One of the reasons Americans seem so willing to tolerate the fact that close to 50 million of us are uninsured and 29 million more of us are underinsured is that most of us who have coverage assume we are OK. That nothing truly catastrophic will happen to us, and that, even if it did, our insurance policies will pay our bills and keep us whole.
Who would think that a decision to go see a movie on a Friday morning could change our lives -- and the lives of our families -- forever? That we or a loved one, even with what we believed was decent coverage, might become a victim of violence that could leave us not only disabled for life but also potentially bankrupt and homeless?
That random act of violence in Aurora, Colorado earlier this month could have happened anywhere in America, of course -- or in any other country, for that matter -- but among the world's developed nations, we live in the only one where the families of some of the injured would have to face begging for money to pay the doctors and hospitals and keep the sheriff and his foreclosure papers at bay. Talk about American exceptionalism. This is one area where, sadly, we truly are unique.
News reports informed us last week that three of the five hospitals where the victims were taken have said they will absorb most, if not all, of the cost of their care if they don't have insurance. But who will pay for the care they'll need after they're discharged? And who will pay the medical bills of those who were unlucky enough to be taken to a hospital that decides not to be so generous? And what about those who have policies with such limited benefits or high deductibles they might actually wind up in worse shape than those who are uninsured? Having any type of insurance, even if it's essentially worthless, can disqualify a patient from charity care.
Twelve people were killed and 58 wounded in that shooting at the Century Aurora 16 theater complex on July 20. While some have been released, others are still fighting for their lives in hospitals. And many of them will likely be fighting to stay afloat financially after they're discharged. According to the Colorado Trust, a philanthropic advocacy organization, almost one in three Coloradans are either uninsured or underinsured. The longer those victims stay in the hospital, the greater the chances that they will be facing a mountain of debt when they're discharged -- even those with insurance.
A 2007 study published in the American Journal of Medicine found that 62.1 percent of all bankruptcies in the United States were the result of medical debt, up from just eight percent as recently as 1981. One of the most surprising findings: less than a fourth of the debtors who filed for bankruptcy were uninsured.
"Most medical debtors were well educated, owned homes, and had middle-class occupations," the researchers wrote. "Three quarters had health insurance."
The problem is that more and more of us are finding ourselves in the ranks of the underinsured. The Commonwealth Fund reported last year that the number of underinsured adults is skyrocketing, rising by 80 percent between 2003 and 2010, to more than 29 million.
The Commonwealth Fund researchers said that number should begin to go down once the Affordable Care Act is fully implemented in 2014. That's because the law sets limits on how much individuals and families will have to spend out of their own pockets for care and because it will outlaw the so-called mini-med plans that consumer advocates call junk insurance. Starting in 2012, all policies will have to include a minimum level of benefits that vastly outstrips those mini-meds.
At least that's what Congress intended. As you can imagine, the nation's insurers want to keep selling junk insurance because it's considerably more profitable than comprehensive coverage. One of the key goals of America's Health Insurance Plans, the big PR and lobbying group for the industry, is to make sure that the minimum level of benefits, which will be determined by the Department of Health and Human Services and the states, is so minimal that many more millions of us will become underinsured and at risk for bankruptcy.
Insurers are not putting it that way, of course. Instead, their lobbyists are telling lawmakers on Capitol Hill they should get rid of the parts of the law that would ban inadequate coverage because, unless they don't, insurance will become "less affordable" for many people, especially young people who are the target market for mini-meds.
I'd be willing to bet that some of the young people who went to see a midnight movie in Aurora, Colorado, a couple of Friday nights ago were paying good money for inadequate coverage. For policies that insurers dearly want to keep selling but that will be of little if any help to those shooting victims as the bills start rolling in and the creditors start calling.