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Stacks Of Medical Bills Afflict The 'Underinsured'

By Richard Knox

Published September 28, 2009 5:01 PM

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Martha Martin of Durham, Maine, works three jobs and still can't keep up with her family's medical bills. She has medical insurance, but she and her husband can't make all of the payments. (Emilie Sommer for NPR)

More than 25 million Americans have Swiss-cheese health insurance: It's full of holes. Experts call them the "underinsured."

They're families like the Martins of Durham, Maine.

Between them, Jim and Martha Martin work five part-time jobs. Yet they still struggle every day with medical debts. The burden warps nearly every aspect of their lives.

On a typical day, Jim and Martha are up before dawn. That's when they talk about necessary stuff.

"We're both working so many jobs, about the only time we sit down together is at breakfast," Martha says. Jim adds: "There's not much time when I'm not at work."

As hard as they both work to make their modest income — about $45,000 a year — the medical bills pile up. Jim and Martha struggle all the time to figure out how to keep up.

Martha talks with her daughter Rebekah. Despite her mom's reassurance, Rebekah struggles with feeling guilty because of the cost of her medical bills.(Emilie Sommer for NPR)

Their daughters' bedrooms are right above the kitchen. So sometimes, 20-year-old Sarah and Rebekah, 14, can't help overhearing some of these early-morning conversations.

"You feel guilty, being their kid and kind of saying, 'Hey, I wish I could get money somewhere so I could help you out with that,' " Sarah says. "You feel guilty."

Some Insurance Isn't Enough

The Martins are basically healthy. But not long ago, Sara had to go to the emergency room — twice — for a locked jaw. She has health coverage through her college, but the insurer wouldn't pay for the visits.

And last year, Rebekah had to have a major operation. The bare-bones insurance policy Martha had at the time, through a part-time job at a local mail-order retailer, didn't pay for a lot of Rebekah's care.

Sitting in her home office, Martha pulls out a fat folder marked Medical Bills.

"We got a bill from the anesthesiologist," she says, riffling through the papers. "We got a bill from the hospital. We got a bill from the surgeon. We got a bill from the blood-work people. We got a bill for the ultrasound. You get to a point where you just feel like you're just a general feeling of overwhelmedness."

The Martins don't walk away from bills. They've set up payment plans with all the medical providers. It adds up to $400 a month — a substantial chunk of their income.

When Martha feels overwhelmed, Jim calms her down. For more than a decade, he's worked at a boatyard, building sleek kayaks and canoes. He makes $16 an hour.

But recently, the boatyard got new owners. And the company doesn't provide health insurance for part-timers. His insurance expired August 31.

Martha leaves the house to take an elderly client grocery shopping. One of her three jobs is providing home help for seniors.(Emilie Sommer for NPR)

Jim also works part-time at Walmart, but he's not eligible for insurance there yet.

Being without health insurance doesn't bother him too much, he says. To take his mind off problems, he gets outside. He's hiked most of New England's tallest peaks.

"My grandfather dropped dead at the age of 58, but he didn't take care of himself," he says. "And I like to think I'm doing things better, healthy-wise, than the generation before me. And maybe that's my insurance — is to stay active."

But what if he had an accident? "I don't know," he replies. "I do possess faith in God." He doesn't think too far ahead, he says. "It's just day to day, week to week, month to month."

The 'Magic Mom Wand' Can't Fix Everything

Around noon on one recent day, Martha gets into her blue minivan. She's on her way to one of her three part-time jobs — providing home help for elderly clients. She's spent the morning at an appointment with her daughter Rebekah.

The 14-year-old has been dealing with anxiety and depression. Her mother's been worried about the cost of counseling. But today, there's good news: A grant from the state of Maine provides free counseling for adolescents.

At the same time, Martha is upset by what the counselor had to say.

"The counselor told me one of Rebekah's major reasons for depression is because she feels like every time she has a medical issue, it generates a bill which she knows we can't pay," she says. "I don't remember as a 14-year-old even being aware that's there's bills that have to be paid. "

Martha says that she can keep her own problems in perspective, but says that it's harder when it comes to Rebekah. "You always want to wave your magic 'Mom wand,' and fairy dust comes out and it makes life, you know, easy for them," she says.

But she can't dwell on that. After helping an elderly client with shopping, she has to report for her job at the local supermarket. She's the helpful lady behind the deli counter who always has time to offer a free slice of cheese or bologna to little kids who are shopping with their moms.

She loves her customers. But she's 52, and after years in the food service business, these jobs are taking their toll. She has carpal tunnel syndrome, but can't afford to see a doctor about it.

"My hands hurt, my feet hurt. You know, I'm getting older," she says. "I'm finding that moving the slicers to clean under them and lifting the heavy things of meat [is hard]. And, you know, I took this [job] because it offered insurance."

Medical Costs Are Nearly Half Their Income

But the policy she has is very limited. It covers only her, not her family. And every time she needs care, she's left with more bills to pay.

After her supermarket shift, Martha goes back to her little house. It's bright pink — the exact color, she says, of Mary Kay cosmetics' Dusty Rose lipstick.

Martha is a Mary Kay "consultant," or saleswoman. That's another one of her part-time jobs. She painted her house pink so her customers could find it more easily. It sits at the end of a country lane.

Inside, there's an impressive collection of antique furniture and carefully displayed blue-patterned china that her parents spent a lifetime collecting. They died last year.

Martha has started selling some of these antiques to keep up with the bills. "You know, it is just stuff," she says. "It's emotional stuff, but it's just stuff and not as important as the people. But, um, once it's gone, it's gone and I can't get it back."

But Martha doesn't have much choice. More medical bills are coming. She needs to have a hysterectomy next month, and she says her insurance will pay only $1,000 of the hospital bill.

For the Martins, 2009 is starting to look a lot like 2008. Last year, they paid $6,210 in health insurance premiums for themselves and daughter Sarah, plus another $13,955 in uncovered hospital bills after Rebekah's surgery.

It added up to almost 45 percent of their total income of $44,815.

"Forty-five percent! That's just crazy! I don't pay that much in taxes," Martha exclaims. "So, you know, I just think there should be a health insurance plan out there that everyone can sign up for."

She'd be happy to pay the premiums, she says, if only she could get decent coverage.

Radio story produced by Rebecca Davis.

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RENEE MONTAGNE, host:

This is MORNING EDITION from NPR News. I'm Renee Montagne.

STEVE INSKEEP, host:

And I'm Steve Inskeep.

As Congress considers changes to the health care system, we've been taking a look at the health insurance we have now. Our series is called Are You Covered? And this morning we report on people who technically are covered but realistically are not. Up to 37 million people have coverage that's full of holes.

We have two reports this morning, starting with NPR's Richard Knox, with a family that is underinsured.

RICHARD KNOX: Jim and Martha Martin and their dog Abbey get up before the sun rises. By five A.M., Martha is already on fast-forward. She has a very busy life.

Ms. MARTHA MARTIN: We're both working so many jobs that about the only time we ever sit down together is at breakfast.

Mr. JIM MARTIN: There's not much time when I'm not at work.

KNOX: Breakfast is when they talk about money and bills, especially medical bills. Sometimes their daughters Sara and Rebekah overhear them.

Ms. MARTIN: I think the girls are sleeping and they hear what we talk about sometimes if they're awake.

KNOX: The girls' bedrooms are right above the kitchen. Nineteen-year-old Sara says she and Rebekah, who is 14, sometimes get upset by what they hear.

Ms. SARA MARTIN: You feel guilty being their kid and, you know, kind of saying, hey, I wish I could get money somewhere so that I could, you know, help you out with that. And you just, I don't know, you feel guilty.

KNOX: Martha says that hurts but she and Jim can't hide the fact that they're constantly struggling with medical bills. Even though they work five jobs between and have some health insurance, the bills pile up.

Just before seven, Jim heads off to work. Martha goes into her small home office. She pulls out a big fat folder marked "Medical bills."

Ms. M. MARTIN: Well, these are the places that I owe money to; bills that I owe that the insurance did not pay.

KNOX: The Martins are basically healthy, but last year, Rebekah had to have a major operation and her insurance policy was lousy.

Ms. M. MARTIN: We got a bill from the anesthesiologist. We got a bill from the hospital. We got a bill from the surgeon. We got a bill from the blood-work people. We got a bill for the ultrasound. You get to a point where you just feel like you're - just a general feeling of overwhelmedness.

KNOX: When Martha gets anxious, Jim calms her down. After 23 years of marriage, they've worked out their roles: she frets, he reassures; she makes phone calls to set up payment plans, he writes the checks.

(Soundbite of machinery)

KNOX: For more than a decade, Jim's worked at a boatyard, building sleek kayaks and canoes. He makes $16 an hour.

Mr. MARTIN: So, on the deck you can just cut that down the middle.

KNOX: But recently, the boatyard got new owners. They've cut his hours and the company doesn't provide health insurance for part-timers.

Mr. MARTIN: My insurance expired August 31st.

KNOX: Jim also works part-time at Wal-Mart, but he's not eligible for insurance there yet. He says being without insurance doesn't bother him too much. To take his mind off things, he gets outside and hikes up mountains.

Mr. MARTIN: My grandfather dropped dead at the age of 58, but he didn't take care of himself. And, you know, I like to think I'm doing things better, healthy-wise, than the generation before me. And maybe that's my insurance - is to stay active.

KNOX: So if you should have an accident, what would happen?

Mr. MARTIN: I don't know. I do possess faith in God and I don't get too caught up in the larger, you know, too far ahead. It's just day-to-day, week-to-week, month-to-month.

KNOX: Martha, on the other hand, worries about what they'd do if Jim got sick or hurt. Not only would they lose his income, but they wouldn't be able to pay the medical bills.

(Soundbite of a vehicle)

KNOX: Around noon, Martha gets into her blue minivan to go to one of her three part-time jobs, doing home help for the elderly. She's spent the morning at an appointment with her daughter, Rebekah.

Ms. M. MARTIN: Well, we just went and had our intake appointment to see the new counseling place. And they said...

KNOX: The 14-year-old has been dealing with anxiety and depression. Martha has been worried about the cost of counseling. But today she's got some good news.

Ms. M. MARTIN: Oh, my gosh. There's a grant - and a grant for children in Maine. And I was like, yes. So we get free counseling care.

KNOX: At the same time, it upset her to hear what the counselor had to say.

Ms. M. MARTIN: One of Rebekah's major reasons for depression is because she feels like every time she has a medical issue it generates a bill, which she knows we can't pay.

KNOX: Martha says it's hard to keep her perspective when it comes to Rebekah's problems.

Ms. M. MARTIN: 'Cause you always want to, you know, wave your magic Mom wand and fairy dust comes out, and it makes life easy for them.

KNOX: It's time for Martha's shift at the supermarket. She's the chipper lady behind the deli counter.

Ms. M. MARTIN: Can I help you find something...

KNOX: She's worked in food service for years.

Ms. M. MARTIN: Would you guys like a piece of cheese? Baloney?

KNOX: She loves her customers, but she's 52 and the job is taking a toll.

Ms. M. MARTIN: My hands hurt. My feet hurt. You know, I'm getting older. I'm finding that, you know, moving the slicers to clean under them and lifting the heavy things of meat... But I took this because it was - offered insurance.

KNOX: But the policy she has is very limited. It covers only her. And every time she needs care, she's left with a big share of the costs.

(Soundbite of a barking dog)

Ms. MARTIN: Abbey.

KNOX: After her shift, Martha goes comes back to her little house at the end of a country lane. It's bright pink.

Mrs. MARTIN: Oh, I do have a pink house.

KNOX: It's very cheerful. Is this the Mary Kay colors?

Mrs. MARTIN: Oh, well yeah, it's dusty rose lipstick.

KNOX: Mary Kay cosmetic consultant, that's another one of Martha's part-time jobs.

Mrs. KNOX: See originally, the idea was that my Mary Kay customers would be able to find me easier, because everybody, like, couldn't find the house.

KNOX: The little pink house holds a collection of antique furniture and blue patterned China that her parents spent a lifetime collecting. They died last year. Martha's started selling some of these antiques to keep up with the bills.

Mrs. MARTIN: And, you know, it is just stuff. I mean, it's emotional stuff, but it's just stuff and it's not as important as the people. But, once it's gone, it's, you know, gone and I can't get it back.

KNOX: But Martha doesn't have much choice. More medical bills are coming and she needs to have a hysterectomy next month. Insurance will pay only $1000 of the hospital bill. So for the Martins, 2009 is looking a lot like 2008.

Mrs. MARTIN: 45 percent of our income last year went for medical bills and health insurance premiums, 45 percent. That's just crazy. I mean I don't pay that much in taxes. So, you know, I just think there should be a health insurance plan out there that everybody can sign up for.

KNOX: Martha Martin says she'd be happy to pay the premiums if only she could get decent coverage.

Richard Knox, NPR News. Transcript provided by NPR, Copyright National Public Radio.

Source: NPR

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