If you think health care problems are only for the uninsured, you should meet Jennifer Mullenhard.
As a state employee in New Jersey, Mullenhard pays very little for her health insurance. Trouble is, the coverage she has doesn't go far enough -- and, specifically, it doesn't cover her daughters' pediatrician, picked when she had a different job and coverage.
With one daughter in kindergarten and another just 15 months old, Mullenhard, 36, has the kids in for checkups every three months. She doesn't want to change doctors, and she says she can't afford to pay for their care out of her own pocket. 
Video: Do you worry about health insurance?
To cover the doctor visits, her husband opts in for his company's insurance as well -- even though that costs the Mullenhards another $300 a month. "So we spend more money through his paycheck to stay with the pediatrician rather than find one who took my policy," she says. "We feel safer having the doctor taking his insurance. But one way or another, we still have an added expense."
Higher health insurance premiums, higher deductibles and incompatibility between policies and family physicians are among the health care problems hurting millions of American families as employers look to transfer a portion of their skyrocketing costs to employees -- or opt for cheaper plans that offer less.
The cost of health insurance in the U.S. rose 6.1% in 2007, outpacing both the 3.7% average increase in workers' wages and the 2.6% inflation rate, according to a September 2007 Kaiser Family Foundation report. Workers now pay an average of $3,281 a year to cover their share of a family policy, the nonprofit research firm said. Chart: Rising cost of health insurance
It's easy to blame big business, but companies, too, are in a bind, as health insurance premiums cut more deeply into profits. Employers faced a $12,106 bill for a family premium in 2007 -- a whopping 78% increase since 2001, according to the Kaiser report. Video: Why are costs rising?
Scott Hauge, president and owner of a San Francisco insurance brokerage firm, says costs like that restrict his options as an employer. So he offers his 31 employees only individual health insurance coverage -- they have to pay for dependents on their own. Even so Hauge says his health insurance costs are up 14% over the past two and a half years.
"A lot of small businesses can't afford the insurance premiums and still want to cover major catastrophes," he says. "But everybody is looking at how they can reduce their costs."
When the plan, a Kaiser HMO, hit a total cost of $144,000 a year in 2005, Hauge started offering his
employees the option of a different plan -- covering major medical expenses only -- alongside a Health Savings Account (HSA), in which they could set aside a portion of their salary before taxes, then use that to pay medical expenses.
"Not all of them moved to the new plan," says Hauge, who is also president and founder of the 2,700-member trade group Small Business California. "But I was saving so much money from the ones who did (that) I put $1,850 into each of their accounts."
Then Hauge anxiously watched as overall premiums shot up with double-digit increases in 2007. He worries that he may have to reduce the amount he deposits into his employees' HSAs.
Beth Bierbower, vice president of product innovation at the benefits giant Humana, says that health care costs have been rising at double the rate of inflation, but she sees some improvement on the insurance side.
"I think over the last few years, the average increase in health care premiums has slightly decreased," she says.
Part of that she attributes to HSAs, such as the one Hauge now offers. Employers continue to ask Humana for ways to keep expenses down, Bierbower says. Her suggestion? Continue to shift cost and responsibility to workers.
"You want to keep within single-digit increases, and not double-digit," she says of premium increases. "You can't sit on a $10 co-pay for your employees for five years, because the employer is then sharing more of the cost."
To find lower prices, employers often shuffle from one plan to another. But for employees, each change brings a different set of complicated choices. Video: A clinic instead of a doctor?
For instance, my family is insured through my husband's job. So last fall, when his then-employer changed health plans, our costs changed. One option would have kept our premium the same but doubled the deductible. Another option allowed us to keep the low co-pays -- but at twice the monthly expense.
Some of the problems reach well beyond the headaches of paperwork. Often, trusted family doctors won't work with a new insurance plan. That can be painful when the doctor in question is a pediatrician who knows every nuance of a child's medical history.
Just ask the Mullenhards. They stayed with their current pediatrician through one policy change, but they may reconsider if their insurance changes again. "My husband and I go to a family-practice provider," says Jennifer Mullenhard. "If something changes with our policy and the pediatrician doesn't accept our
insurance again, we could probably take the children to our doctor -- although we don't want to."
Even relatively good coverage can leave families feeling strapped.
After Danielle Wilkinson's father suffered a heart attack, she watched her parents struggle with huge medical bills.
"My mother works for the post office and has the best health insurance," says the 31-year-old casting director, who lives in Lake Mohawk, N.J. "But my father's costs came in at $150,000 -- and they covered just $120,000. So the insurance company picked up a huge portion of it, but they still have a $30,000 bill, which they're paying from retirement funds."
Wilkinson sees no easy solution for her parents.
"How can you come up with $30,000?" she says. "You can't. You pay it $1 at a time."
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Published Jan. 9, 2008
Produced by Elizabeth Daza and Peggy Collins
Graphics by Joe Farro and Hakan Isik
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