 months. But they must pick up the entire bill -- so if, as an employee, they paid 20 percent and their employer paid 80 percent, under COBRA they must pay 100 percent.
Kerns, who was a hotel-restaurant marketer in Orlando, left her company in 2000 and went into a COBRA plan that let her keep the insurance by paying 100 percent of its cost.
She now pays $14,500 in premiums a year with a $5,000 deductible, and more than $12,000 a year in co-payments for her expensive drugs.
``Premiums keep going up,'' she says.
She has been trying to get cheaper coverage, but can't because of her multiple sclerosis.
Although she is sick, she must do what she can for her husband Gary, 69, who survived esophageal cancer but now has congestive heart failure and just entered a hospice.
``It's horrifying,'' she says. ``I'm a human being. I'd like to enjoy what little time I have left.''
Even when people do find less expensive policies, they often come with limits -- higher deductibles, lower maximum healthcare payments, more exclusions for preexisting conditions and other restrictions.
Liz Verjano of Miami gets health insurance through her work with Americorps Vista. But it doesn't cover her diabetes because she had it before she got the policy.
Verjano, 40, says she can't afford the medicine or blood-testing strips that cost $100 a month. Instead, she tries to do without, even though high blood-sugar readings could send her to the hospital or cause long-term damage to her vital organs.
``I'm feeling the symptoms,'' Verjano says. ``My feet hurt, and I have to go to the bathroom all the time. . . . It's upsetting.''
Consumer advocate Walter Dartland questions whether cut-rate policies are worth even the smaller price they charge.
``People think they're covered, but they really aren't,'' says Dartland, executive director of the Consumer Federation of the Southeast in Tallahassee. ``They're going to end up in bankruptcy.''
Sometimes people do not understand what they are buying, says Dr. Paul Duncan, chairman of the Health Services Research Department at University of Florida.
COMPLICATED POLICIES
``There are hundreds of companies out there offering a huge number of insurance plans. The policies are very complicated, with co-pays, deductibles, annual limits, lifetime limits,'' he says. ``That's often presented in arcane language that's hard to get through.''
``I understand why advocates say that,'' responds Blue Cross Blue Shield spokesman Chip Kenyon. ``Our agents are very sensitive that people understand what they're buying and whether it fits their needs.''
The various overhaul plans winding their way through Congress would deal with some of these problems. Some would give subsidies, limit deductibles and pre-existing conditions to coverage, require coverage of prescription drugs and hospitalization, and do away with lifetime out-of-pocket maximums.
One proposal would establish a national health insurance exchange allowing consumers to choose from a variety of plans. Providers in the exchange would have to meet standards for deductibles and coverage, and would not be able to reject applicants for pre-existing conditions.
At the state level, insurance officials have some power to regulate health insurance companies, but they can't dictate exactly what policies they will offer.
``Health insurance doesn't have the same disclosure requirements we see in other areas,'' says Terry Butler, senior attorney for the state's Office of the Insurance Consumer Advocate. He cited hurricane insurance, where providers are required to disclose windstorm coverage limitations in very large print.
Coverage disputes are handled by the Florida Department of Financial Services' Division of Consumer Services. Serious cases are turned over to the Florida Office of Insurance Regulation.
Such supervision doesn't satisfy some advocates.
``Private insurance plans all have a common denominator -- they're set up to make money,'' says Daniella Levine, founder of the Human Services Coalition of Miami-Dade County. ``There are so many scams in South Florida you don't know who to trust.''
Many consumer advocates say low-cost private health insurance policies do little to cover people's needs.
``People might buy a plan with good catastrophic coverage, but a very high deductible -- $2,500 or more,'' says Sara Collins, assistant vice president for health policy for the Commonwealth Fund. ``In effect, they're paying out-of-pocket for primary care. Or getting no preventative care like checkups or mammograms.
``Also, a lot of people think a $1 million lifetime cap on hospital care is enough. But if you get really sick you can blow through that very quickly.''
Parham, AARP state director, agrees.
``You see an inexpensive plan that pays 80 percent of hospital costs,'' she says. ``That sounds huge, but if the hospital bill is $100,000 and you're left with $20,000 to pay, that can hit middle-income families very hard.''