Courtesy of Jay Bernard

Catherine Howard Lovazzano didn't realize she had stripped-down medical insurance until she got breast cancer at age 31. She still owes $10,000 in medical debt.

Eight years after she was diagnosed with breast cancer at the unusually young age of 31, Catherine Lovazzano is down to her last $10,000 of debt. “I am really looking forward to paying this off, now that I have a job with great health insurance again,” says Lovazzano, now 39 and working for Chrysler in San Francisco.

Lovazzano is part of the 26 percent of U.S. women who had trouble paying medical bills in the United States in 2009-2010, according to a report released by the non-profit Commonwealth Fund on Friday. That’s double the rate of women anywhere else surveyed -- the rate's 13 percent in Australia and just 4 percent of German women report trouble paying medical bills. But Commonwealth, which advocates for health reform, says the 2010 health reform law will slash these numbers when it starts to take full effect in 2014.

Lovazzano, like many young adult Americans, took out a no-frills health insurance plan when she left a paid job to become a freelance film producer nine years ago.  She called her former employer’s insurer to continue coverage after her insurance ran out under COBRA – the law that requires employers to offer coverage to employees for a few months after they leave work. The insurer, Lovazzano said, told her she was young and healthy and needed only coverage for catastrophic events. “They basically sold me junk coverage,” Lovazzano said in a telephone interview.

Catastrophe did strike, in the form of breast cancer. But Lovazzano found out she wasn’t even close to being fully covered. “When I went into surgery they said, ‘You need to write us a check for $1,000 right now’ and I said ‘I don’t have $1,000.' I knew I was in trouble.”

Lovazzano estimates she racked up $200,000 in bills and she was on the hook for about $70,000 of it. It didn’t even occur to her to declare bankruptcy, to negotiate with the hospital and her doctors, or to simply walk away from the debt. “That’s not my style,” she said. “I come from a middle-class family. I have never been part of any welfare system.”

What’s ironic, Lovazzano says, is that had she been unemployed she would have been fully covered for her care by Medi-Cal, California’s Medicaid program. Come 2014, if the health care law is not repealed as promised by Republican politicians, health insurance companies will no longer be allowed to sell stripped-down policies like the one Lovazzano got.

“Women, particularly those in their childbearing years, are uniquely at risk for being unable to afford the care they need, having trouble with medical bills, and having high out-of-pocket costs,” said Commonwealth Fund vice president Sara Collins.

The group focussed its report on women and did not look at medical debt among men because women are uniquely at risk, it says. Insurers charge women more than they charge men of the same age and health for the same policies, says Ruth Robertson, who wrote the report for Commonwealth. “We know that women use more health services than men. They also have lower incomes than men,” she told reporters.  “Thirty-five million women were either uninsured or underinsured in 2009-2010 and the situation has been getting worse in the past decade.”

Commonwealth researchers compared the medical debt of U.S. women to women in 10 other countries -- Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and Britain. They also used data on thousands of U.S. women from three surveys to show that U.S. women uniquely lack insurance coverage and face high medical bills compared to women in these other countries, which all offer universal health insurance and varying levels of privately funded care.

“The analysis finds that 18.7 mil­lion U.S women went without insurance in 2010, and a further 16.7 million were underinsured; that is, they had insurance but were at risk of high out-of-pocket costs relative to their income. Uninsured rates varied across the country. They were highest in the southern and western states; in Texas 30 percent of women were uninsured in 2009–10, compared with 5 percent in Massachusetts,” the report reads.

Other findings in the report:

• Twenty percent of U.S. women (18.7 million) ages 19-64 were uninsured in 2010, up from 15 percent (12.8 million) in 2000
• About 39 percent of women in the U.S. spent $1,000 or more on out-of-pocket medical costs over 2009-2010, compared to 24 percent in in Switzerland, 1 percent in Sweden, and none in Britain
• Twenty-six percent of women in the U.S. had medical bill problems, compared to 13 percent in Australia, 12 percent  in France, and 4 percent in Germany

Last November, the same Commonwealth team reported that the number of underinsured U.S. adults rose by 80 percent between 2003 and 2010, from 16 million to 29 million. In 2009, a team at Harvard Law School, Harvard Medical School and Ohio University reported that medical bills caused 60 percent of personal bankruptcies in the United States, for men and women alike.

Lovazzano worries about her future, even with health reform. “I am branded,” she said. Currently, health insurance companies could cap her lifetime coverage or limit what they pay. “As a cancer survivor, that is always going to be a concern,” she said.

Lovazzano did get a taste of what health care looks like in one of the 10 other countries the Commonwealth Fund is always comparing the U.S. to. “I did end up going to grad school in England and they paid for all of my prescriptions through the National Health Service,” she said. “Even though I wasn’t a citizen, I was treated better than I was in my own country.”

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