Health costs force choices

Illness or medical debt contributes to more than half of all bankruptcies.

Raleigh News & Observer

Getting laid off could cost Tim Willey his life.

Willey, 45, has colon, liver and lung cancer. Health insurance paid for by his former employer, a Raleigh, N.C., electric contractor, covered his chemotherapy until he lost his job Oct. 23. Since then, he has been paying $231 per month to temporarily continue his health insurance benefits under provisions of the Consolidated Omnibus Budget Reconciliation Act, or COBRA.

But he isn’t sure how much longer he can afford the COBRA payments, his co-pay for the prescription drugs and the mortgage payments for his house.

Willey is among an increasing number of people who find themselves in a difficult situation: They have to decide whether to spend their limited resources on food, housing and transportation or on medical care. Many consumers have begun to skip checkups, postpone surgeries and leave prescriptions for expensive medicines unfilled.

At the same time, enrollment in Medicaid, the health insurance program for the poor, has begun to rise again after years of declines.

Waiting to sort out unemployment and disability applications at a North Carolina Employment Security Commission office recently, Willey couldn’t figure out how to adjust his medication to save money.

“If I try to do anything, it’s all downhill,” he said.

As consumers look to lower expenses, cost can trump disease prevention, and lives are put on the line, especially among the uninsured, the underinsured and the increasing number of unemployed about to lose health insurance.

Brian and Kimberly Endicott and their five children have long been one medical emergency away from financial catastrophe.

The Youngsville, N.C., couple’s oldest child has severe brain damage from an accident. Their three youngest children have cystic fibrosis, an incurable genetic disease that affects the lungs and digestive tract and requires constant medical care. In 2002 and 2005, their 12-year-old daughter, Claire, spent months in the hospital with life-threatening bacterial infections brought on by the disease.

The Endicotts, who own a small appliance-repair business, have never been able to afford the $8,000 a month it would cost to insure the whole family. But with the help of Medicaid and supplemental state programs, they were able to pay for most of their children’s medical needs. That changed about nine months ago when customer calls for appliance repairs dropped off by more than half.

“If we have to live with this economy another six months, we’ll be out of business,” Kimberly Endicott said.

The Endicotts have drastically cut their weekly grocery bill, focusing on their children, particularly on the special dietary needs of those with cystic fibrosis. That leaves the parents with about one meal a day. Brian Endicott has lost a lot of weight, partly because of persistent stomach problems. Fearful of a diagnosis that would require costly treatment, he refuses to see a doctor, his wife said.

For years, runaway health-care costs have driven up out-of-pocket expenses that insured workers must pay for medical procedures, doctor visits and prescription drugs. The percentage of workers who pay annual deductibles of at least $1,000 has gone from 12 percent to 18 percent in just the past year, according to the Kaiser Family Foundation.

Illness or medical debt already contributes to more than half of all personal bankruptcies, and in most of the bankruptcies, people have health insurance.