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Premature Twins' Medical Bills Meant Bankruptcy

(Interview 5/2011. Oil on linen, 40 ins. x 30 ins.)

2012 Bearing Witness at the US Capitol, Washington DC

Update 2021

Oh, this story is a hard one to look back on. If I knew then what I know now...but even so, what could I have done? I interviewed this man years after the fact. The twins in the story were 20 years old when I sat with a depleted man living in a well-worn trailer he inherited from his mother.

I did not understand what a self-insured company was. That's a thing? I fleshed out the concept in the revised story below. This Trade-Off podcast episode does an excellent job explaining self-insured companies.


Did this guy's rental property disqualify him for charity care? Did NICU social workers exist in 1991 to steer the couple toward agencies that could have helped with the premature twins' medical bills? I was too new to know how to probe. The early portrait stories pointed me to where I needed to dig. I learned.

The healthcare system allowed this man's life to become disposable.


This subject's descent into bankruptcy started with the birth of his premature twins.

The twins are young adults now. His twins and their two siblings are doing very well today. And they are very close to their dad.

This former heavy equipment operator and excavator was strong, gracious and kind -- disillusioned with the system but still standing.

I wonder if we are not squandering the workforce's power and ingenuity. Americans' efforts could be better spent growing this country and economy. Instead, many people's best selves are depleted trying to survive a medical system that bankrupts them.

This subject worked for a company that had a self-funded insurance plan. Large companies opt to collect the premiums from their employees and set up their own accounts from which to pay their employees' medical claims. These businesses often contract with third-party administrators like commercial insurance carriers to administer their health plans. But the claims are paid from the employers' own money. Employees of self-insured companies often have an insurance card from a well-known insurer. They use that insurer's provider network. And they often have no idea that the Independence Blue Cross name on their insurance card, for example, is NOT the company paying their medical claims. Their employer is.

This subject's boss sat him down to say that the company would no longer pay his twins' medical bills. The employee had reached his lifetime dollar limit for medical claims according to his insurance policy.

I'm sure this portrait story subject did not know his company was paying his twins' medical claims and not the insurance company printed on his insurance card. If he had, would he have pleaded with the company to pay the claims? Why should a person have to know so much about self-funded plans and third party administrators, and so many other strategies, to have a shot at not losing everything. Sickness has no limit; neither should the coverage needed to treat it. (The Affordable Care Act banned annual and lifetime limits.)

"I've been an excavator for 37 years. That's all I know. At 8 years old I was stacking block for my dad. I don't understand the system. I'm trying to get medical assistance." Subject quoted his senator as saying, "There will always be poor people."

It feels like the American worker and patient are trapped in a maze like lab rats. Only the most clever and tenacious survive. This subject did not. Yes, he is alive. But his life took a ruinous turn when his wife delivered premature twins. Medical bills bankrupted them. His marriage collapsed under the strain. He was living alone in an old trailer he inherited from his mother when I interviewed him.


A study. Oil on canvas, 24 ins. x 20 ins.

(Interview May 2011)

Former Heavy Equipment Operator and Excavator, Uninsured, Age 53

In 1991, while insured with a large excavating company, this father had twins premature by 3 months.

The company was self-insured meaning the business took on the risk of paying their employees' medical claims, not an insurance company.

The subject did not know that his health insurance policy had a lifetime dollar limit for medical claims. This worker was responsible for all medical bills over that limit. (The Affordable Care Act has since outlawed annual and lifetime limits.)

Medical bills for his twins reached and exceeded that lifetime limit. The medical care over several years for his premature twins totaled over a million dollars in the 1980s.

The subject’s wife quit her teaching job to care full-time for the twins and two older children. The subject took a second job as a cashier at a beer distributor for extra cash. The couple also sold a rental property to pay some of twins' hospital bills.

By 1999 the subject had a new excavating job with health insurance benefits. By 2008 the economy was reeling from an economic collapse in what now has come to be known as The Great Recession of 2008 . Businesses responded by laying off workers including this subject. After fits and starts, and hopes and promises of re-employment, the company finally folded in 2010.

With savings spent, and medical bills still looming, the couple went bankrupt. Attorneys for the hospital and mortgage company went after the family's primary residence as payment for the twins' outstanding bills . "We held on for as long as we could. " They paid a portion of the mortgage payment every month but it wasn't enough. Authorities gave the family 72 hours to vacate the premises.

On a Monday morning at 7 am, a sheriff oversaw the family's eviction. The couple found a home to rent for $750/month. The couple eventually separated. They had no money to get an actual divorce. The subject blames the stress caused by owing so much money.

The subject now lives in a trailer he inherited from his deceased mother. A local clinic helped him get back surgery from a local hospital system for which he received bills totaling $93,000, $7,000 and $5,000. The subject has no idea how he will pay the new hospital bills. He was also diagnosed with a heart condition which runs in his family.

The hospital has some money for charity care. Neverthless, hospital reps said they do not want to see him again until he has insurance.

"I cannot mentally or physically go through it again." The subject did not qualify for assistance because he has a trailer valued at $58,000 (inherited from his mother), a 1996 Jeep and $400 in the bank. The subject is trying to get disability health benefits.

"I've been an excavator for 37 years. That's all I know. At 8 years old I was stacking block for my dad. I don't understand the system. I'm trying to get medical assistance." Subject quoted his senator as saying, "There will always be poor people."


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