For 23-year-old Phil Atkinson, $73.58 per month seemed like a lot of money.
That could buy a quick trip to Denver or a couple of nights out, so Atkinson opted out of the insurance coverage he was eligible for as a snowmaker at the Steamboat Ski and Resort Corp.
"I decided to take the chance and let my insurance run out," he said. "It's probably the stupidest thing I could have done."
Atkinson wishes he made a different choice. "I could have paid off insurance for 10 years with what I owe in doctor bills," he said.
One minute he was riding his long skateboard, the next minute he was on the ground. When he tried to stand up, something was wrong with his knee.
With one fall, he did $13,500 worth of damage to his meniscus -- a c-shaped piece of cartilage that lines the outside of the knee joint.
Atkinson went to the emergency room, and the bills started with that $510 visit.
With more than $13,000 in debt and a job working as a doorman at Levelz, Atkinson needed help.
The hospital pointed Atkinson to the state-funded Colorado Indigent Care Program. After a lot of paperwork and more phone calls than he could count, CICP agreed to cover part of his surgical bill.
Atkinson still owes $4,500.
"Get insurance," Atkinson said. "It's a necessity in a mountain town. I won't be snowboarding this year until I have insurance."
Nobody knows for sure how many Routt County residents are living without insurance.
Statistics put the number of uninsured Colorado residents at 600,000, or 15 percent of the population, according to Colorado Coalition for the Medically Underserved.
Only 7 percent of the population chooses to go without health insurance.
The uninsured typically are employed in jobs that do not pay enough to cover insurance premiums, yet those same jobs often pay enough that employees fail to qualify for public assistance.
In Steamboat, many residents piece together part-time and seasonal work to make ends meet. Employers in the service industry rarely offer benefits to part-time employees, and only a few companies provide benefits to seasonal employees.
But even those benefits can be cost prohibitive.
Every winter, the population of Steamboat sees hundreds of seasonal workers.
Steamboat Ski and Resort Corp. employs about 2,000 people during the winter. Depending on the job, Ski Corp. pays between $6 and $9 an hour, public relations manager Cathy Wiedemer said.
Recent changes in the cost of health insurance forced Ski Corp. to reduce its health care benefits. Now, the company only offers insurance to seasonal employees after their third consecutive season.
Five hundred seasonal employees take advantage of Ski Corp.'s health insurance plan, Wiedemer said, which means there are many who are privately insured or, more likely, uninsured.
Many uninsured residents risk injury skiing or pursuing other recreational activities for which Steamboat is known. During ski season, the emergency room at Yampa Valley Medical Center frequently hosts people who have been seriously hurt on the slopes.
Not everyone can pay.
"I have a strong opinion that everyone should carry insurance," said Frank May, YVMC chief financial officer. "If you are bombing down the mountain on a mountain bike and you can't take care of yourself, I have to second-guess why you are doing that.
"Some people simply can't afford insurance because it has gotten so high. There is no easy answer, but you have an obligation to have insurance. If you don't, it's really pushing your medical costs off on the rest of the community."
In the nine months since October 2002, Yampa Valley Medical Center gave away $837,000 in charity care. That number is higher than the $824,000 in charity care provided in the 2001-02 fiscal year.
"Charity care is a complete write off," YVMC CEO Karl Gills said. The only way the hospital can reimburse itself for care given to those who can't afford it is to raise the costs of medical care for those who can.
As the number of uninsured and underinsured residents increases, the Visiting Nurse Association has received numerous requests to establish an indigent care clinic. VNA officials understand the need but said there is no funding, said Jan Fritz, VNA's director of Hospice and home care.
An indigent care clinic would be open to walk-in patients who need a medical assessment but can't afford to go to their doctor or the emergency room.
"We would need to find outside funding, or physicians would have to provide their services gratis," Fritz said. "We would provide strep tests and blood tests, but who pays for it?"
Helping the underinsured
Insurance companies have raised rates and deductibles, partly because of the cost shift.
Physical therapist Stephanie Loomis, owner of Spine and Sports Physical Therapy, sees fewer uninsured clients and more underinsured clients.
Years ago, Loomis saw more of the "young indestructibles" who played hard but didn't have insurance.
Today, her office is full of clients who have insurance, "but their deductibles are so high, basically they are uninsured," she said. "That's the problem with the health insurance industry right now.
"They are so into cost containment that patients with $1,000 deductibles wait until they have a full-blown herniated disc instead of a back strain."
Across town at the Center for Sports Medicine, physical therapist Chriss Parks has seen a similar trend.
"A patient will be right in front of us with a particular problem, but there is a limitation in their policy. It's very hard for an individual to know what they purchased as an insurance product until they try to use it."
In some cases, deductibles and co-pays are high enough that clients will forgo physical therapy.
"They'll limp right up to our counter, find out that their co-pay is very high, and limp right out the door. People are very sensitive to what they are going to spend."
Not everyone can afford the $1,100 a month for a family of four that Parks pays. It was painful to write that check every month, he said, "but I'm in the health-care profession. I know what can happen. That's why I buy the best policy I can afford."
It paid off. On Jan. 22, 2002, his son was born 12 weeks premature.
"That $1,100 a month used to be a horrific cost, but no more," he said. Medical bills covered by insurance ended at $350,000, and Parks has a healthy son.
Fritz remembers two cancer deaths in the past year that could have been prevented if the patients had not been afraid of the cost of medical care. The patients were in their 40s and didn't have insurance. By the time they walked through the doors of the hospital, they were very sick with cancer, Fritz said.
Fear of medical bills cost them their lives.
The phones at the VNA ring at least once a day with someone hedging bets, Fritz said. Callers describe their symptoms and ask if they can avoid doctors' visits.
VNA sees it all the time -- the uninsured postpone health care.
"The uninsured don't take steps in getting prevention care," Fritz said. "By the time they come in, they need a lot of care. I can say that is true, especially with a cancer diagnosis.
"The number of people not getting diagnosed until it is almost too late is growing by leaps and bounds. They don't feel well, but they don't come in. It's part of the problem with the system. They know they don't have money, so they don't come in."
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