This is the eighth in a series examining how the candidates’ health care proposals will affect ordinary people who live in the river town of Helena-West Helena, Arkansas, and how the press could cover that angle. The entire series is archived here.

Glenn Hall

Glenn Hall represents everything that’s wrong with American health insurance. If you’re sick, you may not be covered for the very illnesses you have. Yes, that’s counterintuitive—after all, you only need insurance during the times when you’re sick. But it makes perfect sense to insurers that profit by denying claims for medical care. So Hall and others like him have become a litmus test for reform.

Hall farms 2,200 acres of cotton, soybeans, corn, and wheat in the Mississippi Delta and can afford two policies—one for him and one for his wife. A large man with lots of health problems, he holds a Blue Cross Blue Shield major medical policy, so his coverage, at least on paper, is good. He now pays $8400 a year for the policy, with a $2500 deductible. (It used to cost $5400, but the premium jumped when he turned fifty-five last month). He pays $2400 for his wife’s policy, which comes with a $5200 deductible. Hall moved her into a high deductible plan in order to lower the premium. Still, spending almost $11,000 a year for health insurance—plus another $8000 or so in out-of-pocket costs before the policies pay a dime—takes a big chunk out of the budget.

Hall’s policy excludes diseases of the kidney and urinary tract, and Blue Cross won’t cover him for any diseases related to those parts of the body. When he bought his policy six years ago, he had had a kidney stone, so the insurer slapped a two-year exclusion on his policy for urinary and kidney problems. That means he’s on his own if he needs treatment. After the two years were up, the company asked him to have a complete physical, which he declined. “My records were available to them,” he says. But that wasn’t good enough for Blue Cross. The exclusion stayed, and he still pays for treatment.

“I’m paying for full coverage but I’m not getting full coverage,” he says. In the last few years, he has paid several thousand dollars out-of-pocket for procedures to relieve constrictions in his urinary tract. “There’s nothing I can do. I have to have relief,” Hall says. Insurance companies get their relief by placing such exclusions on policies, or charging higher premiums to compensate for the extra financial risk that people with health conditions represent. In the American insurance system, the sicker you are, the more money you may pay, if the carrier decides to issue coverage at all.

Hall has other problems; he is overweight, has diabetes, high blood pressure, high cholesterol, and bad vision. And farmers are prone to accidents, like the snake bite he got after stepping on a Copperhead, resulting in an $86,000 hospital bill for a four-day stay. That was the retail price, but since Hall had insurance, Blue Cross paid its negotiated $6500 rate with the hospital; Hall said he paid his deductible and went home.

Like most Americans, he doesn’t understand why the price of care is so high. Because he has many serious health problems, he is uninsurable and is stuck with Blue Cross. The minute he leaves to find another carrier, he has no coverage for any ailment. Meaningful reform, experts say, must address these peculiarities of American health insurance.

How Hall would do under John McCain’s proposals

McCain’s tax credit may help Hall defray a small part of his policy premium. But the $2500 is a fixed amount, and as the premium increases, the credit will be worth less and less and cover a smaller and smaller portion of the policy. So unless the price of coverage comes down (unlikely under either McCain’s or Obama’s proposals), Hall will find larger portions of his income going toward health insurance.

McCain says he wants families to make more decisions about their health insurance, availing themselves of the new competition he believes market forces will bring. But Hall is already making his own decisions. There’s nothing in that rhetoric for him. Because of his health problems, he has no choice, and that likely won’t change under McCain’s health reform solutions. Carriers would not be required to insure people with preexisting health conditions, and McCain’s fix for dealing with the so-called uninsurables probably won’t be relevant for Hall.

Trudy Lieberman is a fellow at the Center for Advancing Health and a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR’s healthcare desk, which is part of our United States Project on the coverage of politics and policy. Follow her on Twitter @Trudy_Lieberman.