Dan Gerber is what I'd call "insurance poor."

You've heard of people described as "house poor," i.e. a huge chunk of their income goes to their mortgage payment and a bottomless pit of home repairs.

Dan, a 54-year-old Minneapolis resident, is insurance poor.

He says he spent close to 40 percent of his $20,000 annual income this year on health-insurance premiums, the deductible, out-of-pocket costs and co-pays. He is covered by the Minnesota Comprehensive Health Association, the high-risk pool for people denied insurance for pre-existing conditions.

Some health-policy wonks would say Dan meets a common definition of underinsured — he spends more than 10 percent of income on health care.

For a number of years, Dan was eligible for MinnesotaCare, the premium-based insurance program for low-income residents, but he was "dis-enrolled" because a boost in income pushed him over the income limit. "It was probably less than 100 bucks," he said of the increase in income. Before the dis-enrollment, he started draining his savings to pay down his home mortgage in order to stay within MinnesotaCare's asset limits.

Will final bill help these people?
With the U.S. Senate poised to pass its reform bill by Christmas Eve, Dan is among the people on my mind. Will the Senate and the House conferees be able to pass a final bill that will help Dan and the many people I've met in 18 months of covering health policy, reform and state programs? Here are a few others on my mind:

• Lucy Buckner-Watson and her 20-something daughter, who was uninsured when she found a lump in her breast and was afraid to tell her mom.

• Karen Sandness, who carries a high-deductible individual insurance policy but hasn't had a colonoscopy because it costs more than her monthly rent. Dan came to my attention as a commenter on that story.

• A retired insurance broker who emailed that he was turned down for an individual policy by the insurer for whom he sold policies.

• Homeless advocate Monica Nilsson, who tirelessly fights to save Minnesota's endangered General Assistance Medical Care program to help the poorest of the poor at St. Stephens Human Services, and her charges, who eventually could be helped by Medicaid in 2014.

• An uninsured self-employed friend who died 45 days after he was diagnosed with colon cancer. Since he couldn't afford an individual policy, he didn't get the colonoscopy that might have prevented his death. (And even if he'd been able to obtain an individual policy, he still might have had to pay for a colonoscopy because of a likely high deductible.)

These people and others have helped me focus on what's at stake in this national reform debate.

I come from the school of journalism that believes a journalist's role includes, to borrow an old phrase, comforting the afflicted and afflicting the comfortable. I've had the privilege of talking to people from both groups – along with many others from all along the political spectrum – to get their knowledge, insights and views. Having done that, I won't apologize for concluding that our nation should have some kind of universal health care, for digging into why we're not there yet – and for questioning whether reform proposals will improve affordability.

Smaller premiums, out-of-pocket costs
The other day, Dan and I chatted over the phone about his experience with MCHA and MinnesotaCare, as well as the good news that his employer, a "very small medical-device company," will start offering health insurance to its fewer than 20 workers. The premiums and out-of-pocket costs won't devour as much of his income.

But how has Dan managed to fork over that much money for his MCHA premium and out-of-pocket costs this year?

"My income isn't huge," he said. "It's typically less than $20,000 a year, but I'm a pretty good saver. … It's [health care] expensive but I don't know how long I can keep it up."

State law allows MCHA to charge its 27,000 enrollees as much as 125 percent above the market for individual insurance. According to Minnesota Department of Commerce estimates, MCHA received about $123.1 million in premiums and interest income in 2009 and claims of $245.8 million. The difference, about $122.7 million, comes from a 2- to 3 percent assessment on insurers' premiums, a cost passed on to individuals and employers buying insurance in the private market.

"Commerce occasionally receives requests to have the commissioner review MCHA's rates," communications director Nicole Garrison-Sprenger wrote in an email. "In the last nine years, in most cases, we've accepted MCHA's proposed rates. The accepted rates are generally in the 117 percent to 123 percent range."

Besides MCHA, Dan and I talked a bit about the relief that federal reform might bring to people in his boat, which got me to thinking that I've met so many people who also might benefit from some aspect of health-care reform.

Deep in the 2,700-page latest Senate bill and the 2,000-something House bill are provisions to help low- to middle-income Americans buy insurance and to clean up some of the abuses in the individual market.

Subsidies, limits and prevention
For one thing, Dan and others wouldn't be denied insurance because of pre-existing conditions if they lost a job and employer-based insurance in the future. Once reform is implemented, MCHA might not be needed. A layoff from a 20-year employer is what led Dan to MinnesotaCare and MCHA in the first place. Dan would qualify for a federal subsidy through a health-insurance exchange and there would be limits on deductibles and out-of-pocket costs, though there is still concern about affordability. Karen could get her colonoscopy because preventive care would be covered independent of any out-of-pocket costs or deductibles.

Dan and Lucy would be able to carry their young adult children until age 26 or 27, depending on which chamber's provision makes it into the final bill. (Minnesota already requires employer-based policies to carry children until age 25.)

"I've been watching federal reform," Dan said the other day. "When the Senate was thinking of opening Medicare to age 55 I thought, 'Yah!' Then what's-his-name — [Sen. Joe] Lieberman — had to shoot it down."

If only members of Congress and the president would keep front-and-center all the Dans, the Lucys, the Karens and our friends and neighbors, my inner idealist wants to think our lawmakers would have an easier time of bringing some relief to millions of Americans.

Instead, my inner skeptic frequently worries that they are getting lost in the politics and the high-dollar lobbyists for the insurance industry, the pharmaceutical industry, our homegrown medical-device industry, doctors and providers who don't like what Medicare pays or under-pays, and lobbyists for baby boomers like me who don't want anyone messing with Medicare or Social Security.

Big spenders
In June, Common Cause estimated that health-industry lobbyists had spent about $1.4 million a day so far on Capitol Hill. Multiply that daily amount by however many days Congress is in session and the total might well come close to covering the annual expenses for Minnesota's GAMC program for the poor.

And, it seems to me, Dan, Lucy, Karen and others are getting lost in various attempts to hijack the legislation for political causes. For example, health-care reform was held up for millions of Americans because of two anti-abortion Democrats (Rep. Bart Stupak and Sen. Ben Nelson)? Seriously? Shouldn't that be a debate for another day?

Stupak, Nelson and 8 million federal employees are covered by the Federal Employees Health Benefits Program, at times described as the most generous health care in the nation. Day to day, they probably aren't worrying whether they can afford their premiums, a colonoscopy, co-pays for prescriptions and any out-of-pocket costs.

I, too, have been blessed with good health coverage all my life, starting with government care for military families. Taxpayers paid for my tonsillectomy at age 6 and the removal of my wisdom teeth at age 18 and all the shots in-between. Growing up with that kind of health care, I've found myself at times completely flummoxed that the United States of America doesn't offer universal health care. I could get free shots on an Army base in Okinawa long ago, but some of my taxpaying friends and story subjects can't get accessible, affordable care in the United States?

In my adult years, I've been covered by employer-based insurance plans that cost half of what Dan or Karen pay. The highest deductible I've ever faced is $1,000; the highest monthly premium was about $560, when I was on COBRA for several months between jobs.

In June 2008, my uninsured friend died of colon cancer. I wrote about the pain and the questions prompted by his preventable death at age 60 and I promised to ask more questions. Judging from some of the comments on my stories and the emails since then, it appears I've afflicted a few of the comfortable. If I've also occasionally managed to comfort the afflicted in the process I'm doing my job.

As senators prepare to pass a bill and to meet with House conferees in the New Year, my inner idealist and my inner skeptic are slugging it out, one hoping the afflicted will win and the other fearing politics and the comfortable will prevail.

Casey Selix, a news editor and writer for MinnPost.com, can be reached at cselix[at]minnpost[dot]com. Follow her on Twitter.