Using results from a questionnaire we did with American Public Media’s Public Insight Network, we’re looking at how the proposed health care reforms will actually affect people facing common health care coverage situations. See our previous posts on what health care reform means for the uninsured, small businesses, and those enrolled in Medicare programs.

Mary and Mack Kroner

Age: 53, 57 Location: Austin, Texas Work Status: Employed Health Care Status: Underinsured with a high deductible Income: Combined $50,000 per year

Their story:

Mack is a self-employed cab driver and Mary is a self-employed writer; they both pay for their own health insurance. Though together they pay about $600 a month in premiums, they have what Mary Kroner calls "junk insurance."

Rapidly rising premiums have forced them to increase their deductible every year, and now they have a policy with a $5,000 deductible per illness per year. That means that they've been paying essentially all their health care costs out of pocket. Mary pays $100 for her annual mammogram -- a must because her sister had breast cancer -- but she skips recommended pelvic exams. A recent colonoscopy recommended for Mack after he showed signs of bowel cancer cost them $1,376, roughly half their monthly income.

"We just bite the bullet and don't attend to things because we can't afford it," Mary said.

What health care reform means for them...

Nov. 17: This post has been updated.

Using results from a questionnaire we did with American Public Media’s Public Insight Network, we’re looking at how the proposed health care reforms will actually affect people facing common health care coverage situations. This is the third in a series (Part 1, Part 2).

Graydon DeCamp

Age: 75 Location: Elk Rapids, Michigan Work status: Retired Income: About $75,000, including SSI

Medicare Advantage has been a major flash point in the health care reform debate, giving fodder to opponents of reform who say that Medicare would be cut to pay for the proposals. Our analysis of the impact of reforms on one very satisfied Medicare Advantage member finds the changes would be a loss for many seniors, but a win for taxpayers.

About Medicare Advantage: The elderly can participate either in traditional Medicare, which is administered by the government, or in Medicare Advantage, which subsidizes managed care plans administered by private insurance companies.

What health care reform could mean for Graydon Decamp...

Using results from a questionnaire we did with American Public Media’s Public Insight Network, we’re looking at how the proposed health care reforms will actually affect people facing common health care coverage situations. This is the second in a series (Part 1).

Fairfield Lighting and Design, Office Manager Barbara D’Agostino

Location: Fairfield, Conn. Employees: 12 (10 receiving health insurance) Sales: $2 million annually Payroll: $384,000 annually

Their story:

Fairfield Lighting and Design has been in business since 1972, but it is struggling to cope with tough economic times. It has 12 employees, whose average wage is about $20 an hour. Because of the recession, opportunities to work overtime have dwindled, and the regular hours of some employees have been cut.

The recession has also made it difficult to keep paying their health care costs: Fairfield offers health insurance to 10 of its employees, at a company cost of $550 per employee each month.

The costs to each employee are relatively low. They pay only 20 percent of the premium, or $110 per month. Their co-payments are $15 to see a doctor or $500 for a hospital, and medications cost them $15, $25 or $50, depending on the type of drug.

But that could change. Fairfield Lighting and Design was recently notified that its coverage will be taken over by a new company, probably around the beginning of the year.

“Hopefully when this whole thing goes through maybe we can find something less expensive,” D’Agostino said. “Otherwise the employees may have to contribute a bit more.”

What health care reform would mean for them...

Using results from a questionnaire we did with American Public Media’s Public Insight Network, we’re looking at how the proposed health care reforms will actually affect people facing common health care coverage situations. This is the first in a series.

Anne Johnson, 41

Location: Corona, Calif. Work Status: Unemployed Income: $0

Her story:

Anne Johnson lost coverage for herself and her 18-year-old son in February when she lost her job as a secretary at a solar energy company, where she was earning about $25,000 per year.

Shortly before she was laid off, a cardiologist told her she needs her aortic valve replaced, but without insurance she can’t afford the surgery. She is supposed to get checkups every six months, but that is also too expensive – so she has put them off. Her last visit to the cardiologist was in January, so she is already three months overdue.

"Right now I have no idea what type of condition I'm in," Johnson said.

What health care reform would mean for her:

Johnson’s son may already qualify for Medi-Cal, the state’s Medicaid program, which covers low-income children if they do not have private insurance, because her son is under age 21. (We let Johnson know that her son may be eligible.)

But if she gets a job that pays roughly the same as she earned before but does not provide health insurance, he would most likely lose his Medi-Cal coverage.

Read more ...