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November 16, 2009
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Personal stories shared in hopes of health care reform

GLENWOOD SPRINGS, Colorado - Dana Marlatt and her husband Richard Backe considered themselves among the lucky ones.

They had private health insurance through Backe's construction company and were content. Better yet, they were healthy, and they didn't have to use it all that much.

So, about four years ago the Glenwood Springs couple decided to up their yearly deductibles and co-pays from $2,500 each to $7,500, in favor of a lower monthly premium to help make other household budgetary ends meet.

It's a decision many people who have health insurance make, especially if their family is relatively healthy and they feel they can assume the risk.

Then, nine months later, in October 2006, Marlatt was diagnosed with breast cancer.

"This is what can happen to lucky people," Backe said in a recent interview with the Post Independent.

"We thought we were healthy," Marlatt added. "We didn't anticipate anything happening like this."

Three years later, more than $60,000 in the hole - not to mention the emotional trauma associated with any life-threatening illness - they've become a case study for just how fast even someone who is responsible and plays by the rules of the health insurance game can be pushed to the brink of financial ruin.

To date since Marlatt's diagnosis, she and Backe have racked up about $45,000 in out-of-pocket expenses just associated with deductibles and co-pays, including a knee operation for Backe.

Ever-increasing premiums to keep their insurance have come to about $16,800 over the last four years.

"We can't shop insurance for a better deal now, because of the pre-existing condition exclusion," Backe said, referring to a common practice by insurance companies to deny coverage for medical conditions that existed before signing on to a policy.

On top of that was about $3,000 in miscellaneous uncovered medical expenses, plus another $20,000 in travel-related expenses for trips to and from hospitals in Denver and Vail over that same time.

That's more than $85,000 to date, with at least two more deductible years ahead, they figure, and countless more uncovered expenses.

It's a sum of money they acknowledge could easily push others over the brink into bankruptcy.

"At least we're paying our providers, and we haven't had to mortgage the house or go to collections - yet," Backe said. "But at some point we will not be able to afford any more medical expenses."

Especially if they reach the $2 million lifetime insurance expense cap spelled out in their plan. And, after nearly $700,000 in claims over the past three years, that could happen in less than five years, he estimates.

It's a situation another Glenwood Springs resident, Brad Gates, can relate to, although his story is a little different.

Diagnosed with scoliosis as a child, he faced a lifetime of frequent surgeries to correct a variety of related stomach and intestinal problems. He had worked full-time for a local engineering firm up until 1994 when he had to go on disability.

"I applied for permanent disability through the same company," he explained. "I was taking a prescription for my condition when I applied for temporary disability two years earlier. This was all disclosed in the application process.

"I was denied benefits because that made it a 'pre-existing condition,'" Gates said. "Legal recourse was useless."

He eventually signed on to his wife's insurance policy through her employer, and because of his disability also qualifies for some Medicare benefits, although he's only 51.

But the pre-existing condition still meant routine fights with insurance case managers over certain expenses. The bills piled up, as many expenses went uncovered or certain procedures were dropped along the way as he became "too expensive."

"My insurance company marginalized coverage in an effort to manage my care and lower their costs," Gates said. "My case manager from the insurance administration company asked me at one point if I had thought about Medicaid. Clear effort to get me off their policy."

Not only the case manager, but even one of the three lawyers Gates hired in the last 12 years to help him fight for claims at one point suggested he go on the government dole.

"Anyone with a life-long medical disability quickly learns you have two choices," Gates said. "Either divorce your spouse, divest all assets to family members, become indigent, and go on Medicaid.

"Or, you can do what I did," he said. "Keep your coverage and still spend all your money on health care.

"Take your kid's college fund to pay the hospitals. Make it so your spouse might never be able to retire in comfort ... take yourself from being comfortable, to being broke."

Gates said he thought he was doing the responsible thing. In retrospect, he wonders if he shouldn't have taken the lawyer's advice.

"People who know me know I'm not a deadbeat," he said.

"But this is why we need reform. It shouldn't be a better deal financially for disabled people to drop their existing coverage and go to Medicaid."

Gates, along with Marlatt and Backe, are among the growing number of people who are willing to expose their private stories, writing letters to members of Congress and the president in an effort to steer the health care reform debate.

"I have exposed very private information I normally wouldn't let out, because I believe reform is that important," Gates said. "We all need reform, even if you have coverage."

It's not a Democrat or Republican issue, said Backe, who describes himself as an independent voter.

"We understand that many of us have passionate views on this issue, but if we do nothing we are all going to be in serious trouble," Backe and Marlatt co-wrote in a recent letter to the editor.

"We need to make this a bipartisan issue," they wrote. "Both parties have good ideas, but neither are working together to accomplish what should be a common goal."

Backe said he understands concerns by political conservatives about the cost to taxpayers of implementing some of the reforms included in the bill that narrowly passed in the House earlier this month.

But, that cost pales in comparison to the health care costs now being passed along to those, like he and his wife, who have private insurance.

"As I see it we are paying for the uninsured now, and at a rate that is much higher than most health care," Backe said. "Those without health insurance are both in dire straits and a financial drag to the health care system. They need to be covered."

A "great bill," in his mind, would include: mandatory insurance for all, no lifetime caps on insurance, reduced medical costs, limited tort reform for litigation against medical providers, no pre-existing condition exclusions, a public option for the indigent, and limited medical care for illegal immigrants, another hot button issue for reform opponents.

"Either that, or we have to find a way for them to pay into the system," Backe said.

Gates says concerns about illegal immigrants gaining coverage at taxpayers' expense is a red herring.

"The truth is they're going to the emergency room now whenever a health problem arises, and they can't be turned away," he said. "It's the same as if you or I were in another country and had to go to the emergency room. That law is not going to change for anyone."

Gates said he has to stop himself when he finds he's getting too negative in his e-mails to politicians. But he feels he has to get his story out.

"A lot of people don't realize how valuable your health is," he said. "And the need for health care reform is just as important."

jstroud@postindependent.com


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The Post Independent Updated Nov 16, 2009 01:44AM Published Nov 16, 2009 01:39AM Copyright 2009 The Post Independent. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.