Premiums on all forms of insurance have surged in recent years. Between 2002 and 2007, premiums rose 78%, outpacing inflation (17%) and wages (19%). In the individual market, without an employer's subsidy, consumers bear the full cost of coverage.
Most states don't regulate how premiums are set. As a result, women tend to pay more than men (because they have higher medical expenses on average). Rates also go up with age. For many people older than 50, premiums can rival mortgage or rent payments.
When Peter and Brenda Koerner of rural Pennsylvania, both in their 50s, couldn't afford individual policies, they gambled -- and prayed that their health and good luck would hold until Medicare kicked in.
The Koerners sell gifts and custom T-shirts at fairs and street festivals in northeastern Pennsylvania and in their store, Cosmos Crystal Shop, in Carbondale.
"We've been lucky playing the Russian roulette game with not having any health insurance and basically trying to be as careful as you can," Peter Koerner said.
One day about two years ago, he was using a hydraulic splitter to replenish the wood pile that heats their home. Something slipped. His left thumb was severed.
He tried to stop the bleeding with rubber bands, packed the amputated digit in ice to "increase my chances of reattachment" and got a neighbor to drive him to the local hospital.
Doctors in the emergency room cleaned and stitched the wound, but he would have to be airlifted to a bigger hospital for reattachment surgery.
Koerner loves working with his hands. He is a trained goldsmith and silversmith, repairs his car and enjoys sculpting. He knew he would miss his thumb. But there were "too many other bills to pay."
He left his thumb at the hospital.
"It was plain a matter of economics," Koerner said. "I knew I could live without it."