“Today I’m Going Blind”: Many Americans Say Health Insurance Doesn’t Keep Them Healthy

Edna Garcia thinks she’s paid her dues. For 34 years, she worked as a public high school teacher in Bridgeport, Connecticut, while also serving as a local legislator for eight years. In retirement, she volunteers at her church, helping members deal with health insurance issues.

“I’ve been a benefit to my community,” she told CBS MoneyWatch.

But for Garcia, 73, enjoying his retirement has been difficult. Despite having retired teacher health insurance through UnitedHealthcare, she has struggled to afford medical care. Garcia is diabetic, has Crohn’s disease, for which there is no cure, and suffers from an eye condition that has caused her vision to deteriorate over time.

Garcia, who also has Medicare Parts A and B so she can keep her private plan, said her health insurance does not cover her medical expenses or pay for the treatment her doctors recommend.

“My eye doctor said the medication she’s going to prescribe me for the problem I have is not covered by insurance. And I certainly can’t afford it,” she said.

Instead, she uses prescription eye drops that her insurance covers, but that don’t properly treat her condition. “They don’t meet the needs of my eyes. So today I’m going blind,” Garcia told CBS MoneyWatch.

Garcia is just one of many Americans who say they are unable to get the medical care they need despite having health insurance. About 30% of US working-age adults with health coverage said rising medical costs making it difficult to afford essentials like food, utilities, car payments and loans, according to a recent examination from the Commonwealth Fund. It forces millions of people to take on debt to pay for care or make difficult trade-offs.

Edna Garcia, 73, said she struggles to get the medical care she needs even though she has health insurance.

Courtesy of Edna Garcia

Garcia also said her insurance plan does not cover Ozempic, a drug used to treat diabetes that has also become popular for weight loss and it can cost hundreds of dollars a month out of pocket. Meanwhile, she said her UnitedHealthcare plan at one point suddenly stopped covering Remicade, the medication she was taking to control her Crohn’s disease flare-ups.

“I was fine, then all of a sudden the insurance decided they wouldn’t pay for it because it cost too much,” Garcia said. “So my doctor took it off and put me on something else and I got sick as a dog and I’ve been sick ever since.”

She has since been put back on the medication, which UnitedHealthcare is covering again, according to Garcia.

UnitedHealthcare declined to comment.

Still, Garcia said she is often forced to choose between essentials like groceries and more expensive medications that could help her stay healthy but that she can’t afford on her own.

“I go without medication because I have to choose between eating and taking care of my medical needs,” she said.

No birthday trip

Eddie Vader, 45, a veteran who has insurance coverage through TriWest Healthcare Alliance, said he sometimes has to shoulder expensive expenses on his own because his plan doesn’t cover them. Vader will have a root canal this month, a procedure he told CBS MoneyWatch he will have to pay for out of pocket and will cost him about $1,300.

“I can’t really afford it, but we have to make it work,” he said. “It’s going to be a tight month.”

Making it work will mean forgoing an annual trip he and his wife usually take on her birthday. “Typically we would spend a night in a hotel somewhere, get out of town and go somewhere. That’s not going to happen until we can afford it,” he said.

TriWest did not respond to CBS MoneyWatch’s request for comment.

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Adam Rollings, a port builder in North Carolina, is covered along with his two children under his wife’s insurance plan. A school teacher in Onslow County, his wife gets health benefits through a Blue Cross Blue Shield plan for state employees.

That plan costs the family about $10,000 a year. They spend an additional $3,000 to $5,000 a year on additional health care costs, most of which are related to their nine-year-old son’s type 1 diabetes.

“We are fortunate that we are not concerned with any medical debt, but our frustration is that the coverage offered to her as a county employee appears to be inadequate for what is expected of her as a teacher and public service employee,” Rollings said for CBS MoneyWatch. “We expect to be fully covered, or at least that coverage is not as expensive as it is for the typical family of four.”

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