Health Insurance Woes: American Citizens Struggle to Afford Essential Care

By James Wilson November 11, 2023

Despite carrying health insurance, many Americans struggle to afford medical care, forcing them to make difficult choices between essential needs and health.

Edna Garcia, a retired high school teacher from Bridgeport, Connecticut, believed she had earned a worry-free retirement, after decades of valuable service to her community in both education and local government. Nonetheless, the 73-year-old faces significant challenges in trying to afford essential medical care, despite her insurance coverage.

Garcia’s health insurance shifted to a plan from UnitedHealthcare after retirement. However, the coverage falls short in dealing with her serious health complications that include diabetes, Crohn's disease, and an increasingly deteriorating vision.

"The medication recommended by my eye doctor for my specific problem isn’t covered by my insurance, and I absolutely cannot afford it,” lamented Garcia. Currently, she is dependent on prescription eye drops, which are affordable but inadequately treat her vision issues.

Unfortunately, Garcia’s story echoes with millions of Americans. A recent study conducted by The Commonwealth Fund revealed about 30% of working-age adults with health insurance in the U.S., struggle to afford basic expenses such as utilities, food, car payments, and loans due to rising healthcare costs. The result? Either plunging into debt or compromising on essential needs in an effort to afford necessary healthcare.

To make matters worse, Garcia's insurance policy also doesn’t cover the cost of the popular diabetes drug, Ozempic, which costs hundreds of dollars per month. Moreover, her coverage for her Crohn’s disease medication, Remicade, was unexpectedly discontinued. She was switched to a different drug that caused severe side effects. Thankfully, she is back on Remicade as the coverage was reinstated. UnitedHealthcare, however, declined to offer a comment regarding this.

Garcia's struggles extend to making choices between essential groceries and high-cost medications that she cannot afford. “I have to choose between eating or taking care of my health needs,” she exclaims.

Eddie Vader, 45, a veteran insured through TriWest Healthcare Alliance, faces similar struggles. A necessary root canal procedure this month will cost him approximately $1,300 – an expense he has to bear personally. It means compromising on an annual birthday trip he usually takes with his wife. TriWest has not provided any response to these comments.

North Carolina dock builder, Adam Rollings' family also grapples with their health insurance policy. Covered under his wife’s insurance plan at Blue Cross Blue Shield for state employees, their out-of-pocket medical expenses still range from $3,000 to $5,000, in addition to the annual premium of $10,000. Rollings argues that as a public service worker, his wife should receive better insurance coverage.