OLD ORCHARD BEACH – Denise Dudley knew the feeling as she lay in bed one night last month.

Red, burning hives were emerging on her chest and back, apparently an allergic reaction to something in the bowl of cereal she had eaten as an evening snack.

Dudley had been warned to go right to the hospital in a case like this. She even keeps an emergency dose of epinephrine in her home in case there is no time and she can’t breathe.

But, instead of calling 911, Dudley quietly got out of bed and started pacing around the rooms in her mobile home. She was careful not to wake her husband, because he’d make her go to the emergency room. And a trip to the hospital would mean taking more money out of their retirement savings.

“I walked back and forth, talking to myself, tears coming down my cheeks,” Dudley said, sitting at her kitchen table last week. “I did that for two hours straight.”

While Dudley and her husband, Richard, can’t say exactly how to fix it, they know Maine’s individual health insurance system is broken. And they know the toll it can take on the physical and financial health of Mainers who are caught in it.

Dudley has health insurance, for which she pays $438 each month. She is one of about 20,000 Mainers covered by individual polices with Anthem Blue Cross and Blue Shield. The 56-year-old bought the individual coverage last year after being laid off from her job in a local office and losing employee health coverage.

But her policy has a $5,000 deductible, which means she can’t collect on any claims until after she spends $5,000 within a single year. Without that deductible, the couple would pay even higher premiums.

Now she is facing a possible $105 increase in the monthly insurance premium she already can’t afford, part of a proposed 22.9 percent average increase for Anthem’s individual policy holders.

Richard Dudley, who is 73 and insured through Medicare, came out of retirement and works a couple days a week as a parking lot attendant to help pay for Denise’s health insurance.

“What we’re doing to make up the difference is we’re taking it out of our life savings,” he said.

The couple has yet to decide what to do when the rate goes up in July.

“We’re already at each other’s throats,” Denise Dudley said.

“There are no good options,” her husband said.

While she would just drop the insurance, he won’t let her.

“She’s a walking time bomb,” he said.

Denise Dudley developed a severe food allergy as an adult and continues to learn which foods and ingredients to avoid. She’s been to the emergency room for allergic reactions eight times, but not since she bought her current insurance policy. The coverage she had through her job always paid for emergency room visits.

In addition to the food allergy, Dudley takes medications for diabetes, high blood pressure and high cholesterol, all of which the couple pays for.

Richard Dudley said the couple may increase her deductible to $10,000 to keep the premiums down. “That’s scary.” But, he said, “I’d rather owe someone $10,000 than $100,000.”

Denise Dudley, meanwhile, is determined to stay out of the hospital, at least until she gets a new job with health insurance. She’s taking courses on medical terminology and computer programs to give her an edge in the job market.

Denise Dudley assured her husband she would have awakened him last month if the reaction had gotten really bad. “I wait until it affects my breathing,” she said.

Richard Dudley said he wishes he’d heard her pacing that night, and he wishes they didn’t have to worry about the money.

“I wish she had the same medical insurance the politicians in Washington have,” he said.

 

Staff Writer John Richardson can be contacted at 791-6324 or at:

jrichardson@pressherald.com