By Kathleen Sebelius
March 17, 2010
If you want to understand why we need to reform our health insurance system, you need to know about Americans like Natoma Canfield. Natoma is a 50-year-old cancer survivor from Medina, Ohio, who wrote to President Obama last December. Like a growing number of Americans, she's self-employed and can't get health insurance through her job. But until this January, she always made sure to maintain a policy for herself on the individual market. It was the responsible thing to do.
Her insurance company didn't make it easy for her. Year after year, she'd pay higher premiums or have to switch to a plan with a higher deductible. Last year, they hiked her monthly bill by 25 percent, and Natoma ended up spending more than $6,000 in premiums. She also spent more than $4,000 out of her pocket for co-pays and other expenses. But because she never hit her deductible, her insurance company only spent $900 on her care. So she paid more than $10,000 for $900 in benefits.
At the end of last year, she finally hit her breaking point. She got another letter from her insurance company. This time, her premium was going up more than 40 percent. It was too much. She couldn't afford her insurance. So she gave up her coverage and, like a lot Americans, hoped for the best. In her letter to the president, she said she worried that she was now just one health emergency away from losing her family home, which her parents built in 1958.
Then her worst fear came true. Two weeks ago, while she was working, she collapsed. When she went to the hospital, they diagnosed her with leukemia. Now she’s facing more than a month of chemotherapy and has the added worry of how she's going to pay for it.
What's remarkable about Natoma’s story is how unremarkable it is. She was unlucky enough to get sick. But that was just chance. It could have happened to any of the tens of millions of Americans who don't have health insurance. Or to any of the tens of millions more who are underinsured. Some of them have caps on their benefits, which means their coverage can disappear in the middle of a hospital stay or a round of chemotherapy.
Those of us who work for large employers that can negotiate better insurance rates have slightly more security. But the share of Americans under 65 who get health insurance through their job has been going down every year since 2000. And as soon as any of us change jobs or retire or decide to start our own business, we're facing the same risks as Natoma. Even if we keep our jobs, our health care premiums are rising three times faster than wages, eating up a bigger chunk of our paychecks every year.
Our health insurance system is failing at the very job it is supposed to do. It's supposed to protect people against exorbitant health costs, yet many Americans who have insurance still spend tens of thousands of dollars a year on health care. It's supposed to soften the financial blow that comes with getting sick, yet the Americans who are most likely to have serious health problems often can’t get insurance. It's supposed to give families peace of mind, but it’s hard to think of any other issue that causes as many worries.
President Obama's health insurance reform plan will make our insurance system work for families, small business owners, and individuals like Natoma by making three significant changes.
First, it will protect families by ending the worst insurance practices. It will outlaw the practice of arbitrarily canceling someone’s coverage and eliminate caps on benefits. It will also forbid insurance companies from denying you coverage because of a pre-existing condition like high blood pressure. So for the first time ever, every American will be able to get an insurance policy.
Second, it will give self-employed workers and small business owners the same private insurance choices as members of Congress by creating a new, consumer-friendly insurance marketplace called an exchange. Because this marketplace will allow consumers to band together to negotiate lower rates, it's estimated that premiums for many consumers will go down 14 to 20 percent for comparable coverage. And it will provide tax credits to help middle-class Americans and small business owners buy insurance.
Third, the president's plan will bring down costs for families, businesses, and government with the broadest package of health care cost-cutting measures that has ever come before Congress. A report from the Business Roundtable (an association of CEOs from leading U.S. companies) says these reforms could lower costs by as much as $3,000 per employee. According to the Congressional Budget Office , the president's plan will lower the federal deficit by about $100 billion over the next 10 years.
Collectively, these changes will help give Americans control of their health care choices. Under the president's plan, no insurance company would be able to turn Natoma away because of her cancer diagnosis. If one company raised her premium, it would be easy for her to find a new plan in the exchange. The plan's wide range of cost-cutting policies would help ensure she could find affordable coverage.
Natoma wants us to tell her story in the hopes that it will lead to reforms that will protect others from what happened to her. That's what we're going to do.