I’d like you to meet Jill Eicher and Ron Tanner, two people who inspired me to launch the Lower Out-of-Pockets NOW coalition. Launched last September, the coalition now comprises more than 50 organizations and businesses with a single mission: ending the uniquely American crisis of financially crippling out-of-pocket health insurance requirements.
I first learned of Jill and Ron’s plight when I searched GoFundMe for people who have health insurance but whose deductibles and other out-of-pocket obligations are so high they are having a difficult time paying not only their medical bills but also their living expenses.
I’ve known for years that ever-increasing deductibles, copayments, and coinsurance requirements were resulting in millions of Americans falling into the ranks of the functionally uninsured. I noted it in my first Congressional testimony way back in 2009 and wrote extensively about it in Deadly Spin.
The functionally uninsured are people who often pay hundreds of dollars a month in premiums but don’t have enough money in the bank to cover their out-of-pockets, which can be thousands of dollars every year. As a result, many of the functionally uninsured skip their doctor appointments or walk away from the pharmacy counter without their prescriptions. Others who have no alternative but to seek care often wind up so deep in debt they turn to bankruptcy court or, almost as distressfully, to GoFundMe.
Cancer patients enrolled in a high-deductible plan are especially at risk of financial ruin. Two years after a cancer diagnosis, 42% of patients aged 50 or older have depleted their life savings, according to the National Institute of Aging. That includes patients with insurance.
One of the reasons I left my executive position at Cigna was my concern that the company’s push to move all its customers to high-deductible plans would cause financial hardship for many of them.
Jill is enrolled in a Cigna plan. Here’s what Ron wrote on her GoFundMe page after her cancer returned in 2020:
Jill’s Cancer Comes Back With a Vengeance. Please Help Her Live a Little Longer
Jill’s stage-4 metastasized breast cancer is now in its final stage. The cancer has pervaded her body, throughout her bones, and is destroying her liver. She has approximately 9-18 months to live. The loss of her income and the mounting medical bills have compelled us to seek help through Go Fund Me. Our aim at this point is to keep her out of pain and to help her live as fully as possible in her remaining time. We greatly appreciate anything you can do to assist us!
For those of you who can’t imagine being in Jill and Ron’s situation, it’s time to start imagining it. Most people with chronic conditions enrolled in high-deductible plans face high out-of-pocket costs. Even when you meet your deductible in a given year and breathe a sigh of relief, you know the relief is going to be fleeting. That’s because the out-of-pocket requirement resets at the beginning of every plan year. That means that you’re right back at square one.
And know this: Most of us will come down with one or more chronic conditions at some point in our lives.
According to the CDC, 6 in 10 people in the United States have a chronic condition. Four in 10 have two or more.
Jill and Ron were living what many would consider the American dream before Jill was diagnosed with breast cancer a few years ago. Both had good jobs: Ron was an author and writing professor at Loyola University Maryland, and Jill was a social worker, working primarily with homeless and previously incarcerated people to help them get their lives back together. In 2000, they bought a condemned Victorian brownstone that had been a frat house in Baltimore’s Charles Village neighborhood. They restored it to its 1897 glory so meticulously that it was featured on This Old House. Ron even wrote a book about their years-long rehab: “From Animal House to Our House: A Love Story.”
Jill’s first bout with cancer was treated successfully, and they went about their lives. They saved what they thought would be enough money for Ron to retire early and, eventually, for them to move to the country. With some of their savings and cash from selling their Baltimore house, they bought an old farmhouse several miles out of the city with the goal of not only restoring it as their new home but also establishing a writer’s retreat on the property. They set about converting the barn and even the hen house into furnished apartments.
Soon though, Jill’s cancer came back. Fortunately, they still had health insurance from Loyola, thanks to the Cobra program, but Loyola had switched from a Blue Cross managed care plan to a Cigna high-deductible plan.
It did not take long for their savings to begin to dwindle. When Jill’s uncovered medical bills started rolling in, they began to worry they would lose everything. So they made the gut-wrenching decision to ask friends–and strangers–for financial help on GoFundMe. So far, they have raised $56,270 of their $100,000 goal.
When I came across their GoFundMe page, I wrote a Twitter thread about them and later went to visit them. Now that it’s spring, Ron and Jill have a lot of planting, weeding, and mowing to do, but Jill, who used to mow all of their six acres, isn’t well enough now to help Ron with the chores. Ron is now on Medicare, but Jill, who is 58, is a few years away from eligibility, so they have her health insurance premiums to pay every month. And her uncovered medical bills keep flowing in.
Jill told me last week that the cost of her premiums and the copays for her eight medications and four-five medical appointments are a minimum of $1,000 a month. On top of that are the deductibles she has to meet before her coverage will kick in.
“Since the return of my cancer in 2020, the typical pattern has been that, with the start of each fiscal year (July 1), the deductible and coinsurance/out-of-pocket max start over, and then we pay about $8,000 to $10,000 out of pocket until those maxes are met, usually around August or September of each year,” she wrote me.
Altogether, her premium, copays, deductibles, and coinsurance total about $23,000 a year. And that still doesn’t cover all the care her doctor prescribes.
“I’m unable to get all the care I need,” she said. “I need PT for lymphedema on my left arm, but PT is in some special category with Cigna. We cannot afford the weekly $180 appointments, so I’m going without it.”
Ron continues to write when he can and posted an update on his blog a few days ago. He ended it with this:
Alas, our medical bills are coming at us hard and heavy. We’d be so grateful for any help you can offer.”
This piece was originally published via Wendell Potter’s Substack.