With a shortage of quality, affordable heath coverage options on the market, Ken's customers - and his own family - endure expensive, unreliable health insurance

And yet, as Ken knows all too well, good health coverage is hard to come by these days.

Starting the insurance agency with his wife Kathy seven years ago, Ken left behind a company job and a health plan that “covered everything”. It’s the kind of thing, he said, that you don’t miss until it’s gone.

Ken sells mostly homeowners and auto insurance. He’ll also sell the occasional health insurance policy too – but he has reservations. Compared to the other products he sells, Ken says the coverage offered by individual health insurance plans is so poor he hesitates to promote them. What if his customers think all of the other policies he sells are so limited and unreliable?

And it’s not via word of mouth or even customer complaints that Ken knows the shortcomings of a policy with the insurance carrier he uses. He and Kathy have one themselves. Between the $500 monthly premiums, a $5,000 deductible, and no coverage for preventative care, he’s come to the conclusion that “health insurance is confusing for everyone and it is not a level playing field.” This coming from a guy that sells it.

Every year the $100 to $200 increases in their monthly premiums squeeze their budget a little tighter, making Ken wonder how long it’ll be feasible for them to run their own business. He’s seen friends and colleagues return to work just for the health insurance at an age when they should be thinking about retirement and wonders if this might be his fate as well. At age 49, his premiums are already skyrocketing. What will they be like when he’s 60?

As confusing and expensive as health insurance is, surely it would seem that the agents and brokers who sell it would have a leg up on the rest of us – a sort of insider’s secret to getting quality coverage at a price that won’t break the bank. But the grim reality is that in a health care system as broken as ours, inside or outside of the game, there is no assurance of good health insurance to be found.

From one job with a 90-day waiting period for coverage, to another with the state that classified her as a contractor, to yet another with a temp agency that provided no benefits – Mary has seen it all and knows exactly what it means to put off care. It’s a constantly growing problem in America. Not only do many employers not offer benefits to all workers or certain groups of employees, those that do are aggressively raising out-of-pocket costs. The result of all this stress on average Americans is exemplified perfectly in Mary’s health and history of coverage.

For years she’s avoided seeking care because of the cost, and at times when she did visit a doctor she’s even been denied treatment for being uninsured and unable to pay upfront. In one remarkable instance a doctor found "something that could be a cyst, a fibroid, or cancer" during a sonogram and immediately scheduled a biopsy. But that was before the office staff found out that Mary had no insurance and couldn’t afford to pay upfront. The procedure was cancelled and Mary had to go home wondering what exactly that “something” was.

Currently she’s in one of those 90-day wait periods to test her resolve and staying power before they’ll give her health insurance. However, Mary couldn’t wait any longer. With growing concerns about her health that couldn’t be cured with at-home remedies, she finally sent a desperate plea to area doctors. In exchange for medical treatment she offered help around the office using skills she learned as a nurse’s assistant.

Luckily one doctor responded to Mary’s call and connected her with a clinic that’s now beginning to address the health issues she built up from years of neglect that befall those lacking adequate coverage. But could those issues have been addressed more cost effectively at early stages? Will Mary’s health ever be as good as it could have been with the proper preventive care? Tough to know for sure but we do know that in general treatment is cheaper, easier, and more effective when illness is identified early.

Turns out that no one - not even a doctor - is immune to outrageous premiums and denial for pre-existing conditions.

Dr. Kesani knows this better than anyone…he has diabetes, and he's uninsured.

Running his own practice is a near-literal description of Dr. Kesani, who hustles back and forth between several hospitals in the Chicago area where he maintains offices as a kidney specialist.

He wasn't always uninsured. Dr. Kesani had a group plan at a former practice in North Dakota, where he was shocked by the diagnosis of diabetes at the age of 33.

When an opportunity arose to start his own practice in Chicago, he decided to make the move and kept his group insurance through COBRA for a year and half. When it expired he was told that in order to maintain the same policy his premiums would jump to $1700 a month—five times what he'd been paying. Then he tried to apply for an individual policy. He was flatly rejected by his health insurance company of ten years, and several others.

Dr. Kesani doesn't need to consult a(nother) physician to know how to properly manage diabetes—he maintains a healthy lifestyle, takes his medication, and gets exercise by playing soccer a few times a week. Having the professional training to keep this health issue in check is one thing, but accidents and emergencies are another thing entirely. Those are things that no one, not even a doctor, is immune to. When asked what he'd do if he got injured playing soccer, Dr. Kesani said he's already had to tough out a few knee problems. And, of course, it helps having friends in the medical field.

He's looked into other health insurance options, but so far none have been the golden ticket to coverage. Although he qualifies for the Illinois Comprehensive Health Insurance Program, the state's high-risk pool, Dr. Kesani hesitates to sign on to a policy that would set him back $450 a month with limited coverage. He's holding out to see if an insurance plan soon to be offered to doctors by the Illinois State Medical Association will come through for him, unsure if the group plans to exclude applicants—even though they're doctors—based on pre-existing conditions.

When Dr. Kesani says "health insurance companies only want to insure the healthy," it's not merely out of sympathy for those struggling to get coverage. It's empathy shaped by his own fight to obtain reasonably priced health insurance in a system of care so broken that even a doctor can't afford to be a patient.

Savings account drained, Cindy and her daughters teeter on the edge of living uninsured.

In July, Cindy told us she wasn’t sure what she’d do when her COBRA benefits expired. But as it turns out, the money ran out before the COBRA did.

She says: “I have fought so hard and spent so many thousands of dollars this year just trying to keep it up [paying health insurance premiums]. So, all that money is gone and for what?? No retirement account left and no money either.”

Working for a temp agency when we last saw her, Cindy was hopeful about finding a job with benefits to ease the strain of the $600 monthly premium on her family’s budget – a high price tag that didn’t include coverage for her husband. But the temp work dried up and the job market is tight. Without a steady paycheck, continuing to pay the premiums chewed through her retirement savings quickly.

Cindy will do whatever it takes to hang onto her health insurance – as a cancer survivor, she feels there’s not much of a choice. Once she loses her coverage it’ll be nearly impossible to obtain health insurance with that kind of pre-existing condition.

This month Cindy and her two daughters are covered – but it was only by the grace of a “miracle,” as she put it. On the brink of cancelling her COBRA insurance, she was given loans by family and friends to keep them insured for another 30 days.

But the close of September will bring the family right back to where it was pre-miracle. Borrowing money is not a long-term plan to sustain their health insurance costs and besides, Cindy noted, now they are further in debt to repay the loans.

She questions whether or not scraping together the funds to hang on to the coverage was the right thing to do, but at least has peace of mind for one more month. Come October though, she knows they’ll be struggling again to accept the unacceptable, “letting go of the idea health insurance”.

It’s a complete change in mindset for this family that for so long has sacrificed so much in order to keep their health care coverage intact. A lack of job security compounded by a loss of retirement security means they are battling day-to-day in their fight to hang onto some sort of health security.

The first 17,000 miles were only the beginning on the road to health care reform.

Tangible reminders of the people we met on this summer-long journey to document health care experiences across America decorate the office/abode/vehicle we’ve called home for nearly four months.

We captured 100 Americans on film talking frankly – and bravely – about their health care situations. Often people told us, “I shared my story – but I didn’t think anyone was actually listening,” until a giant blue RV and camera crew showed up at their homes to let them know their stories are being heard, and they matter.

One woman said that sending in her story was like throwing a pebble in a pond, but having a means to tell it in her own voice to the world felt more like throwing a rock, making bigger ripples.

In that case, we’ve gathered a big pile of big rocks – ammunition for the fight for health care reform, as we see it.

Struggling small business owners for whom insurance costs are crippling, if attainable at all. Retirees being forced back to work strictly for the health benefits. Families breaking their budgets for health insurance they can’t afford to use. Patients who thought they were covered – until they actually tried to use their insurance.

One man or woman telling their story represents a whole slew of Americans with the same problems. And like it or not, we are all in this together when it comes to fixing this country’s health care system. If our elected officials aren’t working to fix the kind of problems that Dave and Cindy and Michelle talked about, then they’re not really serious about health care reform

As the on-the-road portion of the Cover America Tour comes to an end this week, our on-the-ground work is just heating up. Forty-eight days away from the 2008 elections, the countdown has candidates vying for 435 House seats, 33 Senate seats and one important spot in the Oval Office. They may disagree on just about everything else, but most of those running for office agree that this is the time to fix the broken health care system failing so many Americans.

We’re going to Washington to hold them to it – and we’ll be bringing your stories with us.

In her home hidden among corn fields, she shared her story of struggling to obtain affordable and high quality health insurance and provided yet more insight into the experience of ordinary citizens. In reviewing her options she’s been forced to settle for the best of the worst.

Barbara’s employer provides health insurance through her job as a medical transcriptionist, but at a high monthly cost of over $400 and huge out of pocket expenses. The family has to pay 30% of all claims until they’ve spent $19,000 out-of-pocket annually. Working on a nearby dairy farm, her husband’s employer can’t afford to insure its workers so the family began looking for private coverage in the individual insurance market.

Barbara eventually found a seemingly better insurance option, one with a monthly premium of $330 and a family deductible of just over $5,000 per year. It provides 100% coverage once the deductible is met. Still, the prescription drugs they need are not on the plan’s formulary so they’ve had to purchase them from an online pharmacy based out of Canada.

Furthermore, the premium recently jumped to $420 per month and with their high deductible, Barbara is being forced to put off care. "I am scared to death to take my children or my husband or myself to the doctor. Yes, we have insurance, but let's face it, it is only for emergencies," said Barbara.

Last year she was faced with one of those emergencies when she accidentally cut a tendon in her hand. The family had to find the money to meet their annual deductible and its left them searching for ways to pay off the debt. "I used our (federal) stimulus and tax (refund) to help pay it down."

Her story is not unlike many others that we've heard this summer, but Barbara brought up an important point others haven't mentioned. If she were to opt for her less generous employer provided health insurance, the cost would be paid with pre-tax income under current federal law. But as an individual health insurance consumer, she isn’t getting the same benefit and she wants to know why her premium costs aren’t tax deductible.

This is yet another hardship faced by Americans attempting to purchase health insurance on their own. Not only are the options often expensive and limited, consumers aren’t eligible for the benefits others with employer-based coverage receive.

Barbara’s now looking for a job again, hoping she can find one that will provide a better option for her family’s health coverage. "No one’s willing to step up for us, in the government or private sector," she said. "I know we can do better. We can put people on the moon, send satellites to the edge of our galaxy, take pictures of galaxies we will never even get to, and we cannot put together a system that is economically feasible to provide healthcare to our citizens."

Kim is used to taking on the giants in the pharmaceutical world in the fight for safer drugs. But she was blindsided by another giant - her own insurance company - and found herself in a battle to keep her health insurance.

In the interest of full disclosure, Kim already has a place in the hearts of many of us at Consumers Union. A tireless advocate for drug safety, Kim has made over 40 trips to Washington, D.C. to tell the story of her late husband, Woody, who took his own life at age 37 after five weeks on antidepressants – sample packets given to him by his doctor to help him sleep better as he faced the anxiety of starting a new company.

Kim’s testimonials in Washington have helped convince Congress to pass stronger drug safety laws, including last year’s legislation requiring the disclosure of clinical trial results and tighter regulations on drug advertising.

Looking towards the future Kim has made some recent life changes, including a fresh start in her new home and leaving a company she’d been with for ten years to go out on her own as a freelance ad producer.

Enter the insidious individual health insurance market.

Kim maintained her coverage via COBRA until it expired after a year and half, and then decided to purchase an individual policy through the same company for the sake of ease and consistency. After all, she’d had insurance with them for over a decade.

She was denied coverage.

The company decided she had “mental illness” and rejected her for having had the audacity to use the 20 annual visits to a counselor that were included in her previous coverage. She explained that it was grief counseling after the sudden loss of her husband. They said that’s how it starts for people with mental illness.

Incredulous, she called another company. They rejected her on the same basis. After rounds of phone calls, arguing, and talking to managers she was finally able to get them to sell her health insurance … but the counseling is excluded for two years.

Now in order to continue to see the therapist she’s spent years building a relationship with, Kim has to pay out of pocket or not go at all. The therapist feels terrible that the visits nearly cost Kim her health insurance. Kim is outraged that she now has to pay for the visits – one of the only things she’d actually used her coverage for.

During a summer of listening to health care stories from people all across the country, we thought we had heard it all when it comes to heartless maneuvers by insurance companies. In fact, we heard about a nearly identical situation when we visited Janne in Norman, OK.

But the injustice of Kim’s circumstance seemed to take it to a new level. She was denied coverage by an insurance company because she had actually used the coverage it had previously provided her and told her she was entitled to use.

An insurance company behaving this way no longer shocks us, but it does make us mad as hell. It’s cruel and callous. Going through what Kim has experienced with her insurance company would no doubt make most people depressed, maybe even to the point where the healthiest thing to do is seek some professional help. But take it from Kim, you don’t want something like that showing up on your record.

Health insurance should be good for more than just cancer or getting hit by a bus.

Welcome the world of the underinsured...

Read the rest of this blog at Consumer Reports Health

This young couple goes uninsured but does whatever they can to make sure daughter Fiona stays covered.

It’s like a joke, Buffy said. They only make about $12,000 a year but it’s still above what a family of three can make to qualify for help. Unable to afford health insurance, she and Jeremy live without coverage.

Fortunately, Fiona qualifies for a state children’s health plan – but that presents problems in and of itself.

Reapplying for the program, which used to be an annual ordeal, is now required every six months by the government. Getting together all the necessary the paperwork and going through the application process takes so long that by the time her daughter is approved, it’s practically time to start all over again. The sheer amount of time it takes to apply, coupled with the fact that they never know for sure if Fiona will be re-approved, is a constant stress on the family.

Buffy has considered getting a part-time job to supplement Jeremy’s stipend as a PhD student, but worries any extra income will mean Fiona will be disqualified for the state program. It’s not a sacrifice she’s willing to make, even if it means extra income.

It’s a Catch-22 for these young parents wanting to better their financial situation and find a way to get health care. For now, Buffy will continue to stay at home and watch Fiona with one eye to the part-time job market, tracking the calendar for the next application deadline to make sure at least Fiona hangs onto her health coverage.

Kifah in Chicago Ridge, IL, mother of two, had a financial decision to make about the international birth of her second son.

Years later, pregnant with her second son and uninsured, Kifah feared the worst. She didn’t want to rely on any public assistance to pay for the birth, but knew the bills would wipe out their savings and suck their bank account dry.

In the meantime, she’d planned a one month trip early in the pregnancy to visit family in Palestine. Once there, however, she realized she could have the C-section for $800 – a true bargain compared to what she and her husband anticipated paying in the US. They stayed.

That one month trip turned into a nine month stay and they returned home from Palestine with their second baby boy, whose entire birth – including plane tickets – cost less than the birth of their first son did, even with the insurance.

Kifah knows the United States can do better by its citizens.

Even now, as she, her husband and youngest son live without insurance she remains optimistic, dedicating herself to helping others in need in her community. She’s deeply committed to her faith, which she says helps her overcome the fear of living uninsured. Everything happens for a reason, she says.

As we interviewed Kifah she insisted we stay for dinner – after warming us up with coffee and sage tea. We couldn’t say no, particularly when we smelled the delicious aromas wafting from a pot on the stove through the entire interview.

Kifah treated us to a traditional meal called mansef: tender lamb over rice and pita in a yogurt sauce. It was an unexpected treat and certainly unlike any on-the-road fare we’ve experienced (and sometimes, endured) this summer.

We're down to our last couple of weeks on the road, re-energizing after back to back weeks of convention-mania

We’re not the only ones feeling the effects of 16,000+ miles – seems the Blue Beast is too. We hit the road eastbound to the sound of interesting new creaks and bangs that we swear the ol’ girl didn’t have when we pulled into the state of Minnesota.

We also had an extra-special surprise in the refrigerator. Turns out there’s some sort of malfunction that’s causing the fridge to act more like a freezer. Know what happens when you freeze a can of soda? The rogue Diet Pepsi left in there during the RNC exploded and managed to blow out an entire container of parmesan cheese sitting next to it (honestly, we’ve never seen anything like this happen in a fridge before). The fantastic Pepsi/parmesan aroma that it gave the RV came second only to the pleasure we had cleaning up the cheesy, sticky mess.

Odd banging noises and smelly fridge aside, we managed to catch up with some great folks along the way in Milwaukee and Chicago and film a few health care stories – and we’ll continue driving and filming stories until the tour ends next week in Washington, D.C.

Do you live in Ohio? West Virginia? Virginia? We’re heading home through your states and would love to hear from you. Share your health care story with us and we just might swing by in the home stretch of the Cover America Tour.

Gatherings in Denver and Minneapolis provided the perfect opportunities to meet and greet with local consumer advocates and supporters. Want to be a part of the next big get together? Read more.

True to form we showed up with video equipment in tow, poking the camera in on peoples’ conversations about health care issues, asking them to share opinions on reform efforts and documenting their experiences trying to afford and use the health care system.

Twin Cities party

Entertainment was provided by Senator Hillary Clinton and Governor Sarah Palin, respectively, as party-goers kept one ear on the conversation and the other tuned into coverage of the conventions.

Some work, some play, and some great footage of Denver- and Twin Cities-ites talking to us about health care.

Want to be a part of the next gathering?

Last summer Consumers Union hosted its first Activist Summit at our headquarters in Yonkers, NY. Fifty people from around the country came together to learn more about important consumer issues like health care and food & product safety, attend workshops and tour the Consumer Reports labs.

We’ll be hosting the second annual Activist Summit in Yonkers this year from October 22 – 24. Interested in getting involved with Consumers Union? Take a minute to answer a few questions – just tell us a little bit about yourself and why you’re interested in coming. Submit the application by September 7th at midnight, and we’ll get back to you within a couple weeks.

Denver house party

We arrived in St. Paul after a few days' drive from Denver, barely recovered from the DNC but looking forward to a packed week of events at the RNC...

Monday, amidst a shortened agenda of events so officials could focus on monitoring the landfall of Gustav, we still managed to catch up with a few folks out on the street. A young woman, uninsured, who has been paying off hospital bills from a gall bladder surgery for years. A Vietnam veteran who thinks health care for those that have served our country should be the top priority for our leaders. A health care clinic director who believes Minnesota does a good job, but still sees the needs of many communities going unmet.

We too kept an eye on the effects of Gustav as it hit the Gulf Coast, seeing places on the news that the RV had been only a month or so ago and thinking of people like Karen and Sheila we met along the way. Three years after Katrina we saw first hand how long it can take communities to rebuild, and how difficult the lasting effects of a hurricane can make finding jobs or accessing health care.

After three months of traveling cross country covering the health care woes of Americans, we could almost predict the next thing Doris would tell us. Within the first month of retirement, her insurance premiums increased a stunning 70 percent. When budgeting for retirement she told us that she “even planned an extra 10 percent for increases in health insurance costs.” Her prudent plan was destroyed by the first and increase and she’s been told more premium hikes are almost a certainty.

Doris says her state has been forced to raise premiums because of poor fiscal management, or what she wryly refers to as “the politics of bad behavior.” Rising health care premiums are particularly difficult to absorb for retirees who live on a fixed income. As monthly contributions rise pension checks remain the same, forcing retirees and others to make budgets cuts or go back to work.

For Doris the best option was to go back to school, this time as a tutor. Now she works a few days a week to make extra money, in part to help pay for her increased monthly health insurance premium.

But she hasn’t remained silent about this issue. “I’ve been fighting with Retiree Health Care, since I’ve been retired,” she told us. Doris has written and made phone calls to her representatives, encouraging them to revisit this issue and find a way to provide her and others the benefits they were promised at an affordable price.

For now, Doris continues to work to keep up with her retiree insurance premiums and the out-of-pocket costs associated with visiting her doctor, who is considered out of network. Doris finds that part particularly frustrating. She has to work during retirement to afford insurance premiums, but can’t use that insurance to visit the doctor she’s built a relationship with for almost a decade.