At 50 years old, Matt Herman sold his beer distributorship and retired early. Now he says he just enjoys life through daily golf outings and quality time with his daughter. It’s no secret that he’s done very well for himself - retiring at 50 is out of reach for most Americans. But that doesn’t mean the health care system is working for him. As we’ve traveled the country this summer it’s become clear that people at almost all income levels are having trouble obtaining decent and affordable health insurance.

Previously, he was covered under his company’s group policy, but in the often bizzaro world of individual insurance he and his wife were deemed uninsurable. That’s when Matt learned about high risk pools. According to data from the Kaiser Family Foundation 33 states currently offer insurance coverage for the uninsurable through a high risk pool program. For Matt it’s the Nebraska Comprehensive Health Insurance Pool, or CHIP.

In many states insurance companies are allowed to set their own guidelines for offering coverage. This means people with chronic illnesses or expensive medical conditions are often left uninsured. Matt and his wife unfortunately fell into this category and found that the CHIP program was their only option.

Although Matt’s happy to have some form of insurance, he says it’s basically only catastrophic coverage. Despite paying monthly premiums of more than $1,000, he and his wife each have a deductible of $5,000 that they have never met in the three years they’ve been covered under CHIP.

He told us the only benefit he sees of having insurance through the state high risk pool are the “write-downs.” That’s when insurance companies negotiate discounted rates with physicians. A 2007 report by Health Affairs found that hospitals often charge self-pay patients 2.5 times more than what some insurers pay and more than three times the Medicare allowable rate. In Matt’s eyes, this is the only benefit of being covered under the Nebraska CHIP program.

So for now Matt and his wife are not one of the millions of uninsured, but are still not getting the coverage they need. Fortunately, they can afford the out-of-pocket expenses and monthly premiums associated with high risk pool coverage. But for someone that’s not “well heeled”, as Matt puts it, these costs would likely be unaffordable.

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Comments

1 Posted by JR Mcmahan at 08/03/08 01:50 PM

for the self employed this has always been a big problem. If a family member develops almost any significant health problem you are uninsurable. Don't list an existing condtition and the insurance company will take your premium until you submit a big bill then they drop you. Its all about making money. Not providing you with healthcare access.

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