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RENEE MONTAGNE, host:

This is MORNING EDITION from NPR News. I'm Renee Montagne.

STEVE INSKEEP, host:

And I'm Steve Inskeep.

As Congress considers changes to the health care system, we've been taking a look at the health insurance we have now. Our series is called Are You Covered? And this morning we report on people who technically are covered but realistically are not. Up to 37 million people have coverage that's full of holes.

We have two reports this morning, starting with NPR's Richard Knox, with a family that is underinsured.

RICHARD KNOX: Jim and Martha Martin and their dog Abbey get up before the sun rises. By five A.M., Martha is already on fast-forward. She has a very busy life.

Ms. MARTHA MARTIN: We're both working so many jobs that about the only time we ever sit down together is at breakfast.

Mr. JIM MARTIN: There's not much time when I'm not at work.

KNOX: Breakfast is when they talk about money and bills, especially medical bills. Sometimes their daughters Sara and Rebekah overhear them.

Ms. MARTIN: I think the girls are sleeping and they hear what we talk about sometimes if they're awake.

KNOX: The girls' bedrooms are right above the kitchen. Nineteen-year-old Sara says she and Rebekah, who is 14, sometimes get upset by what they hear.

Ms. SARA MARTIN: You feel guilty being their kid and, you know, kind of saying, hey, I wish I could get money somewhere so that I could, you know, help you out with that. And you just, I don't know, you feel guilty.

KNOX: Martha says that hurts but she and Jim can't hide the fact that they're constantly struggling with medical bills. Even though they work five jobs between and have some health insurance, the bills pile up.

Just before seven, Jim heads off to work. Martha goes into her small home office. She pulls out a big fat folder marked "Medical bills."

Ms. M. MARTIN: Well, these are the places that I owe money to; bills that I owe that the insurance did not pay.

KNOX: The Martins are basically healthy, but last year, Rebekah had to have a major operation and her insurance policy was lousy.

Ms. M. MARTIN: We got a bill from the anesthesiologist. We got a bill from the hospital. We got a bill from the surgeon. We got a bill from the blood-work people. We got a bill for the ultrasound. You get to a point where you just feel like you're - just a general feeling of overwhelmedness.

KNOX: When Martha gets anxious, Jim calms her down. After 23 years of marriage, they've worked out their roles: she frets, he reassures; she makes phone calls to set up payment plans, he writes the checks.

(Soundbite of machinery)

KNOX: For more than a decade, Jim's worked at a boatyard, building sleek kayaks and canoes. He makes $16 an hour.

Mr. MARTIN: So, on the deck you can just cut that down the middle.

KNOX: But recently, the boatyard got new owners. They've cut his hours and the company doesn't provide health insurance for part-timers.

Mr. MARTIN: My insurance expired August 31st.

KNOX: Jim also works part-time at Wal-Mart, but he's not eligible for insurance there yet. He says being without insurance doesn't bother him too much. To take his mind off things, he gets outside and hikes up mountains.

Mr. MARTIN: My grandfather dropped dead at the age of 58, but he didn't take care of himself. And, you know, I like to think I'm doing things better, healthy-wise, than the generation before me. And maybe that's my insurance - is to stay active.

KNOX: So if you should have an accident, what would happen?

Mr. MARTIN: I don't know. I do possess faith in God and I don't get too caught up in the larger, you know, too far ahead. It's just day-to-day, week-to-week, month-to-month.

KNOX: Martha, on the other hand, worries about what they'd do if Jim got sick or hurt. Not only would they lose his income, but they wouldn't be able to pay the medical bills.

(Soundbite of a vehicle)

KNOX: Around noon, Martha gets into her blue minivan to go to one of her three part-time jobs, doing home help for the elderly. She's spent the morning at an appointment with her daughter, Rebekah.

Ms. M. MARTIN: Well, we just went and had our intake appointment to see the new counseling place. And they said...

KNOX: The 14-year-old has been dealing with anxiety and depression. Martha has been worried about the cost of counseling. But today she's got some good news.

Ms. M. MARTIN: Oh, my gosh. There's a grant - and a grant for children in Maine. And I was like, yes. So we get free counseling care.

KNOX: At the same time, it upset her to hear what the counselor had to say.

Ms. M. MARTIN: One of Rebekah's major reasons for depression is because she feels like every time she has a medical issue it generates a bill, which she knows we can't pay.

KNOX: Martha says it's hard to keep her perspective when it comes to Rebekah's problems.

Ms. M. MARTIN: 'Cause you always want to, you know, wave your magic Mom wand and fairy dust comes out, and it makes life easy for them.

KNOX: It's time for Martha's shift at the supermarket. She's the chipper lady behind the deli counter.

Ms. M. MARTIN: Can I help you find something...

KNOX: She's worked in food service for years.

Ms. M. MARTIN: Would you guys like a piece of cheese? Baloney?

KNOX: She loves her customers, but she's 52 and the job is taking a toll.

Ms. M. MARTIN: My hands hurt. My feet hurt. You know, I'm getting older. I'm finding that, you know, moving the slicers to clean under them and lifting the heavy things of meat... But I took this because it was - offered insurance.

KNOX: But the policy she has is very limited. It covers only her. And every time she needs care, she's left with a big share of the costs.

(Soundbite of a barking dog)

Ms. MARTIN: Abbey.

KNOX: After her shift, Martha goes comes back to her little house at the end of a country lane. It's bright pink.

Mrs. MARTIN: Oh, I do have a pink house.

KNOX: It's very cheerful. Is this the Mary Kay colors?

Mrs. MARTIN: Oh, well yeah, it's dusty rose lipstick.

KNOX: Mary Kay cosmetic consultant, that's another one of Martha's part-time jobs.

Mrs. KNOX: See originally, the idea was that my Mary Kay customers would be able to find me easier, because everybody, like, couldn't find the house.

KNOX: The little pink house holds a collection of antique furniture and blue patterned China that her parents spent a lifetime collecting. They died last year. Martha's started selling some of these antiques to keep up with the bills.

Mrs. MARTIN: And, you know, it is just stuff. I mean, it's emotional stuff, but it's just stuff and it's not as important as the people. But, once it's gone, it's, you know, gone and I can't get it back.

KNOX: But Martha doesn't have much choice. More medical bills are coming and she needs to have a hysterectomy next month. Insurance will pay only $1000 of the hospital bill. So for the Martins, 2009 is looking a lot like 2008.

Mrs. MARTIN: 45 percent of our income last year went for medical bills and health insurance premiums, 45 percent. That's just crazy. I mean I don't pay that much in taxes. So, you know, I just think there should be a health insurance plan out there that everybody can sign up for.

KNOX: Martha Martin says she'd be happy to pay the premiums if only she could get decent coverage.

Richard Knox, NPR News.

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