COUPLE ENCOUNTER RISING COSTS

JACKSON -- For Ella Skinner, health insurance these days is a Catch-22 situation.

The rural Jackson woman, who has had some health problems, says she can't afford to go without health coverage, but she wonders if she and her husband can continue to afford its high cost.

"We are going to have to file bankruptcy and go on welfare if somebody doesn't help us," she said.

Skinner said she hopes Missouri's new high-risk insurance pool, scheduled to be in operation later this year, offers an affordable alternative. The insurance pool is designed to provide coverage to those who can't get it or must pay high premiums for it because of catastrophic illnesses or high-risk health factors.

Skinner has a $600 deductible policy and pays a monthly premium of $551 for individual health insurance coverage with Blue Cross and Blue Shield of Missouri. In June her monthly premium will increase to $746; she turns 60 then and that will result in another increase.

In July, she said, she will be paying more than $800 a month for health insurance.

Blue Cross-Blue Shield officials said Skinner's situation is not an isolated case. "She is not alone in this; there are a lot of people who are stuck like this," said Gary Johnson, regional manager for Blue Cross in Cape Girardeau.

Health care costs have risen dramatically over the past decade. "We have seen a trend factor in the last 10 years of anywhere from about a 15 to 25 percent increase in medical costs," said Johnson.

Blue Cross of Missouri's premium income increased 21 percent in 1990, reaching more than $650 million.

But the company paid just over $512 million in claims that same year, an increase of nearly 18 percent over 1989, officials said.

While the cost of health care has increased so has the level of care, Johnson said.

Skinner said that both she and her husband, Warren, used to be covered by Blue Cross. But last fall he switched to a different insurance company because it was cheaper, she said.

"He's paying $218 a month with a $250 deductible," she said. The premium had been $176 a month but increased when he turned 60 in March.

Skinner said she checked with several other insurance companies and none would insure her because of a pre-existing medical condition.

Skinner said she has suffered from stomach ulcers. As a result, she said she had to undergo surgery in 1976 and 1981. In 1987 she had a hysterectomy. Combined, Skinner said, she and her husband are now faced with paying more than $12,000 a year in health insurance premiums.

Her husband was in the plumbing and heating business for years. He now operates an excavating company that has a handful of employees. The company doesn't have a health insurance plan.

Skinner said the high health insurance costs are eating away at the couple's savings.

"If I sound angry or frustrated, I am," she said. "We have five years to go before Social Security and Medicare kick in. How can we hang on" until then?

Skinner said the couple used to be covered in a Blue Cross group plan offered through the Missouri Farm Bureau. She said premiums were paid quarterly.

In 1982, the Skinners paid $622 a quarter for coverage. In 1983, the quarterly premiums jumped to more than $820.

As a result, she said, they decided to switch to an individual policy with Blue Cross. The deductible later increased from $250 to $300.

In 1984, the Skinners paid $550 quarterly to Blue Cross. In 1985, the premiums increased to nearly $940, she said. In 1986, the quarterly premium jumped to $1,227.

In 1987, she said, they started paying monthly premiums of nearly $409. That increased to $631 in 1988, at which time the deductible was increased to $600, Skinner said.

By July 1989, the Skinners were paying $782 a month in health insurance premiums to Blue Cross. By last July, she said, they were paying more than $1,000 a month to Blue Cross.

Over a two-year period (1988 and 1989), Skinner said, she and her husband paid more than $20,700 for medical care, including more than $16,600 in insurance premiums. During that same period, she said, Blue Cross paid more than $5,600 of the couple's medical bills.

On the Blue Cross policy, her husband was listed as the policy holder while she was listed as a dependent.

Skinner said that thanks to assistance from state Rep. Mary Kasten, R-Cape Girardeau, she was able to continue receiving coverage from Blue Cross last year, even though her husband was dropped from the plan.

Blue Cross officials said that when the Skinners dropped the Farm Bureau group policy about seven years ago and went to an individual insurance plan, they were accepted into a Blue Cross conversion pool, which doesn't require medical examinations and is generally a high-risk pool.

Insurance is more costly the older a person gets, Johnson said. "Insurance tends to have higher escalating factors at 50 and over because the risk is so much greater at that age and older."

He said Skinner's high premiums are the result of "the rising costs of medical care and the increasing probability of her receiving health care because of her age."

Johnson said there are many major carriers that no longer write individual health care policies. "You're pool has to be gigantic to try to keep the rates anywhere normal," he said.

Richard Smith, senior vice president for Blue Cross headquartered in St. Louis, said Skinner could lower her premiums if the deductible were increased to $1,000. Instead of paying monthly premiums of $805 in July, Skinner would pay $735, a savings of $70 a month, Smith said.

When told of Smith's suggestion about paying a higher deductible, Skinner said Blue Cross officials had never offered her such an alternative.

She said that she and her husband were never told when they changed to an individual policy that the cost of such insurance could escalate dramatically.

"If they had told us it would go up considerably, which it did, we wouldn't have taken it," said Skinner.