Case study: Paying for health care in a recession

NPR reports on the health care struggles of Howard County, Maryland, a well-off and generally liberal area with hospital fees set by the state and a county program for the uninsured. "But like the rest the country, Howard County is facing the impact of the recession: Employers have to cut back on benefits, so employees cut back on their coverage."

Herb Huston, 61, lost his employer-provided insurance when he was laid off a few years ago. He'd always been healthy, but one night in May he suffered a heart attack. "Neither old enough for Medicare nor poor enough for Medicaid," Huston will be responsible for the costs himself, which "should easily exceed $50,000." On the other end of the spectrum is 62-year-old Judy Weeter, who pays no premium for the insurance she receives through her employer. She's undergoing expensive chemotherapy for breast cancer but expects to pay no more than her $20 copays.

But Linda Faggio, who "administers the oncology practice where Weeter gets chemo" says she is "seeing an increasing number of patients who are underinsured and can't afford adequate coverage." Many have "reduced their coverage because their employers have reduced their contributions" as sales slumped in the recession. Lin Eagan, who runs a mortgage company that employs 15 people, "went from paying 100 percent of her employees' health insurance to a 50-50 split" after the residential real estate market crashed. "Obviously we needed to look at cuts in the payroll. In our whole budget, health care was a big number," she explains.

"Small businesses like Eagan's have been making similar decisions in Howard County and all over the country. Workers who are laid off get COBRA and without a new job could end up uninsured. But workers who keep their jobs face steeply increased premiums as the burden shifts to them, and they take cheaper options and risk being underinsured" (Siegel, 6/15).