Thank you for the information. Since the husband is self-employed, he can deduct the medical insurance premiums he pays for the family directly from the money he earns in his business. Deducting 100% of medical premiums from taxpayer's income is only allowed to self-employed people, but it can offset much of the premium with tax savings.
An option that is available to your sister and her family is a high-deductible health insurance plan. A way to save money for most people is a health savings account (HSA), which is a program that allows people to pay for normal health care out of pocket using pre-tax money, while having an insurance plan with a high deductible for significant and costly health emergencies. Since your sister's husband is self-employed, he can already deduct health insurance premiums, but it still would be worthwhile for your sister and her husband to discuss a HSA with the various health insurance companies they contact for quotes on health insurance coverage.
Since your sister has such high premiums on their health insurance, a high deductible health insurance plan might save money for them. It depends on how much money they have to regularly pay for health care. If their regular payments are low, but they may have extremely costly emergencies; a high-deductible plan may help them. The high deductible plans work just like auto insurance. If you have a high deductible, you pay more out of pocket before the insurance starts paying, but the premiums are lower.
Many companies offer high deductible health insurance plans. Some of these companies with programs worth reviewing are: Regence, PacificSource, United Health One, Anthem, Humana, and Blue Cross/Blue Shield. Your sister and her husband should either review the web sites of these companies and see if they can get quotes online or contact these companies by phone and request a quote. There are many other companies; these are just the biggest companies that offer high deductible health insurance plans.
Unfortunately, while the Patient Protection and Affordable Care Act of 2010 made it illegal for a health insurance company to refuse to insure someone due to a pre-existing condition, the companies can still increase premiums to account for the higher costs of someone with pre-existing conditions. Your sister and her husband will be able to change health insurance companies despite the pre-existing conditions; but the premiums may be too high for this new rule to help.
Another option that your sister should explore is the income limits for Medicaid in the state in which they reside. Based on the family income, they may be able to qualify for Medicaid or at least for some help with their health care costs. You should be able to find a number for your sister's state's Medicaid program in the state government information part of your (their) telephone book.
I hope these suggestions are helpful. Please let me know if you want me to clarify any information or give you more information about anything I've discussed. I will be happy to continue help you with this question.