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Consumer Stories


Laurel Kaufer, San Fernando Valley, California
When Laurel Kaufer's divorce came through and she became a single mom to two kids, she took over responsibility for their health care. Self-employed, she knew it was going to be a struggle, but she had little idea just how tough the health care industry was going to make it for her.

Because of relentless rate increases, Laurel has to measure each proposed trip to the doctor very carefully against her other household expenses, and no longer takes her children to the doctor with every illness.

Neither she nor anyone else should be forced into that kind of juggling act with their children's health, she believes

Laurel, a mediator, moved to California from Florida in the early 1980s. Now 41, she lives in the San Fernando Valley with her sons, 14 and 12. While she was married, she and her husband and the boys were covered by family plans, through Blue Cross

In the late 1990s, rates began to mount steadily. The pace accelerated in February 2001: She has faced six increases since then. In April 1998 Laurel paid $129 a month in premiums to Blue Cross, for a policy that had a $1,500 deductible per family member, for herself and her two children.

A year ago, that same policy, with fewer benefits, cost Laurel $448 a month. She was steamed at the time, but this year's notice, which she received in January, really raised her temperature

"As of March 1, my policy will go up from $448 to $470 a month. For that increase I get the benefits of a new $6,000 per year maximum co-pay (per individual, two member max), (up) from $4,000 in the past. I get to pay a $100 co-pay for ER visits, instead of $30. I also get to pay 50 percent of the costs of non-formulary drugs rather than the standard $10/$30 for generic/brand name."

"How cool is this?" she adds sardonically. "I feel like such a valued customer. Here my insurer goes, sticking it to me yet again"

Being self-employed and unwilling to subject herself and her children to an HMO system, Laurel has few options for private health coverage. Blue Cross and the few other companies that offer similar individual policies know this, and have continued to capitalize on the monopolies they have built at the expense of consumers like Laurel.

A financially savvy consumer, she has shopped around and tried to secure the best coverage for the best rates. But the dizzying pace of rate increases, as well as changes in what exactly is offered, to whom, for how much and under what circumstances, have her reeling.

Like other parents in this age when medical insurers put profits first, she finds herself making decisions that she would rather not make. Last year, for example, her son was not feeling well. But she didn't take him to the doctor, as she would have, because of the higher deductible she had to accept in 1998, after another premium increase, in order to keep her premiums affordable.

Skyrocketing rates are "having a chilling effect on people seeking early health care," when they could prevent an illness or stop it early in its attack.

Laurel, like so many other health care consumers, is educating herself about health care in California. One thing she is discovering is that it is virtually unregulated. "The insurance companies have a huge lobby, with a great deal of financial backing, and so remain in control," Laurel says. That, she adds, must change.

"I'd like to see the Legislature mandate caps on increases," she says. "And every increase should be approved by a panel of non-industry personnel." Taking the decisions out of the hands of the insurers, who are in the business for profit only, is key, she says. "In order for the consumer's needs to be protected, the insurance industry must be watched and held accountable