As health rates soar, many choose to forgo insurance

Vic Shunkwiler thought he was paying too much for his health plan, so he did something drastic: He stopped buying insurance.

"We hated writing that insurance check every month, knowing that it was so high and we're probably not going to collect on it because we're basically healthy," Shunkwiler, 64, said. "We really felt we were getting ripped off."

Ann Williams left health coverage behind when she cut back to part-time hours and has remained uninsured for the past six years.

Both Virginia Beach residents continue to monitor their health but have found alternate ways to pay for their care.

For decades, the American health care system has relied on insurance - both government and private - to pay patients' medical bills. Even last year's controversial overhaul was based on the assumption that universal insurance coverage is desirable for both patients and health care providers.

Yet with rising health costs, high unemployment and a stagnant economy, insurance keeps getting more difficult to afford. Most people still believe they need insurance, but more and more are going without, and it's not just those with low income. In the past few years, the number of uninsured people with higher incomes increased significantly, according to the nonprofit Kaiser Family Foundation. The U.S. census shows that about 8 percent of people in households with incomes above $75,000 were uninsured in 2010.

Those without coverage tend to be less healthy, struggle more with finances and pay more for their health care. Some researchers say they also die sooner.

"If people who are uninsured are less likely to receive regular care, then a health problem is less likely to be caught at an early stage," said Rachel Garfield, a senior researcher with the Kaiser Family Foundation. "So when they are presenting with an illness - let's say cancer - they're much more likely to be further along in the progression of that illness."

Not everyone without insurance neglects his or her health, however.

After Shunkwiler canceled his insurance, he didn't stop going to the doctor or optometrist. A diabetic, he continued filling his six maintenance prescriptions and going for his lab work every three months.

He didn't stop making monthly payments either.

But instead of paying premiums, Shunkwiler started writing checks to help fellow Christians. He and his wife joined a group called Samaritan Ministries International.

The Illinois-based nonprofit organization manages the medical bills of about 19,000 households. Only practicing Christians qualify: They must prove their faith with a note from their pastor.

At least two other similar organizations exist in the United States, and at least 13 states - including Virginia - have laws that recognize such health care sharing ministries and exempt them from insurance regulations. Members are not bound by the insurance mandate in last year's federal Patient Protection and Affordable Care Act.

At Samaritan, all members must pay a $175 annual fee and make a monthly payment, determined by a board of directors and approved by membership vote. This year's monthly rates range from $135 for a single person to $320 for a couple with children.

Through a newsletter, Samaritan Ministries notifies members where to send their monthly checks. The money goes directly to individuals to pay bills after Medicare or another insurance has paid or after they've negotiated self-pay discounts. Nearly all of Samaritan's members are uninsured.

Members are expected to pay the first $300 of their own bill but can ask for help beyond that, as long as the condition is on the approved list. Conditions that qualify range from cancer to carpal tunnel syndrome.

Not on the approved list: abortion and treatment for mental illness, among others. The maximum for any one illness or injury is $250,000. Members have the option of signing up for a program to voluntarily help with expenses greater than that amount, though.

After sending in their medical bills, participants receive a list of individuals from whom they should get a check, and Samaritan tracks those who don't send in their share. Members who are struggling financially can apply for help. Otherwise, people who have stopped "sharing" cannot ask for donations for their own bills.

"Less than a half of 1 percent of our members on a given month don't ever end up paying their shares," said James Lansberry, Samaritan's executive vice president. "We have a common religious bond, and because of that we consider that a moral responsibility to take care of one another."

Shunkwiler first heard of Samaritan Ministries from a friend at church, who was a longtime member and had received $20,000 toward medical expenses.

He liked the idea that his monthly checks would help someone directly, and that Samaritan's newsletters also gave other updates and requests for prayers. "It's so much fun to write that check every month," he said.

Once, after he joined in April, Shunkwiler was away when the newsletter came, and he wanted to notify the recipient that his check would be a little late. He Googled the name and found an obituary. Shunkwiler called to speak with the widow, who still needed to pay her late husband's medical bills.

"She broke down in tears," he said. "She really just needed somebody to pray with her. She was really down that particular morning, and I just happened to call at the right time."

Shunkwiler hasn't sent any bills to Samaritan Ministries yet. As a self-pay patient, he negotiates with his health providers. Through discounts, he's found a way to pay less than $100 for his lab work rather than the $500 charged to insurance companies, he said.

Shunkwiler also has been exploring different drug combinations for his diabetes because Samaritan Ministries doesn't pay for prescriptions.

He stopped taking some that he'd tried after learning they could cause serious side effects. He dropped another because it cost $600 a month, and now he is trying insulin injections.

"You actually become quite involved in your course of care," he said. "You really start studying things and say, 'OK, what if I do this? What if I do that?' "

Shunkwiler sets aside what he can in case he needs treatment for his diabetes. Samaritan Ministries doesn't ask members to pay for treatments for pre-existing conditions unless the patient hadn't experienced symptoms, needed treatment or taken medicine for the condition for at least a year. For cancer, the waiting period is seven years. Bills for new treatment of pre-existing heart conditions and diabetes don't qualify at all.

"We just pray that we'll be OK, but you never know," he said. "It's nice to have that family there supporting you."

Ann Williams gave up her employer-sponsored health insurance when she moved home to Virginia Beach to take care of a family member. She researched her options, but insurance companies quoted up to $900 a month - too expensive for her part-time paycheck as a saleswoman.

"With the big pay cut that I'd taken, I wasn't going to buy something that left me just a few dollars left over a month," Williams said. "That's silly."

A lifelong asthmatic with chronic bronchitis problems, she figured she knew her health issues well enough to manage them on her own. Three medicines along with doctor visits, occasional trips to urgent care and additional drugs when she suffered from bronchitis totaled between $3,500 and $4,000 a year.

Over the years, Williams kept looking for insurance that would work, but rates only got higher.

This year, her search took on a new focus. At 51, Williams realized that it had been years since she'd had health tests recommended for women her age, such as screenings for cholesterol and Vitamin D. The additional services were just too expensive without insurance.

Williams and her partner looked for an alternative. They found Dr. Christopher Dowd and his Cornerstone Private Practice in Suffolk.

Dowd is an osteopathic physician. His degree is similar to an M.D. degree, but with training that focused more on holistic medicine and included healing through muscle and joint manipulation.

He emphasizes preventive care, with what he's called "uncommonly thorough, prevention-focused" annual physical exams, such as a digital electrocardiogram and nutrition consultation in addition to advanced cholesterol testing and diabetes screening.

He makes himself available for patients around the clock through a payment model known as concierge medicine or direct care.

Patients pay a flat rate for wide access to his services, including house calls when necessary. The fee typically isn't covered by insurance, but those who are insured choose to pay it in addition to their health plan obligations.

Most of Dowd's patients have health coverage, however, which is what he prefers. Although care focused on nutrition, exercise and early detection can prevent problems and save money in the long run, it doesn't always.

"I try to provide some context and say, 'God forbid something bad happens. There's the potential need for insurance down the road, and there's the potential that I'm going to uncover something that insurance would help take care of or help pay for,' " he said.

Williams paid $1,600 for a year. She believes it's worth every penny, even though her prescriptions aren't covered.

In the first three months, she saw Dowd three times and attended appointments with a nutritionist and fitness specialist. She discovered that her cholesterol was higher than it should be, and that she needed to limit the fats and carbohydrates in her diet - including those from fruit.

"That was news to me," Williams said. "I thought fruit and vegetables were lumped under the same umbrella."

Since signing on with Dowd, Williams says she feels a new sense of relief.

She likes that she can easily reach her doctor, and that he always has abundant time for her. She likes that her health needs are being addressed through a comprehensive plan and that she's learning new information about how to take care of herself. She likes that Dowd will be involved in her care if she ever goes to the hospital.

The only thing missing now is financial protection from a serious calamity. Williams and her partner say they'd love to find coverage for such a catastrophic event, and they're going to start exploring their options.

Next year, they intend to renew their subscription with Dowd.

"We plan to make that a priority when we're doing our annual budget," Williams said. "We consider it a personal investment."

Amy Jeter, (757) 446-2730, amy.jeter@pilotonline.com