MANKATO — The worst day wasn’t the day when Christine Carmichael of New Ulm was a teenager and learned she had rheumatoid arthritis.

It wasn’t any of the 12 days during her life when Carmichael underwent surgeries for everything from hip replacements to a perforated ulcer.

It wasn’t the day when she decided that her private insurance ($900 a month) and out of pocket costs (approximately $1,400 a month) were more than she could afford with a take-home pay of $2,500 to $3,000 a month.

It wasn’t any of the long days she worked toward building up her New Ulm interior design business, hours that totaled as many as 80 hours a week despite her rheumatoid arthritis and ankylosing spondylitis, a chronic arthritis affecting her spine.

“The day that things crashed, I’ll never forget it,” Carmichael told Congressman Tim Walz Wednesday.

It was when three of her interior design customers — suffering because of the severe economic recession — called on the same day to say they needed to put their projects on hold. After years of ever-growing premiums and out-of-pocket costs, she had little in savings.

“I ended up having to default on my house,” Carmichael said. “It went into foreclosure in December.”

Cascading problems
Friends have helped her in the ensuing months, and her parents sold their house and moved in with her to help her cover costs. Then she bounced a check to the state-subsidized insurance pool for high-risk patients who can’t get private insurance. Warned that another missed payment would result in termination of coverage, there wasn’t enough money in her account when the program mistakenly billed her for three months.

“They refused to reinstate me,” she said. “... By the end of August, I lost that insurance and I went off the Remicade.”

The drug, which costs $4,600 a month, was the most effective her doctors had found at controlling the inflammation and other symptoms of her disease. Unable to afford it without insurance, Carmichael’s symptoms spiked by January and February. She has infected lymph nodes and an infection in her foot that is likely to lead to partial amputation.

She now qualifies as totally disabled, making her eligible for Medical Assistance.

“I fought to stay off disability my whole life, just because of the principles I hold,” Carmichael said. “... I’m on welfare now.”

Two days of testimony
Carmichael was one of five people sitting around a kitchen table in rural Mankato Wednesday, talking to Walz about their experiences and frustrations with America’s current health care system. The by-invitation meeting, involving people who had contacted Walz’s staff with their health care stories, mirrored a similar event held in Rochester on Tuesday.

The stories come as members of Congress are preparing to tackle one of the nation’s thorniest issues. Health care reform has been discussed for decades, but past attempts to pass major legislation have bogged down due to opposition from insurance companies, medical groups and citizens skeptical about the federal government’s ability to improve the system.

But Walz said the stories he heard in Rochester and Mankato reinforce his belief that reform is necessary.

“To kill health care reform is to condemn more people to the stories we just heard,” he said after the meeting.

Double-digit increases in health insurance costs are going to continue for years into the future without legislation aimed at controlling costs, focusing medical care on preventative medicine and providing coverage for the millions of Americans who are without it, according to Walz. He also said it’s important to recognize the struggles of many Americans who have insurance but are unable to afford the increasingly costly deductibles and co-payments.

The current system also stifles the entrepreneurial spirit that’s vital to the American economy, he said. It forces people to stay in jobs to preserve health care coverage rather than start businesses and create jobs.

Fearful of the future
Carmichael’s story illustrated the difficulty of trying to run a small business while fighting to keep up with health care costs. Others at the meeting said health care coverage controls the decisions they and their families make about employment.

Lisa Wojcik of Mankato said she and her husband would like to start their own business.

“That’s just not a realistic option,” said Wojcik, who described her family as solidly middle-class.

The problem comes with the costs of buying health insurance for a family of six. One of their sons, age 7, has a series of medical conditions ranging from cerebral palsy to autism to epilepsy.

He’s now eligible for Medical Assistance with the Wojciks paying a monthly parental fee based on their income. They hold hope that their son’s health won’t prevent him from becoming a productive adult, a man with a job — but they wonder if he would be hired by an employer who had to worry about the insurance costs of an employee with a long list of medical challenges.

The shunt in his brain to relieve pressure caused by hydrocephalus, for instance, could fail without warning, she said.

“It could fail tomorrow, and there would be a $20,000 surgery,” Wojcik said.

Compared to others Walz has talked to, Wes Gilbert’s medical problems are more routine. Gilbert, who works more than full-time at a small computer-service company, has shoulder and knee injuries that require continuing treatment.

A grandmother has been covering his COBRA payments to keep previous insurance coverage in place, but the economy has made it impossible for her to continue making the payments.

“So I’ve got one more month of COBRA and then I’m on my own,” Gilbert said.

His boss can’t afford to insure his employees. He doesn’t even have insurance himself, Gilbert said.

Betty Winkworth of Mankato came to the meeting to talk about her three adult children. There’s a daughter who took a low-paying job because it was the one offer that included insurance coverage, then saw her premiums triple on July 1.

Her new daughter-in-law has been fighting cancer for 18 months. She had to quit her job working with autistic children because of the risk of contracting infections.

“As far as a financial toll, it’s just a terrible situation for this young person starting off,” Winkworth said. “... They are conceivably facing bankruptcy.”

Her son — frustrated with the health care system and concerned that other serious problems have been neglected by the nation’s leaders — told her he thinks America can do much better.

“He said, ‘You’re not personally responsible, but you’re generation is handing us quite a world,’” Winkworth said.