Health insurance is expensive, and the premiums keep rising. Even with the Prepaid Health Care Act in Hawaii, requiring employers to provide insurance for anyone working more than 20 hours a week for four consecutive weeks, there are still some residents that don’t have health insurance.

Indeed, why would someone want to spend what could be half of their paycheck on insurance that they may never use, especially now that it’s no longer legally required?

There are several reasons to stay insured. Accidents, emergencies, prevention and the overall cost of paying for medical care top the list.

Queens Hospital Emergency sign. 14 feb 2017

People’s plans never call for a trip to the emergency room, but when it happens it’s expensive.

Cory Lum/Civil Beat

Although courts don’t require a reason, the most common cause of bankruptcy is thought to be due to medical bills.

Accidents can happen at any time. The average cost for a broken leg could be up to $6,000 for the ER visit, the orthopedic consultation, potential surgery and follow-up care. This could be out-of-pocket if someone doesn’t have insurance, and that’s not the kind of money many people have on hand.

Those numbers apply if the injury doesn’t require a hospital stay. Three days in the hospital can cost more than $30,000. A simple cut that requires suturing can run in the hundreds of dollars — thousands if it’s done in the ER. Not having insurance coverage for these events can lead to a catastrophic medical bill that could take years to pay off.

An appendicitis requires emergency surgery. Statistics show that one in 20 people will have procedure in their lifetime, most commonly in the age range of 10-20. This one procedure can cost more than $10,000.

Other surgeries, such as gall bladder surgery and breast biopsies to rule out cancer are not usually elective and are best done urgently. Waiting can cause even more complications and a much higher cost if the condition gets worse and requires more intensive care.

Although courts don’t require a reason, the most common cause of bankruptcy is thought to be due to medical bills.

Pregnancy can also be unexpected, and although many states offer Medicaid coverage up through delivery, not all charges are covered. The criteria to be eligible for Medicaid insurance are also quite strict, and this puts not only mom but also baby at risk if prenatal care isn’t readily available.

Preventative care is an often overlooked benefit of having health insurance. Earlier diagnosis of certain conditions leads to better outcomes by allowing for treatment before certain conditions worsen. Vaccinations against viruses like Human papillomavirus can help protect against cervical cancer in women, and genital warts in men. These types of services are very costly if paid for out-of-pocket, but are often fully covered in a health plan.

Cancer screening, such as for the colon, breast or lung, is covered with insurance, and can be cost-prohibitive without. Even something as simple as cholesterol testing can cost a lot more than the average monthly premium, when lab testing and doctor’s visits are factored into the equation.

Although many doctor’s offices and hospitals may offer a discount on payments made in cash, the overall lack of transparency in the health care system makes it very difficult to know how much even a simple procedure may cost. Different fees from anesthesia providers, laboratory studies done in the hospital — all of these expenses add up, and often to a much greater amount than any yearly health care premium, possibly even for the entire family.

Getting sick and not having the ability to see a doctor can also wreak havoc for those who find themselves unable to work. Without income, the bills pile up and even a simple visit to the doctor might not be possible if no payment is arranged in advance.

Going to the emergency room is not the most cost effective way to utilize health care services, and the charges for a single visit are 10 times higher than a regular office visit. But one of the first questions doctor’s offices ask is what type of insurance someone has, and rather than taking a chance on payment, many offices won’t accept patients who don’t have any. That leaves many to go to the only care facility available when they need it, and then have to pay the bill that could otherwise have been avoided.

Once medical bills add up, there is nothing to protect consumers from collection agencies calling them for payment. Credit scores can be affected, making loans for all types of purchases even more costly. Bad debt can make someone unable to rent an apartment or buy a house, get a car loan or even get a credit card to help pay for the bills.

The end of the legal requirement that people have health insurance in the tax reform bill just approved by Congress has already had ripple effects in the health insurance industry. Premiums are going up, and there is no end in sight. But if fewer people enter the market, then the cost will go up for everyone else, healthy or not.

Although the Affordable Care Act prohibited denial of coverage for pre-existing conditions, nothing in the current health law prevents insurance companies from charging more to those who have cancer, or other costly illnesses. After all, insurance is at its very core a business. If there is not enough money coming in, then the company can’t exist for long.

One of the only ways to ensure that health care is affordable is to have more people covered by insurance, and that requires even young people buying into the system, perhaps spending more in premiums some years than in expenses.

Until the U.S. has a better handle on how to reduce the rising costs of health care, there is no way to completely protect oneself from medical expenditures. Even the healthiest person needs vaccines, or cancer screening, or potentially emergency- or accident-related care.

Although it’s no longer required, it’s in everyone’s best interest to make sure that they and their loved ones are covered.

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