Coverage, in pieces

Some stories of what people do to stay covered are whispered in confidence: a marriage of convenience, a divorce put on hold, a person too sick to work kept on the payroll by a compassionate boss.

Others are more obvious: a hated job held onto; retirement ruled out because a worker, or the worker's spouse, is not yet 65 and, therefore, ineligible for Medicare; an economically comfortable couple, thriving on one self-employed income, sending the other spouse to a 9-to-5 job for the health insurance.

The nation's political, business and community leaders are all grappling with the escalating cost of healthcare. But it's not just Medicare and Medicaid budgets that cause concern in the public discourse. Events that once may have been seen as unrelated corporate decisions, such as layoffs at General Motors, are readily linked to the problem of rising healthcare costs.

Among the general public, there is a gnawing uneasiness that anyone, at any time, is a pink slip away from joining the ranks of the uninsured.

But it can happen even without the pink slip. A good job used to mean good health insurance. Since 2001, employees' share of health insurance costs has risen 58% for family coverage, 63% for single coverage. Working people who can no longer afford the bite out of their take-home pay become uninsured. And more companies are dropping health benefits altogether. Today, only 61.9% of working people get coverage through their employers, according to the Kaiser Family Foundation, down from 71% in 1987.

In discussion groups around the country, called for by Congress in a little-noticed provision of the Medicare Modernization Act of 2003, individuals are talking about their worries. A meeting was held last month in Los Angeles, and about two-dozen similar town hall-style meetings are scheduled for other cities. In the fall, these opinions will be added to a mix of reports Congress will receive summarizing meetings held in 36 cities, as well as survey results received on the Internet (www.citizenshealthcare.gov).

"I think many people are starting to feel the slipping-through-the-cracks phenomenon, that it could happen to them," says George Grob, executive director of the Citizens' Health Care Working Group, which is organizing the meetings. "In general, people worry about the cost of care, about access to care for themselves, and for everyone else. A common theme is that it's time to do something about it."