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CNN Sunday Morning
Weekend House Call
Aired October 05, 2003 - 08:29 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Good morning. Welcome to WEEKEND HOUSE CALL. Big topic today are you uninsured or do you know someone without health insurance? Odds are you do. Listen to this fact from "Families USA": 232 people lose their health insurance every hour, that's because they lost their job, got laid off, or can't afford it anymore. That's a crisis, a crisis of epidemic proportion in America. And according to the U.S. Census Bureau, it just got even worse, the number of people living without insurance rose by two-and-a-half million, that's the biggest increase in a decade. And as Jeff Flock reports, having a job even, doesn't guarantee coverage.
(BEGIN VIDEOTAPE)
GIL DAVIS, GOLF PRO: Hold. It hold it. Fix your feet.
JEFF FLOCK, CNN CORRESPONDENT (voice-over): Meet Gil Davis, 34 years old, full time job as golf pro.
DAVIS: Very good.
FLOCK: And, one of 43 million Americans without health insurance.
DAVIS: It just doesn't seem to make sense.
FLOCK: The downtown Chicago course where he works scaled back to a driving rage to make way for new condos, cutting staff and eliminating employee health care.
DAVIS: You can do COBRA, but you know that's really...
FLOCK: That's a lot of money, right?
DAVIS: ...a lot of money. It's a lot of money.
FLOCK: And you just flat out couldn't afford it.
DAVIS: Yeah, couldn't afford it.
FLOCK: One of 1.3 million people who the government says lost employer-sponsored health care in the U.S. last year. Now, just 60 percent of Americans get their insurance where they work.
DR. CLAUDIA FEGAN, PHYSICIANS NATL. HEALTH: People are really very angry and very frustrated. FLOCK: Claudia Fegan is a Medical director for one of the county clinics in Chicago that are bursting with people who don't have insurance and have nowhere else to go.
FEGAN: Increasingly, we're seeing people who never thought that they would have to come to a public clinic to get care, people who have professional jobs, but don't have health insurance.
FLOCK: The number of full-time workers without insurance jumped 897,000 last year to nearly 20 million. And, it figures to get worse.
AUSTIN GOOLSBEE, UNIVERSITY OF CHICAGO: The thing is, it's been a brutal two years for American business.
FLOCK: University of Chicago economics professor, Austin Goolsbee, says businesses are just passing along increased costs that they are paying.
GOOLSBEE: But, you've got thousands of businesses that are right on the margin of going under and they say, we can't cover those -- those kind of costs and remain competitive or, in many cases, even remain in business.
FLOCK: Like Gill Davis' golf course.
DAVIS: It's tough, especially for small businesses.
FLOCK: Davis understands, sort of.
DAVIS: You would think we could come up with something of all of the governmental programs that we have to provide health care for everybody.
FLOCK: Nothing in congress on universal health care, right now. But, with an election ahead and outrage brewing it may become enough of an emergency to make it a campaign issue.
I'm Jeff Flock, CNN in Chicago.
(END VIDEOTAPE)
GUPTA: All right. Thanks, Jeff. We're going to try and work through this now. Most Americans rely on employer for health coverage, so if you lost your job -- lost your job, you not only lost income, you probably also lost health benefits, as well. If you've been laid off, you're married and spouse works, your best bet is to enroll in your spouse's coverage. If you're single, your first option is to use COBRA, a federal law that allows you to continue the coverage that you had through our former employer, for up to 18 months. COBRA can be expensive, however, and that's a problem, because you're paying the premium yourself.
According to the Kaiser Family Foundation, only 20 percent of eligible people actually use COBRA, the other 80 percent buy on the individual market or go uninsured. We're going to talk about all of the other options out there, as well, including short-term insurance plans, qualifying for Medicare or Medicaid, state-run programs, and discount drug cards.
We also want to answer your questions, as always. Call us at 1- 800-807-2620, e-mail us at housecall@cnn.com.
Really important topic, today. Stay with us. Trudy Lieberman's going to help us work through it, as well. She the director of the Center for Consumer Health Choices and joins us New York.
Thanks for waking up with us this morning, Trudy.
TRUDY LIEBERMAN, CNTR. FOR CONSUMER HEALTH CHOICES: Thank you, it's a pleasure to be here.
GUPTA: You know, One thing that's always mystifying when we talk about the uninsured people who, sort of, characterize the uninsured who are the uninsured, who makes up the 44 million people? Can you help characterize those folks?
LIEBERMAN: I think the -- it's a common misconception the uninsured are people who don't have jobs and that are living on the street, and that's not the case at all. Most of the uninsured are hard-working Americans and they do not have coverage from their employers for various reasons. And, sometimes we even find that they might have coverage, but their family doesn't, because they can't afford to pay for the additional coverage.
GUPTA: We're going to get to some real specifics here, because it's a very complicated topic. We want to give people valuable information, so let's right to our first e-mail.
Tim from Texas asking, "Should I drop my COBRA insurance to take a chance that Medicaid will cover my medical expenses?"
And Trudy, as part of that, can you just -- we just talked about COBRA, but again, in a nutshell, just tell people what COBRA is.
LIEBERMAN: COBRA is a federal law that lets people continue on their employer's coverage, usually for 18 months, but in some cases it can be as long as 36 months and it's very important that people retain their COBRA coverage, even though it is really expensive and everybody who goes on it knows that, because if you don't use all of your COBRA coverage you no longer have a right to buy a policy in the individual market without having the health insurer look at your health problems.
GUPTA: OK. And, we're going through some specific numbers, as well.
Let's go straight to the phone lines, though, first. Valerie from South Carolina calling in.
Welcome to HOUSE CALL, Valerie.
VALERIE, SOUTH CAROLINA: Good morning, Sanjay. I am currently paying the COBRA fees and they are astronomical. As of December of 2003, my COBRA ends. I have extensive health problems I take eight prescriptions and have a pain pump up planted. And as of December, I mean, I have been turned down by so many insurance companies. I'm totally uninsurable. So, what is somebody supposed to do?
Real quick Valerie, how much is your premium COBRA?
VALERIE: It's 377 a month.
GUPTA: OK. Trudy, so her COBRA's about to run out, she was paying an astronomical fee, even when she did have it. Where does she go now?
LIEBERMAN: Well, under another federal law called HIPA, she has a right to buy what we call a guaranteed issue policy. That means the insurer has to issue you coverage regardless of how many health problems you have. But, you have to follow the rules, and one of the rules is that you have to use up all of your COBRA and then after that's exhausted in December, Valerie, it's a good idea that you shop for coverage right away because you have 63 days in which to buy a new policy under the HIPA regulations. So, you do have some options, but you have to just know the rules and act quickly.
GUPTA: So, within those 63 days, two months roughly, she's still covered by COBRA or she's just uninsured at that the point?
LIEBERMAN: Depends on what her employer's plan is. I think she needs to check with HR person.
GUPTA: All right. All right. I know there -- I know it is complicated and, you know, there's a lot of, sort of, little intricacies we're going try and work through.
Let's go back to the phone lines. Heading a little West now, Dale from Texas.
Welcome to HOUSE CALL, Dale.
DALE, TEXAS: Yes, good morning.
GUPTA: Good morning.
DALE: My question is, I work in the front of the house in a restaurant and I haven't had -- I've worked as a waiter, but never had, actually, coverage. My question is, how do you find coverage for a single person that -- because my coverage with my company's too expensive to afford. They're looking at anywhere from $65 taken out of my check, which is my whole check, beside tips that I collect? What insurance would I look into?
GUPTA: And Dale, let me just ask you a couple of questions to help us answer. How old are you, first of all?
DALE: I'm 33.
GUPTA: And, have you ever had health problems?
DALE: No.
GUPTA: A healthy, fairly young guy, Trudy. What does someone like Dale do?
LIEBERMAN: Well, he might have some options. First thing I would suggest is to check with the local Blue Cross or Blue Shield plan in your area. Often these organizations have a wide range of HMO insurance products for single people who are in the -- what we call the individual market. And, many of these have very good coverage at fairly low rates. So, that's the first place you should begin to look.
GUPTA: OK, let's go back to our e-mails, now. Kathy from Virginia has a e-mail question, it is: "A family member of mine recently had a heart attack at age 42. He worked fro a small company what does not provide health care coverage. He's uninsured and the medicine he needs is $300 per month. Just the medicine. Where can he go to get help with the cost of the medicine he must take?"
SO, a heart attack, fairly young, very expensive medication, what does he do?
LIEBERMAN: Well, that's a tough one. But, it's a question that many Americans are facing, right now. One thing he can do is look to see whether his state has any kind of pharmaceutical assistance program. Many of the states do, some of them have fairly low income limits, however. The other place he can look is for the drug assistance programs of the pharmaceutical companies. Now, most of the pharmaceutical companies do have programs for people who are having trouble paying for their drugs. Some of these, unfortunately, are kind of complicated to access, but a doctor or a nurse in your physician's office should be able to help you with that.
GUPTA: OK. One place people always go to try to get their care is the emergency room. We're going to talk about that. Many people think emergency rooms will handle the medical needs of everyone without insurance. That's coming up. We'll also tell you if that's a myth or a reality.
LIEBERMAN: Plus, we'll look at what some states are doing, specific states, to combat high health care costs. And, we'll answerer your questions, as always, 1-800-807-2620 or e-mail us at housecall@cnn.com.
Now, before we go to the break, check out our "Daily Dose Health Quiz": Which age group is most unlikely to have health insurance? That answer when WEEKEND HOUSE CALL continues.
(COMMERCIAL BREAK)
GUPTA: Checking our "Health Quiz" now, which age group is most unlikely to have health insurance? The answer, young adults age 18 to 24. Kids fresh out of college are the least likely to have insurance. They're usually dropped from their parents' policy when they graduate. Now, if a kid decides not to go to college, they're usually dropped from the parents' policy, as well.
This is WEEKEND HOUSE CALL, we're talking about being uninsured in America. Each year million of people with out insurance go to hospitals and specifically ERs for their medical care, but the majority of those visits are for non-urgent treatment. Trudy Lieberman is joining us, from the Consumer's Union, she's in New York.
Quick question about that, Trudy, is the emergency room the best place to go if you don't have insurance?
LIEBERMAN: No, it's not a good place to go at all. Emergency rooms are set up for people who have true emergencies they're not set up for people who have sore throats and colds and things like that. But, often the myth is that people can always get care because they can go to the emergency room. The reality is, emergency rooms don't provide preventive care, they don't help you with chronic care, such as diabetes or asthma and they don't really help you for specialty care. They often refer you on for that kind of care and most people can't afford it and have to end up at free clinics and wait for care there. So, emergency rooms are not the place to go.
GUPTA: We're going to hear a real-life story about that very thing. Now, Christy from Michigan is on the phone with us.
Welcome to HOUSE CALL, Christy.
CHRISTY, MICHIGAN: Yes, doctor, my question is I injured myself very severely a week ago and my only choice was to go to emergency. I have no insurance, no means of paying for this high expense. But I was left -- I'm in the cracks, I don't qualify for Medicare, I have no insurance. My job is being affected by this fall. What does a person like me do?
GUPTA: A couple of questions. First now, how old are you?
CHRISTY: I'm 62.
GUPTA: What sort of work do you do?
CHRISTY: I'm an assistant director of an art gallery.
GUPTA: OK. So Trudy, this is sort of a real-life example, now. So, she went to the emergency room, sounds like a legitimate emergency, she fell and hurt her knee. What does someone like her do?
LIEBERMAN: In Michigan there are many free clinics, I don't know where in Michigan she lives, but there are many places that are set up for people who have no health insurance and who need medical care, because I have visited many of them in that state. And, I would suggest that she begin to look for those clinics to help her through this period as she begins to recover from this injury.
GUPTA: OK, good. All right. Let's keep on the phone lines, here. A caller from Kentucky, I believe, is on the line. Welcome to HOUSE CALL.
OK.
UNIDENTIFIED FEMALE: Who's this? GUPTA: Go ahead. Are you there, ma'am? OK. I think we -- we got -- let's go to an e-mail. We'll get the phone lines back working again, here.
Jonathan from Florida asking, "If our family is uninsured, is it possible to negotiate with a hospital to lower our bill after a hospital stay?"
Judy, sort of the bartering system, here. He's got a family and wants to see if they can lower the bill, do you, sort of, bargain with the hospital, what can you do with that?
LIEBERMAN: Well, that goes on all the time. And I think hospitals have come to realize that that's how people who don't have insurance get their bills paid. And they are generally set up to help people work out payment plans for that very purpose. And hospitals also have what's known as a charity care budget. So, sometimes a family simply, simply can't pay and there's no way to provide the hospital with money, sometimes the hospital is willing to write off the debt. But, that is something that is down the line. They really do want people to try to make payments first and many people try to do that.
GUPTA: You know, Trudy, I was talking to a lot of my colleagues about this show today. And, the U.S. spends more money on health care than any other industrialized nation. Why is it that it's so difficult -- why are so many uninsured, here? Just from a, sort of, philosophical level?
LIEBERMAN: Well, we spend more money than any other country, something like 14 percent of GDP, which is far more than Canada or Germany spends and they're the next ones in line, but I think the money is just going for other things other than care of the uninsured. We spend money awful lot of money on administrative detail and chasing claims and on underwriting, which is the practice of screening out people from the system, because they have health problems. We also spend an enormous amount on advertising, and new technology. Sometimes without even proving whether or not it's effective for use.
GUPTA: Well, that really gets a lot of people steamed, there's no question. We're going to talk more about that, as well. But, let's go straight to our next e-mail, first.
Mark from Seattle writing, "I am currently employed by a small company and received no insurance benefits. I am single and one year out of college. Are there inexpensive plans I can purchase or programs I can participate in beyond the emergency insurance I already have?"
LIEBERMAN: Well, Mark can probably buy a pretty cheap policy on his own in the individual market, providing he is pretty healthy. The costs of that kind of insurance really should not be very onerous for somebody that young who is healthy. And I will caution people, even though many people in that age group are going uninsured because they do think they're young and healthy and never are going to get sick, many times people do. So, it's a good idea to get yourself covered some way.
GUPTA: All right. We're going to talk much more about health insurance, as well. What about health insurance for your child? That's a really important topic, as well. We'll go over some of the low cost options and there's always the last resort insurance, as well. We'll find out what that is, all of that ahead on WEEKEND HOUSE CALL.
(COMMERCIAL BREAK)
(NEWSBREAK)
(COMMERCIAL BREAK)
GUPTA: In June of this year, the Maine governor, John Baldacci, a democrat, signed a law that aims to provide health insurance by all state residents by 2009. The law will also try to rein in medical costs by establishing voluntary price caps for providers, hospitals, and insurers. Law makers in several states including: Maryland, Illinois, New Mexico, and Wisconsin conducting studies or drafting legislation to expand health coverage that could be considered as early as next year.
On another note, Ohio just launched a discount drug card program; it's opened to all Ohioans age 60 and over. Participants get a discount at pharmacies and there are even bigger savings on drugs by mail order.
What about health insurance for your children? This is a big topic. Children's health insurance programs or CHIP programs, they're called, are free in most states. States have different eligibility rules but in most cases uninsured children 18 and younger, whose families earn up to $34,100, a year for a family of four -- are eligible. To learn more about this program, go to www.insurekidsnow.gov or call 1-877-kids-now.
Important stuff. Trudy Lieberman joining us from the Consumer's Union. Lots of specific questions from viewers about insuring kids, specifically, especially when they make too much to qualify for those state programs.
GRIZELDA, MUNDELEIN, ILLINOIS: One of the e-mails is from Illinois, who writes, "Where can I get affordable insurance for my children? My husband is disabled. I work and can't afford to pay for my children's insurance; I applied for Kid Care and was denied because income is just too much. I'm making -- just making ends meet and living paycheck-to-paycheck."
So, this is a typical -- she makes too -- she makes too much to qualify, but still living paycheck-to-paycheck, how does she get health insurance for her kids?
LIEBERMAN: That's a real tough question. Unfortunately the SCHIP program in the states is based on income and it's reserved for people whom the states declare have the very lowest incomes. And, what this means is that people often have just a little bit too much money to qualify for the programs. The only thing I can suggest, in this case, is that she tries to find the cheapest possible coverage in the individual market and try the Blue Cross plans and the HMOs because that is where she's probably going to get the best rate. And, it doesn't cost a lot of money to insure children, because they're young and if they're healthy. She just, probably, doesn't need a lot of coverage. But, that's the first place that she should begin to look.
GUPTA: OK, those are some really good specific tips. Let's go to our phone lines again; I think we got them up and working.
Evelyn from Wisconsin, welcome to HOUSE CALL.
EVELYN, WISCONSIN: Thank you.
GUPTA: Good morning, what's your question?
EVELYN: Well, I just have more of a comment. I just turned 55, I received a letter from Blue Cross/Blue Shield that my premiums, because of my age, would be going up 40 percent. My monthly premium is $546.10.
GUPTA: That is a very interesting comment. And Trudy -- go ahead.
EVELYN: Well, and then, just at the same time, like the same day, we get a letter dated 30th of September, now this is still recent, that we no longer can go to the Beloit Hospital and clinic because they've discontinued the PHO with them and we have to now go to a different hospital and clinic in a different town if we have the insurance and if we pay the higher deductible.
GUPTA: So, Trudy, she's 55, her insurance goes up by 40 percent and she's no longer getting care at the hospital where she was getting care. Is this typical? Is this something that you see?
LIEBERMAN: Yes, this is happening all the time. People in this age group, particularly 55 to 65, before people are eligible for Medicare find themselves really in a tough situation, here. The premiums are going up because they're getting older and insurers always raise the rates as people get older. But, also because healthcare costs keep going up. And so, she -- 40 percent is really high, but she may find higher increases as she goes on and there really isn't many things that she can do except try to hang on to the coverage.
GUPTA: So, the problem is bad, but it could be worse, essentially. Hopefully this isn't going to be entirely bleak information. We'll try and get some good information, positive stuff, as well. Let's go straight to our next e-mail.
Randy from Utah can't find insurance for his teenager. He writes, for 10 years, he's been successfully self-employed. In spite of his best efforts, he has no hope for insurance on his 19 year-old- son who had a kidney transplant. What are suggestions on finding insurance? So, his son is 19, no longer theoretically a kid, he's a -- you know, over 18, right?
LIEBERMAN: But, the 19-year-old is probably not insurable because of his health condition. But, in the state of Utah, there is what's called a high-risk pool. Some 29 states have these high-risk pools and work very much like a high-risk pool does for bad drivers. I think all of your viewers can relate to risk pools for bad drivers. But, in this case it's for people who have health problems that insurance companies don't want to deal with. So, my suggestion would be to contact the State Insurance Department in Utah and find out how to get on the waiting list, if there is a waiting list, or how to get coverage from the high-risk pool. And, mind you, the premiums are going to be high, but it is a place where you can get coverage.
GUPTA: Sort of a last resort-type insurance. That's a good tip, as well. We're going to take a quick break, here. Now, everyone at home grab some pen and paper. We're going to give you some websites and phone numbers to help in your insurance search. This is going to be important information, please write this down. You are watching WEEKEND HOUSE CALL.
(COMMERCIAL BREAK)
GUPTA: For detailed information on insurance coverage available in your state, go to www.healthinsuranceinfo.net. You can also get a transcript of this program, today, by going to cnn.com/transcripts.
Lots of important information came out today, it's a bleak situation, but there are ways to navigate through it. Trudy Lieberman's been our guest.
Thank you very much for waking up with us this morning on WEEKEND HOUSE CALL.
Do you have any last thoughts?
LIEBERMAN: One thought is that any one of us could be in the situation that our callers were in today and we need some better way to pay for health care for all Americans.
GUPTA: All right. That's good advice. Maybe over the next couple of years with the elections, it's going to be a hot issue. A lot of people, a little more informed, today.
Thank you very much, Trudy.
LIEBERMAN: Thank you.
GUPTA: And, I want to thank your viewers, as well, for calling in. You're a big part of the show. You're calls and your e-mails mean a lot to us. Remember, this is place for answers to your medical questions. Thanks for watching. I'm Dr. Sanjay Gupta. "CNN Sunday Morning" continues, now.
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Aired October 5, 2003 - 08:29 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Good morning. Welcome to WEEKEND HOUSE CALL. Big topic today are you uninsured or do you know someone without health insurance? Odds are you do. Listen to this fact from "Families USA": 232 people lose their health insurance every hour, that's because they lost their job, got laid off, or can't afford it anymore. That's a crisis, a crisis of epidemic proportion in America. And according to the U.S. Census Bureau, it just got even worse, the number of people living without insurance rose by two-and-a-half million, that's the biggest increase in a decade. And as Jeff Flock reports, having a job even, doesn't guarantee coverage.
(BEGIN VIDEOTAPE)
GIL DAVIS, GOLF PRO: Hold. It hold it. Fix your feet.
JEFF FLOCK, CNN CORRESPONDENT (voice-over): Meet Gil Davis, 34 years old, full time job as golf pro.
DAVIS: Very good.
FLOCK: And, one of 43 million Americans without health insurance.
DAVIS: It just doesn't seem to make sense.
FLOCK: The downtown Chicago course where he works scaled back to a driving rage to make way for new condos, cutting staff and eliminating employee health care.
DAVIS: You can do COBRA, but you know that's really...
FLOCK: That's a lot of money, right?
DAVIS: ...a lot of money. It's a lot of money.
FLOCK: And you just flat out couldn't afford it.
DAVIS: Yeah, couldn't afford it.
FLOCK: One of 1.3 million people who the government says lost employer-sponsored health care in the U.S. last year. Now, just 60 percent of Americans get their insurance where they work.
DR. CLAUDIA FEGAN, PHYSICIANS NATL. HEALTH: People are really very angry and very frustrated. FLOCK: Claudia Fegan is a Medical director for one of the county clinics in Chicago that are bursting with people who don't have insurance and have nowhere else to go.
FEGAN: Increasingly, we're seeing people who never thought that they would have to come to a public clinic to get care, people who have professional jobs, but don't have health insurance.
FLOCK: The number of full-time workers without insurance jumped 897,000 last year to nearly 20 million. And, it figures to get worse.
AUSTIN GOOLSBEE, UNIVERSITY OF CHICAGO: The thing is, it's been a brutal two years for American business.
FLOCK: University of Chicago economics professor, Austin Goolsbee, says businesses are just passing along increased costs that they are paying.
GOOLSBEE: But, you've got thousands of businesses that are right on the margin of going under and they say, we can't cover those -- those kind of costs and remain competitive or, in many cases, even remain in business.
FLOCK: Like Gill Davis' golf course.
DAVIS: It's tough, especially for small businesses.
FLOCK: Davis understands, sort of.
DAVIS: You would think we could come up with something of all of the governmental programs that we have to provide health care for everybody.
FLOCK: Nothing in congress on universal health care, right now. But, with an election ahead and outrage brewing it may become enough of an emergency to make it a campaign issue.
I'm Jeff Flock, CNN in Chicago.
(END VIDEOTAPE)
GUPTA: All right. Thanks, Jeff. We're going to try and work through this now. Most Americans rely on employer for health coverage, so if you lost your job -- lost your job, you not only lost income, you probably also lost health benefits, as well. If you've been laid off, you're married and spouse works, your best bet is to enroll in your spouse's coverage. If you're single, your first option is to use COBRA, a federal law that allows you to continue the coverage that you had through our former employer, for up to 18 months. COBRA can be expensive, however, and that's a problem, because you're paying the premium yourself.
According to the Kaiser Family Foundation, only 20 percent of eligible people actually use COBRA, the other 80 percent buy on the individual market or go uninsured. We're going to talk about all of the other options out there, as well, including short-term insurance plans, qualifying for Medicare or Medicaid, state-run programs, and discount drug cards.
We also want to answer your questions, as always. Call us at 1- 800-807-2620, e-mail us at housecall@cnn.com.
Really important topic, today. Stay with us. Trudy Lieberman's going to help us work through it, as well. She the director of the Center for Consumer Health Choices and joins us New York.
Thanks for waking up with us this morning, Trudy.
TRUDY LIEBERMAN, CNTR. FOR CONSUMER HEALTH CHOICES: Thank you, it's a pleasure to be here.
GUPTA: You know, One thing that's always mystifying when we talk about the uninsured people who, sort of, characterize the uninsured who are the uninsured, who makes up the 44 million people? Can you help characterize those folks?
LIEBERMAN: I think the -- it's a common misconception the uninsured are people who don't have jobs and that are living on the street, and that's not the case at all. Most of the uninsured are hard-working Americans and they do not have coverage from their employers for various reasons. And, sometimes we even find that they might have coverage, but their family doesn't, because they can't afford to pay for the additional coverage.
GUPTA: We're going to get to some real specifics here, because it's a very complicated topic. We want to give people valuable information, so let's right to our first e-mail.
Tim from Texas asking, "Should I drop my COBRA insurance to take a chance that Medicaid will cover my medical expenses?"
And Trudy, as part of that, can you just -- we just talked about COBRA, but again, in a nutshell, just tell people what COBRA is.
LIEBERMAN: COBRA is a federal law that lets people continue on their employer's coverage, usually for 18 months, but in some cases it can be as long as 36 months and it's very important that people retain their COBRA coverage, even though it is really expensive and everybody who goes on it knows that, because if you don't use all of your COBRA coverage you no longer have a right to buy a policy in the individual market without having the health insurer look at your health problems.
GUPTA: OK. And, we're going through some specific numbers, as well.
Let's go straight to the phone lines, though, first. Valerie from South Carolina calling in.
Welcome to HOUSE CALL, Valerie.
VALERIE, SOUTH CAROLINA: Good morning, Sanjay. I am currently paying the COBRA fees and they are astronomical. As of December of 2003, my COBRA ends. I have extensive health problems I take eight prescriptions and have a pain pump up planted. And as of December, I mean, I have been turned down by so many insurance companies. I'm totally uninsurable. So, what is somebody supposed to do?
Real quick Valerie, how much is your premium COBRA?
VALERIE: It's 377 a month.
GUPTA: OK. Trudy, so her COBRA's about to run out, she was paying an astronomical fee, even when she did have it. Where does she go now?
LIEBERMAN: Well, under another federal law called HIPA, she has a right to buy what we call a guaranteed issue policy. That means the insurer has to issue you coverage regardless of how many health problems you have. But, you have to follow the rules, and one of the rules is that you have to use up all of your COBRA and then after that's exhausted in December, Valerie, it's a good idea that you shop for coverage right away because you have 63 days in which to buy a new policy under the HIPA regulations. So, you do have some options, but you have to just know the rules and act quickly.
GUPTA: So, within those 63 days, two months roughly, she's still covered by COBRA or she's just uninsured at that the point?
LIEBERMAN: Depends on what her employer's plan is. I think she needs to check with HR person.
GUPTA: All right. All right. I know there -- I know it is complicated and, you know, there's a lot of, sort of, little intricacies we're going try and work through.
Let's go back to the phone lines. Heading a little West now, Dale from Texas.
Welcome to HOUSE CALL, Dale.
DALE, TEXAS: Yes, good morning.
GUPTA: Good morning.
DALE: My question is, I work in the front of the house in a restaurant and I haven't had -- I've worked as a waiter, but never had, actually, coverage. My question is, how do you find coverage for a single person that -- because my coverage with my company's too expensive to afford. They're looking at anywhere from $65 taken out of my check, which is my whole check, beside tips that I collect? What insurance would I look into?
GUPTA: And Dale, let me just ask you a couple of questions to help us answer. How old are you, first of all?
DALE: I'm 33.
GUPTA: And, have you ever had health problems?
DALE: No.
GUPTA: A healthy, fairly young guy, Trudy. What does someone like Dale do?
LIEBERMAN: Well, he might have some options. First thing I would suggest is to check with the local Blue Cross or Blue Shield plan in your area. Often these organizations have a wide range of HMO insurance products for single people who are in the -- what we call the individual market. And, many of these have very good coverage at fairly low rates. So, that's the first place you should begin to look.
GUPTA: OK, let's go back to our e-mails, now. Kathy from Virginia has a e-mail question, it is: "A family member of mine recently had a heart attack at age 42. He worked fro a small company what does not provide health care coverage. He's uninsured and the medicine he needs is $300 per month. Just the medicine. Where can he go to get help with the cost of the medicine he must take?"
SO, a heart attack, fairly young, very expensive medication, what does he do?
LIEBERMAN: Well, that's a tough one. But, it's a question that many Americans are facing, right now. One thing he can do is look to see whether his state has any kind of pharmaceutical assistance program. Many of the states do, some of them have fairly low income limits, however. The other place he can look is for the drug assistance programs of the pharmaceutical companies. Now, most of the pharmaceutical companies do have programs for people who are having trouble paying for their drugs. Some of these, unfortunately, are kind of complicated to access, but a doctor or a nurse in your physician's office should be able to help you with that.
GUPTA: OK. One place people always go to try to get their care is the emergency room. We're going to talk about that. Many people think emergency rooms will handle the medical needs of everyone without insurance. That's coming up. We'll also tell you if that's a myth or a reality.
LIEBERMAN: Plus, we'll look at what some states are doing, specific states, to combat high health care costs. And, we'll answerer your questions, as always, 1-800-807-2620 or e-mail us at housecall@cnn.com.
Now, before we go to the break, check out our "Daily Dose Health Quiz": Which age group is most unlikely to have health insurance? That answer when WEEKEND HOUSE CALL continues.
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GUPTA: Checking our "Health Quiz" now, which age group is most unlikely to have health insurance? The answer, young adults age 18 to 24. Kids fresh out of college are the least likely to have insurance. They're usually dropped from their parents' policy when they graduate. Now, if a kid decides not to go to college, they're usually dropped from the parents' policy, as well.
This is WEEKEND HOUSE CALL, we're talking about being uninsured in America. Each year million of people with out insurance go to hospitals and specifically ERs for their medical care, but the majority of those visits are for non-urgent treatment. Trudy Lieberman is joining us, from the Consumer's Union, she's in New York.
Quick question about that, Trudy, is the emergency room the best place to go if you don't have insurance?
LIEBERMAN: No, it's not a good place to go at all. Emergency rooms are set up for people who have true emergencies they're not set up for people who have sore throats and colds and things like that. But, often the myth is that people can always get care because they can go to the emergency room. The reality is, emergency rooms don't provide preventive care, they don't help you with chronic care, such as diabetes or asthma and they don't really help you for specialty care. They often refer you on for that kind of care and most people can't afford it and have to end up at free clinics and wait for care there. So, emergency rooms are not the place to go.
GUPTA: We're going to hear a real-life story about that very thing. Now, Christy from Michigan is on the phone with us.
Welcome to HOUSE CALL, Christy.
CHRISTY, MICHIGAN: Yes, doctor, my question is I injured myself very severely a week ago and my only choice was to go to emergency. I have no insurance, no means of paying for this high expense. But I was left -- I'm in the cracks, I don't qualify for Medicare, I have no insurance. My job is being affected by this fall. What does a person like me do?
GUPTA: A couple of questions. First now, how old are you?
CHRISTY: I'm 62.
GUPTA: What sort of work do you do?
CHRISTY: I'm an assistant director of an art gallery.
GUPTA: OK. So Trudy, this is sort of a real-life example, now. So, she went to the emergency room, sounds like a legitimate emergency, she fell and hurt her knee. What does someone like her do?
LIEBERMAN: In Michigan there are many free clinics, I don't know where in Michigan she lives, but there are many places that are set up for people who have no health insurance and who need medical care, because I have visited many of them in that state. And, I would suggest that she begin to look for those clinics to help her through this period as she begins to recover from this injury.
GUPTA: OK, good. All right. Let's keep on the phone lines, here. A caller from Kentucky, I believe, is on the line. Welcome to HOUSE CALL.
OK.
UNIDENTIFIED FEMALE: Who's this? GUPTA: Go ahead. Are you there, ma'am? OK. I think we -- we got -- let's go to an e-mail. We'll get the phone lines back working again, here.
Jonathan from Florida asking, "If our family is uninsured, is it possible to negotiate with a hospital to lower our bill after a hospital stay?"
Judy, sort of the bartering system, here. He's got a family and wants to see if they can lower the bill, do you, sort of, bargain with the hospital, what can you do with that?
LIEBERMAN: Well, that goes on all the time. And I think hospitals have come to realize that that's how people who don't have insurance get their bills paid. And they are generally set up to help people work out payment plans for that very purpose. And hospitals also have what's known as a charity care budget. So, sometimes a family simply, simply can't pay and there's no way to provide the hospital with money, sometimes the hospital is willing to write off the debt. But, that is something that is down the line. They really do want people to try to make payments first and many people try to do that.
GUPTA: You know, Trudy, I was talking to a lot of my colleagues about this show today. And, the U.S. spends more money on health care than any other industrialized nation. Why is it that it's so difficult -- why are so many uninsured, here? Just from a, sort of, philosophical level?
LIEBERMAN: Well, we spend more money than any other country, something like 14 percent of GDP, which is far more than Canada or Germany spends and they're the next ones in line, but I think the money is just going for other things other than care of the uninsured. We spend money awful lot of money on administrative detail and chasing claims and on underwriting, which is the practice of screening out people from the system, because they have health problems. We also spend an enormous amount on advertising, and new technology. Sometimes without even proving whether or not it's effective for use.
GUPTA: Well, that really gets a lot of people steamed, there's no question. We're going to talk more about that, as well. But, let's go straight to our next e-mail, first.
Mark from Seattle writing, "I am currently employed by a small company and received no insurance benefits. I am single and one year out of college. Are there inexpensive plans I can purchase or programs I can participate in beyond the emergency insurance I already have?"
LIEBERMAN: Well, Mark can probably buy a pretty cheap policy on his own in the individual market, providing he is pretty healthy. The costs of that kind of insurance really should not be very onerous for somebody that young who is healthy. And I will caution people, even though many people in that age group are going uninsured because they do think they're young and healthy and never are going to get sick, many times people do. So, it's a good idea to get yourself covered some way.
GUPTA: All right. We're going to talk much more about health insurance, as well. What about health insurance for your child? That's a really important topic, as well. We'll go over some of the low cost options and there's always the last resort insurance, as well. We'll find out what that is, all of that ahead on WEEKEND HOUSE CALL.
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GUPTA: In June of this year, the Maine governor, John Baldacci, a democrat, signed a law that aims to provide health insurance by all state residents by 2009. The law will also try to rein in medical costs by establishing voluntary price caps for providers, hospitals, and insurers. Law makers in several states including: Maryland, Illinois, New Mexico, and Wisconsin conducting studies or drafting legislation to expand health coverage that could be considered as early as next year.
On another note, Ohio just launched a discount drug card program; it's opened to all Ohioans age 60 and over. Participants get a discount at pharmacies and there are even bigger savings on drugs by mail order.
What about health insurance for your children? This is a big topic. Children's health insurance programs or CHIP programs, they're called, are free in most states. States have different eligibility rules but in most cases uninsured children 18 and younger, whose families earn up to $34,100, a year for a family of four -- are eligible. To learn more about this program, go to www.insurekidsnow.gov or call 1-877-kids-now.
Important stuff. Trudy Lieberman joining us from the Consumer's Union. Lots of specific questions from viewers about insuring kids, specifically, especially when they make too much to qualify for those state programs.
GRIZELDA, MUNDELEIN, ILLINOIS: One of the e-mails is from Illinois, who writes, "Where can I get affordable insurance for my children? My husband is disabled. I work and can't afford to pay for my children's insurance; I applied for Kid Care and was denied because income is just too much. I'm making -- just making ends meet and living paycheck-to-paycheck."
So, this is a typical -- she makes too -- she makes too much to qualify, but still living paycheck-to-paycheck, how does she get health insurance for her kids?
LIEBERMAN: That's a real tough question. Unfortunately the SCHIP program in the states is based on income and it's reserved for people whom the states declare have the very lowest incomes. And, what this means is that people often have just a little bit too much money to qualify for the programs. The only thing I can suggest, in this case, is that she tries to find the cheapest possible coverage in the individual market and try the Blue Cross plans and the HMOs because that is where she's probably going to get the best rate. And, it doesn't cost a lot of money to insure children, because they're young and if they're healthy. She just, probably, doesn't need a lot of coverage. But, that's the first place that she should begin to look.
GUPTA: OK, those are some really good specific tips. Let's go to our phone lines again; I think we got them up and working.
Evelyn from Wisconsin, welcome to HOUSE CALL.
EVELYN, WISCONSIN: Thank you.
GUPTA: Good morning, what's your question?
EVELYN: Well, I just have more of a comment. I just turned 55, I received a letter from Blue Cross/Blue Shield that my premiums, because of my age, would be going up 40 percent. My monthly premium is $546.10.
GUPTA: That is a very interesting comment. And Trudy -- go ahead.
EVELYN: Well, and then, just at the same time, like the same day, we get a letter dated 30th of September, now this is still recent, that we no longer can go to the Beloit Hospital and clinic because they've discontinued the PHO with them and we have to now go to a different hospital and clinic in a different town if we have the insurance and if we pay the higher deductible.
GUPTA: So, Trudy, she's 55, her insurance goes up by 40 percent and she's no longer getting care at the hospital where she was getting care. Is this typical? Is this something that you see?
LIEBERMAN: Yes, this is happening all the time. People in this age group, particularly 55 to 65, before people are eligible for Medicare find themselves really in a tough situation, here. The premiums are going up because they're getting older and insurers always raise the rates as people get older. But, also because healthcare costs keep going up. And so, she -- 40 percent is really high, but she may find higher increases as she goes on and there really isn't many things that she can do except try to hang on to the coverage.
GUPTA: So, the problem is bad, but it could be worse, essentially. Hopefully this isn't going to be entirely bleak information. We'll try and get some good information, positive stuff, as well. Let's go straight to our next e-mail.
Randy from Utah can't find insurance for his teenager. He writes, for 10 years, he's been successfully self-employed. In spite of his best efforts, he has no hope for insurance on his 19 year-old- son who had a kidney transplant. What are suggestions on finding insurance? So, his son is 19, no longer theoretically a kid, he's a -- you know, over 18, right?
LIEBERMAN: But, the 19-year-old is probably not insurable because of his health condition. But, in the state of Utah, there is what's called a high-risk pool. Some 29 states have these high-risk pools and work very much like a high-risk pool does for bad drivers. I think all of your viewers can relate to risk pools for bad drivers. But, in this case it's for people who have health problems that insurance companies don't want to deal with. So, my suggestion would be to contact the State Insurance Department in Utah and find out how to get on the waiting list, if there is a waiting list, or how to get coverage from the high-risk pool. And, mind you, the premiums are going to be high, but it is a place where you can get coverage.
GUPTA: Sort of a last resort-type insurance. That's a good tip, as well. We're going to take a quick break, here. Now, everyone at home grab some pen and paper. We're going to give you some websites and phone numbers to help in your insurance search. This is going to be important information, please write this down. You are watching WEEKEND HOUSE CALL.
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GUPTA: For detailed information on insurance coverage available in your state, go to www.healthinsuranceinfo.net. You can also get a transcript of this program, today, by going to cnn.com/transcripts.
Lots of important information came out today, it's a bleak situation, but there are ways to navigate through it. Trudy Lieberman's been our guest.
Thank you very much for waking up with us this morning on WEEKEND HOUSE CALL.
Do you have any last thoughts?
LIEBERMAN: One thought is that any one of us could be in the situation that our callers were in today and we need some better way to pay for health care for all Americans.
GUPTA: All right. That's good advice. Maybe over the next couple of years with the elections, it's going to be a hot issue. A lot of people, a little more informed, today.
Thank you very much, Trudy.
LIEBERMAN: Thank you.
GUPTA: And, I want to thank your viewers, as well, for calling in. You're a big part of the show. You're calls and your e-mails mean a lot to us. Remember, this is place for answers to your medical questions. Thanks for watching. I'm Dr. Sanjay Gupta. "CNN Sunday Morning" continues, now.
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