After her husband died in 2004, Gayla Moeckel decided to give up teaching and take over the family farm near Plevna, Kan. The land had been in her and her husband's families for more than a century.

But when she gave up teaching, she also gave up the health insurance plan that went with it.

She pays the $157 cost of her annual mammograms out of pocket. Given her family history, she's religious about getting them. Her sister died of breast cancer at 37. Her paternal grandmother died of it at age 52. Her mother has survived it.

When Moeckel turned 50 in February 1999, her primary-care doctor advised her to get a screening colonoscopy. Her maternal grandfather died of colon cancer 45 years ago. She knew it was important to get screened.

But nearly eight years passed before she could afford to comply.

As the recession continues and unemployment climbs, surveys suggest many Americans are cutting costs by delaying or forgoing preventive health care.


Emphasis on prevention

Although the details of President Obama's health care plan are not yet known, much of the discussion has centered on preventive care. "We can all agree that if we want to bring down skyrocketing costs, we'll need to modernize our system and invest in prevention," Obama said March 5.

Moeckel, 59, pays $490 a month for catastrophic health insurance, which would cover up to $1 million worth of her care if she were hospitalized for colon cancer. It won't pay for a colonoscopy.

So Moeckel saved up and paid for it herself. The colonoscopy itself cost $1,450. Removing and biopsying three polyps cost extra. "There were plenty of other things that needed to be paid," such as bills for diesel fuel and fertilizer, Moeckel says.

But she's relieved that the polyps were benign, and now she's saving up for her next screening colonoscopy in 3 1/2 years. To help, she works occasionally as a substitute teacher at a school 22 miles from her home. Her take-home pay: $64 a day.

If she lived in Connecticut, Moeckel might have been able to take advantage of a state-funded pilot project that provides free screening colonoscopies to people who lack coverage for them.

"Here at the University of Connecticut, you will see a lot of people come to you because they didn't get screened in time for cancer," says gastroenterologist Joseph Anderson, clinical director of the UConn Health Center's Colon Cancer Prevention Program.

The program pays gastroenterologists and pathologists half their usual fees.

"I think that everybody understands that the bottom line is we all need to sort of pull together to try to fix the holes in the current system," Anderson says.

One morning last week, Anderson screened seven people through the project, including Veronica Francis, 56. "At present, I'm not working, and I don't really have insurance," says Francis, a Jamaica native who moved to Hartford, Conn., last September from New York.

Anderson told her that her colon looked fine and that she doesn't need another screening colonoscopy for 10 years, Francis says. "You don't know how relieved I am."

More health problems

A survey of family doctors released last month by the American Academy of Family Physicians suggests not everyone who puts off preventive care is as fortunate as Francis or Moeckel. Six out of 10 respondents said they were seeing more health problems as a result of skipped preventive care, such as screenings, or unfilled prescriptions.

"What's become clear with this economic recession is that America is sicker than it was prior to the recession," says Ted Epperly, a Boise doctor who serves as president of the family physicians' group.

One survey respondent wrote about a 46-year-old patient who cut back on his pills for type 2 diabetes, Epperly says. The man's blood sugar got out of control, and he ended up having a fatal heart attack.


Another respondent wrote of a patient with bipolar disorder who tried to save money by not filling his prescription for an antipsychotic medication. "Within a week to 10 days, he spun out of control," Epperly says, and he lost his job, his family and his house.

Deb Clements, an associate professor of family medicine at the University of Kansas, says her practice has seen fewer patients coming in for preventive care.

Recently, an older patient was hospitalized with high blood pressure. A combination of five medications lowered it, and she was released. A week later, she was back in the hospital.

"To tell you the truth, I didn't take the medicine," Clements says the woman told her. "I couldn't afford it."