NOTES FROM THE INSURANCE UNDERGROUND - HOW THE CHRONICALLY ILL COPE

This report from the field is an account of the experience of individu als with multiple sclerosis (MS) in Indiana in getting and keeping pri vate health insurance. The report presents the findings of a telephone survey of individuals with MS in Indiana. While survey respondents we re generally able to obtain health insurance through the Medicare prog ram or employer-based private health insurance plans, many experienced formidable barriers to adequate and affordable health insurance, such as preexisting exclusions, cancellations, high premiums, and coinsura nce. Respondents adopted a variety of strategies to keep private healt h insurance, including selectivity in submitting claims, which worked to reduce their health insurance coverage. Our findings raise two cruc ial questions: (1) to what extent are the chronically ill forced to ta ke extraordinary measures to get and keep health insurance? and (2) to what extent do insurer practices in pricing insurance and determining coverage of benefits actually make health insurance even more inadequ ate and unaffordable for the chronically ill? These two questions are critical in understanding the full dimensions of the health insurance crisis in the United States today.