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Abu Dhabi, UAEMonday 21 January 2019

Americans forced to gamble with their health

For many, the financial burden of buying medical insurance means going without makes more sense than paying for coverage

A community health centre's pharmacy in West Virginia. Many Americans cannot afford adequate health cover. AFP
A community health centre's pharmacy in West Virginia. Many Americans cannot afford adequate health cover. AFP

For many Americans, 2018 was the year that health care reached a breaking point.

Insurance was still too expensive to buy. It didn’t cover nearly enough. And as the country’s politics festered, the government once again failed to solve the insurance conundrum, even as a large majority of Americans who flocked to voting booths said health care was their top concern.

Many people had weighed the health benefits against the financial burden of purchasing insurance. Most decided to risk it, betting that going without made more sense than paying for coverage.

Most are people who were trying to work, raise children and pay for a house or college.

In Virginia, the Jordan family shared their tale of sinking into bankruptcy because of unexpected medical expenses, even though they had insurance.

The Maldonados, in Texas, were forced to choose which members of their family to keep on insurance policies as costs ratcheted ever higher.

Others tried to find creative solutions, like the patchwork of alternatives to traditional coverage that the Bergevin family in Boise, Idaho, assembled. A nurse in South Carolina said she buys insurance every other year, getting screenings and care in even years and rolling the dice in odd years.

This is a problem reaching far higher into the economic spectrum than many realise. Of more than 100 people Bloomberg interviewed over the year most had incomes of $100,000 or more; comfortable families, from the outside. Yet it was clear how much they needed to stretch to afford health care.

That often meant self-imposed health-care rationing. They didn’t make these decisions lightly. These weren’t uninsured-by-choice “young invincibles”. They weren’t reckless or ignorant - quite the opposite. Many were educated professionals, entrepreneurs and business owners. They had bad options and were forced to make a choice about which family “need” had to be downgraded to a “want”.

Some were more comfortable with the risks they were taking than others.

Keith and Diana Buchanan of North Carolina gave up their expensive health insurance this year and bought a Bowflex exercise machine. Keith said he got into the best shape of his life: “A lot of it is a result of knowing that we’re going to have to take care of our own health a little better,” he said.

Others weren’t so lucky. In West Virginia, Tara Sullivan, didn’t go to the doctor until her flu turned into pneumonia. The drugs she needed cost $250. Among the more financially strapped of those we chronicled, she was able to buy her meds only by skipping a payment on her gas bill. The utility threatened to turn off her heat in the middle of winter.

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“We don’t have enough money to go out to eat or take my grandchildren to the movies, much less pay for health insurance,” Ms Sullivan said.

We also talked to people who couldn’t afford to go without insurance - some of the 133 million people with pre-existing conditions who might have been shut out of insurance markets before the Affordable Care Act.

Andrea Preston in Bloomington, Indiana, lives with a rare auto-immune disease that causes her airway to collapse. At 38, she needs repeated surgeries to keep it open; she has already had seven and takes 15 medications. Ms Preston has insurance through her job as a technical writer but, even then, her medical bills accumulate faster than she can pay them. “It’s a rolling ball I can’t get ahead of,” she said. “It’s slowly steamrolling me.”

In Chicago, Joe Della Croce, a Vietnam veteran and two-time cancer survivor, should be retired at the age of 79. Instead, he holds down a low-wage job at a Home Depot to get insurance for his wife Rose, 61, who has multiple sclerosis. She’s too young to get on Medicare and can’t afford medication without insurance.

“It wasn’t what he had planned to do in his later years,” Rose said.

If 2018 was the year that health care fell apart, 2019 isn’t looking much better. On a Friday night in mid-December, a Texas judge ruled that the entire Affordable Care Act ought to be struck down. For millions of people who have coverage, whether they get to keep it may come down to yet another high-stakes legal drama as the case works its way through the court system.

Large employers are signalling they are fed up with the current state of health insurance dysfunction. A three-way effort between JP Morgan, Amazon.com and Berkshire Hathaway is attempting to increase quality and deal with rising costs.

Berkshire Hathaway has related interests in the UAE also. Last month, The National reported that Mr Buffet's insurance unit may offer more products to its clients from its office in Dubai as its remains bullish on the prospects of economic growth in regions from Middle East and North Africa to India, Turkey and CIS, a company official said.

The Berkshire Hathaway Specialty Insurance, based in the Dubai International Financial Centre, offers speciality and commercial insurance and reinsurance products with a focus on construction, energy, property, marine, casualty and executive and professional segments.

“We are already reviewing additional products. We might also offer group personal accident,” said Alessandro Cerase, senior executive officer for BHSI Middle East.

“Right now we are not considering entering the retail business but that does not mean we will not review our position if regulations change over the years. We might decide to expand in the local environment.”

The UAE's insurance market is growing, although over 60 insurers compete in a country with a population of some 9 million.

Back in the US, Amazon and such other tech powers as Google parent Alphabet have begun to delve into pharmacy and health records. And a handful of start-ups are offering new ways to buy coverage and get care.

But those sorts of fixes are years away - if they ever happen. For the people we spoke with, that means more last-ditch compromises to cobble together a plan or stay healthy.

In Virginia, the Jordans’ deductible still isn’t affordable and their bankruptcy proceeding will likely stretch into 2020. In Texas, the Maldonado family was able to buy coverage again for a college-age daughter and her mother Maribel, a cancer survivor. But, David, the father, is keeping himself off the policy for an additional year to save money. Tara Sullivan will be eligible for health coverage at a new job in Florida, starting this month.

But, at $200 a month, Ms Sullivan doesn’t think she can afford it - so she'll remain in the ranks of Americans risking it, for yet another year.

Updated: January 6, 2019 03:19 PM

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