Gina lives next door to the house she grew up in on a rural road in St. Joseph, Missouri. There used to be a lot of industry here, she told us, but most of the factories have closed up and moved out. Very few jobs in the area come with benefits anymore.

She and her husband Mike run their own small business contracting with the U.S.Postal Service to deliver packages, so they too are on their own when it comes to getting health insurance.

The monthly premiums of $400 already make the family budget tight, but it’s the $3500 deductible that makes actually using that coverage out of the question. No trips to the doctor for preventative care or head colds… not even for a miscarriage that occurred recently. She avoided getting care knowing that those first several thousand dollars were their own responsibility, and it was a bill they wouldn’t be able to pay.

She calls her coverage “death insurance” – to be used only in the most dire of circumstances. Thousands of dollars a year paid and still she goes without needed care. It defies logic.

And yet, Gina’s story sounded all too familiar.

The day before, on the other side of the Mississippi River, we visited Jeannie and family in Overland Park, Kansas, a suburb of Kansas City. Small business owners, she and her husband are being stretched to their financial limit trying to keep a company health insurance policy available to their employees. Costs rise by 20, 30, even 40% annually, and Jeannie can’t seem to get a straight answer out of the insurance company as to why.

The costs for their own family are outrageous. When the latest increase kicks in for August’s bill, they’ll pay $1,600 a month – more than their mortgage payment – and that doesn’t include the $2,000 deductible per person. Jeannie says that by the time they hit the deductible for one person, another one needs to see a doctor. They have to budget a about $24,000 a year for the family’s health care. (That would be one heck of a family vacation, she noted.)

The truly mind boggling part is that – despite paying these enormous costs – they are afraid to get a proper diagnosis for their youngest daughter’s health condition. What if it’s something serious and expensive to treat? The costs for everyone on their small group plan would go up even higher. For now they’ll try to keep their daughter’s problem in check with a special diet.

Driven by the fear of a truly devastating illness or accident, these two families on opposite sides of the Mississippi buy insurance policies they can barely afford. They have slightly different circumstances with very similar outcomes: paying exorbitant costs into health plans that they’re afraid to use.

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