LINDA WERTHEIMER, host:
This is MORNING EDITION from NPR News. I'm Linda Wertheimer.
STEVE INSKEEP, host:
And I'm Steve Inskeep. Good morning.
Today, we begin a new series which we call Are You Covered. It looks at the various ways that Americans get health insurance - or don't. Our first story looks at a statement that you have most likely heard from the president or from a member of Congress or from any number of Congressional candidates over the years: the statement that everyone should have the same choices that federal workers have when it comes to health insurance. NPR's Joseph Shapiro has more.
JOSEPH SHAPIRO: Toni Bethea picks a tiny glass bottle off the kitchen counter.
Ms. TONI BETHEA: This is what keeps me alive.
SHAPIRO: The clear liquid inside is insulin.
Ms. BETHEA: I was five years old when I was first diagnosed with diabetes.
SHAPIRO: She's 13 now and starting high school. She pretty, smiling and stylish - from her bangs angled across her forehead to her sparkly red fingernails. Toni's had Type 1 diabetes for as long as she can remember.
Ms. BETHEA: At five I really didn't know what was going on, but I remember having my mother and my grandfather holding me down to give me shots and prick my fingers. And I was scared. I was confused. And it wasn't a good time.
SHAPIRO: Rhonda Dorsey is Toni's mother.
Ms. RHONDA DORSEY: In order to live a healthy life with Type 1 diabetes or any kind of chronic illness, it's so important to have good insurance. And I tell Toni all the time how blessed we are, because we've met a lot of people who don't have insurance at all and insurance that covers Toni as well as it does.
SHAPIRO: Rhonda Dorsey has good insurance, because she works for the federal government. She's covered by the Federal Employees Health Benefits Program. It insures eight million workers, retirees and their families — and members of Congress. And they do report high levels of satisfaction. Still, it's not some kind of super insurance. It's pretty much like most insurance people get through their jobs.
Federal workers, including Rhonda Dorsey, sometimes complain about the rising costs of their premiums and co-payments, and about the hassles of getting care. In those early stressful days of her daughter's illness, Rhonda belonged to a traditional HMO.
Ms. DORSEY: I'd always have to get a referral.
SHAPIRO: She'd take Toni to see an endocrinologist, an eye doctor and one specialist after another.
Ms. DORSEY: And sometimes I would forget and I'd get to the doctor's office and it would be a mess. And so I'd be very apologetic and we'd have to call the pediatrician's office, and it just was a waste of time in my opinion.
SHAPIRO: There were limits, too, on the supplies she needed to manage Toni's diabetes. Sometimes a prescription refill for needles or testing strips would be denied. So Rhonda switched insurance companies. Her new plan allows her to keep taking her daughter back to the specialists who know her best.
Ms. DORSEY: And I have the standard plan which means that I pay a little bit more up front. My deductible is a little bit higher, but I don't have to deal with the referrals. I can go to any doctor.
SHAPIRO: And that's what makes the Federal Employees Health Benefits Program stand out compared to other insurance - choice. Most federal employees have lots of choices for health insurance. In the Washington, D.C. area where Rhonda lives, there are at least 16 health plans to choose from. Nationwide, most companies offer only one health plan to their employees, and just one percent of companies offer three or more - that's according to the Kaiser Family Foundation.
Ms. DORSEY: That is one good thing about the federal benefit is that you have numerous options. And I don't remember how many, but it was quite a few. It was enough for me to have to do my homework to check to see which one would, you know, best suit our needs.
SHAPIRO: Even with good insurance it's expensive to manage diabetes. Toni pricks her calloused fingertips several times a day to check her blood sugar levels. Rhonda pays a little more than $200 a month for supplies. Toni wears an insulin pump — it's the size of a cell phone and it's pink.
Ms. BETHEA: It had to be pink.
Ms. DORSEY: This is her. Pink is definitely her style.
(Soundbite of laughter)
SHAPIRO: The first pump cost $5,000. Insurance paid all but $500. Toni knows she's fortunate. This summer, she went to a summer camp for kids with diabetes. And she saw what kids do when they don't have good health insurance.
Ms. BETHEA: At camp they provide you with supplies, but I've seen kids who have saved their needles and taken them with them. Even though you weren't like supposed to, they would kind of sneak them just to make sure that they would have something when they got back home.
SHAPIRO: Toni and Rhonda know that when people don't have good insurance, they're so desperate they will even reuse a needle.
Ms. DORSEY: It gets dull. And so it really hurts. But you have to have insulin, just like I said. I mean, without insulin, Toni would die. So you, take the pain in order to live.
Ms. BETHEA: I do feel very grateful for all that I have, because that could be me.
SHAPIRO: Joseph Shapiro, NPR News.
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