Coloradans share stories

Check out our new video library.

Even with employer-based health insurance, health costs skyrocket
Kyla Pfief, Emma Pfief, and Mr. Pfief

Kyla Pfief, Emma Pfief, and Mr. Pfief

Kyla Pfief and her husband never really thought about health care until she became

pregnant with their daughter, Emma, in 2011. But they weren’t worried, either.

“We thought we had a really great insurance plan (through my husband’s employer) with a $1,000 deductible and $3,000 maximum out-of-pocket,” Pfief said. “We thought we were golden.”

When Pfief had to have an emergency C-section, newborn Emma needed a three-week stay in the Neonatal Intensive Care Unit.

The Pfiefs soon realized how expensive health care can be even for those with good coverage. The family paid $6,000 that year—10 percent of their annual earnings—toward Emma’s care. Still, they felt blessed to have Emma blank doing well and access to good insurance.

Then, when Emma was almost 2, Pfief found her in her crib unresponsive.

“It was three times that we went into her room that we could not wake her up. She didn’t wake up in the car ride either, or at the doctor’s office, so they took her by ambulance to the hospital.”

Each hospital visit came with $350 co-pay, and it took three stays, several specialists, and many months to determine a diagnosis: a genetic metabolic disorder that means Emma can’t make her own carnitine, a cellular compound essential to the breakdown of food into energy.

Some weeks, the family traveled to Denver two or three times for appointments at Children’s Hospital or National Jewish Health. Each appointment meant a $50 co-pay in addition to co-insurance payments for all diagnostic testing.

During the fiscal year Emma was 2, the family spent nearly $10,000 on medical expenses, and their medical bills continue to mount. That’s because the out-of-pocket maximum doesn’t include co-pays and co-insurance charges.

Still, Pfief counts her blessings that Emma thrives at almost 3.

“She’s healthy as can be.”

And, flawed as it is, she knows she’s better with insurance than without it.

“In my job, I work with a lot of people who were uninsured before (the Affordable Care Act). Most are on Medicaid now. They’d come in with these $7,000, $8,000 or $10,000 bills for an overnight hospital stay. How are people who are living on $700 a month supposed to pay a $15,000 hospital bill?”

And Pfief still worries about the rising costs of health care.

“There are just so many different medical bills and fees that we have to pay in addition to our monthly premium. None of those costs are deducted from our annual-out-of-pocket responsibility. Our daughter’s health care bills will eat up a tremendous amount of our annual income this year and I don’t know how we will afford higher premiums again next year,” said Pfeif.

Universal health care: Where a nurse can be a nurse

John Gurule went into shock when he took his first rounds as a professional nurse in 1993, and it wasn’t the physical shock he’d treat many times during his 20-year nursing career. Instead, Gurule could hardly believe that he had no time be the kind of nurse he was trained to be.
“They build up a nurse’s ethic in you to always put your patients first. I learned in school that nursing is a full complement of skills—it’s emotional, it’s physical, it’s spiritual. Taking care of a patient isn’t just giving meds and keeping someone clean. Nurses, in their training, learn that it’s good to take time to listen to your patients because sometimes they know more about what they need than you do.”

Yet as Licensed Practical Nurse in private nursing homes and then at for-profit hospitals as a Registered Nurse, Gurule found that many facilities understaff nurses to cut costs.
“I was shocked because you couldn’t really be a nurse. You couldn’t take care of patients. You were given lots and lots of patients, and you had to triage them in your day, and God help you if you were given a lot of really sick patients.”
Faced with so many pressing tasks, Gurule found he could barely stop for a kind word or joke that builds the human connection.
“I had thousands of patients who I couldn’t get a rapport with. But when I was able to let patients talk to me, and I talked to them and still got everything done, I felt really fulfilled.”
Gurule wanted to understand how the U.S. health system had strayed so far from putting patients first. He launched a 10-year investigation into the history of nursing and health care in the U.S. and across the globe. Then, on June 21, 2000, the World Health Organization released its first-ever rating of the most effective health systems across the world. The U.S. ranked 37th of 191 countries, despite spending more of its gross domestic product on health care than any other nation.
“(Every health system that) worked had some form of universal health care,” Gurule said. “If (the health system) works right, that’s where a nurse will be able to finally be everything a nurse should be.”
Gurule said universal health care is effective and affordable because it puts patients and prevention first.
“That’s why I founded Colorado Nurses 4 Health Care 4 All, because I want nurses to be in on the transformation to universal health care and prevention. Whatever affects nurses, I want them to have a role in, because it’s going to affect the patient.’ I say to them, “The state of Colorado is your patient and you need to do everything you can to get it healthy.

Leave a Reply

Your email address will not be published. Required fields are marked *