Uninsured Americans are more than 40 million strong, and they are all around us.
They may be the waitresses who pour our coffee in restaurants, the substitute teachers who sometimes take over our children’s classrooms.
Or the nanny, the cleaning lady, the artist down the street, the freelance writer, the part-time clerk in a drugstore who also works a second job, the neighbor who lost his job when a company folded or moved out of town.
Congress has been debating a patient’s bill of rights for the already insured and has considered revising the rules under which the poorest Americans are served through Medicaid, also numbering about 40 million. Meanwhile, the vast population of the uninsured still lives in fear of the next unexplained ache.
They’re living on a prayer, hoping that an accident or serious illness won’t strike them or their loved ones and turning to charitable clinics when necessary. They’re good, industrious, taxpaying people who live under the constant threat of financial ruin.
Cherie and Walter Knitter of Wheaton have been struggling without health insurance for several years.
Walter was a sales manager until the company he worked for closed its local office a year and a half ago. Even with full-time employment, insurance wasn’t a benefit. Now he’s doing some consulting work while trying to find a full-time job with benefits. The Knitters, both 44, have five children ages 6 through 16, all diagnosed with attention-deficit disorder. With income from sales commissions unsteady in a shaky economy, the premium for family insurance coverage at $700 a month would have been prohibitive.
When Cherie, trained as a lab technician, took a low-paying job to help out, it turned out to be counterproductive. “Everything kind of fell apart at home because the kids need structure,” she said, “and by the time taxes and insurance were deducted, I wasn’t clearing that much.”
She said she spends a lot of time worrying about her family’s health.
“My 13-year-old loves skateboarding. Even though I insist that he wear a helmet and wrist guards, it’s very scary thinking about him getting hurt. You have to make sure they understand that they have to be really careful. We can’t just pack them up and take them to the emergency room. It’s costly.”
For treatment of their children’s ADD, they take them to DuPage Community Clinic, a facility staffed by volunteer doctors and nurses that asks for only a $5 voluntary donation. It’s part of a loose safety net of clinics and sympathetic doctors who lower their fees or extend credit to the uninsured.
The Knitters would prefer to make it on their own, but for now they’re grateful for the clinic’s help.
They also take their children to a pediatrician who gives them a discount.
“It’s still $60 a visit per child,” Cherie Knitter said. “In the winter season we usually have a running balance of $500 or $600 for them.”
Upon learning of KidCare, a state program to insure children, the Knitters said they may look into that for help. (See accompanying story.)
The elder Knitters try to take care of themselves, eating healthy food and handling minor problems with over-the-counter remedies.
“I went to an urgent-care center for a throat problem, but other than that I haven’t seen a doctor since my postpartum exam after the birth of my 6-year-old twins,” Cherie said.
“Luckily, neither of us has been really ill, knock on wood. It’s scary; we’re getting older. I pray that God watches out for us until things get better.”
Millions without insurance
In 1999, 42 million, or more than 1 in 6 non-elderly Americans, did not have health insurance, according to the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured.
Eighty-three percent of the uninsured are in working families, 71 percent employed full time and 12 percent part time.
Low-wage workers are less likely than others to be offered insurance as a benefit either through their own or a spouse’s job, and the cost of private insurance may be economically out of reach.
“Seventy percent of the people at our clinic are working,” said Joyce Poll of the Community Health Clinic in Chicago. “But either they can’t afford the premiums, their employer doesn’t offer health insurance, or they give it to the employee only. Some won’t take that because they feel guilty being the only one in the family with health insurance.”
What’s more, the insurance void grows even larger when other screening limitations are taken into account.
A Kaiser report released this summer on the accessibility of health insurance for consumers “in less than perfect health” showed that even if coverage is available, benefits may be limited, and premiums may come with a surcharge.
The study followed seven hypothetical consumers through the applications process with 19 insurance companies and HMOs in eight markets around the country, including Arlington Heights.
All of the applications of a 36-year-old man who is HIV positive were rejected, as were 55 percent of the claims of a 62-year-old overweight smoker with high blood pressure.
Living in fear
But even people with mild and common health conditions such as hay fever and asthma faced rejection.
Karen Bonnes, 39, of Burbank, a clinical social worker, is typical. Bonnes contracts her services to nursing homes and makes visits to the homebound.
Yet she cannot get affordable health insurance because she has epilepsy, a disorder that developed as a result of a head injury almost 20 years ago.
“Even though the seizures are under control with medication, it’s considered a `pre-existing condition,'” she said.
“I’ve tried to get insurance, but the premiums would be $380 a month. I don’t even make $380 a month.”
Bonnes is treated by a family practitioner associated with Access to Care, a health-care program based in Westchester that serves low-income, uninsured people in suburban Cook County, charging nominal fees.
Still, “every day of my life I’m afraid of something happening,” Bonnes said. “I had an emergency appendectomy three years ago at Oak Forest Hospital, and I’m still paying on the bill. I pay $10 a month. I never get ahead financially.”
Back to work
Lorraine Leon, 66, of Chicago, retired a year ago but was forced back to work to pay the costly insurance premiums for her 60-year-old husband, Salvador.
The couple work in a small suburban tool factory. They had been paying $400 a month for his share of an insurance premium under the Illinois Comprehensive Health Insurance Plan, a program meant for low-income people who cannot afford standard health insurance, and $100 for her Medicare supplement. Salvador’s premium recently increased by about $25. Even so, they have to pay the first $1,000 of the cost of the medication Salvador needs to treat his high blood pressure.
“I can’t quit work,” said Lorraine Leon, “and I’m frightened about what would happen if my husband got laid off.
“All we made last year was $42,000 for both of us. That is hardly anything nowadays. We have to pay our house taxes. Thank God we just finished off paying the mortgage or we’d be choking. My 17-year-old grandchild lives with us. She works in a drugstore part time to pay for her clothes.
“I have been in good health. So far I only had a hernia. I don’t know what I am going to do if I have to buy medicine.”
A path to bankruptcy
Uninsured medical expenses often lead to financial collapse.
An article published in the May issue of the New York University Law Review that analyzed bankruptcy filings in 1999 as part of an ongoing Consumer Bankruptcy Project estimated that more than half a million middle-class families turned to bankruptcy courts for help after illness or injury that year.
As a cause for bankruptcy, it was second only to “poor debt management.”
Untreated medical problems exact another toll.
“The biggest effect of not having medical insurance is delay of proper care,” said Dr. William Preston, an internist in Western Springs who volunteers his services to Access to Care, which pays him a reduced rate.
“Sometimes people end up being sicker, and they get admitted to the hospital in crisis. For example, gallbladder attacks. People will put up with the pain, struggle through it rather than have gallbladder removal. And when they’re finally forced to have it done, it’s because the gallbladder is ruptured, and that becomes a more serious problem.”
Preston said he chose to participate in Access to Care because of the realization “that people often end up uninsurable or underinsured for reasons beyond their control. It isn’t always voluntary, and for those who are the `haves,’ that’s sometimes hard to remember. I see no reason to penalize them.”
`I can’t get sick’
Lucy Hall of Hanover Park, a 44-year-old single adoptive mother, was in a bad way one day a while back when she was taking her two daughters, now 9 and 10, to see a physician under their insurance associated with the adoption.
Hall felt terrible but did not seek help because she was without medical insurance since she lost a managerial job when the company folded. She turned to full-time substitute teaching so that she could keep the same hours as her daughters. (She plans to earn a master’s degree and get a full-time teaching job.)
She found herself silently repeating a mantra: “I can’t get sick. I can’t get sick.” But her children’s doctor noticed her distress and referred her to a free clinic.
As it turned out, her blood pressure was elevated and she also needed an echocardiogram.
Though she acknowledged, “I’m out on a limb,” she has turned to the community for help reluctantly. “I don’t have the money to pay,” she said. “It’s a pride thing.”
The situation seems bleak, but Dr. Richard Corlin, president of the American Medical Association, believes things could change if ideology would give way to pragmatism.
“We need to be prepared to accept incremental improvements,” he said, noting that proposed solutions in the past would not have solved the entire problem and were rejected accordingly.
Proposals for change
For starters, the association proposes a change in the federal tax code to redirect current tax subsidies from employer-sponsored health plans to income-related, refundable tax credits to individuals, a change that would benefit lower-wage earners.
The doctors’ group also proposes that the consumer rather than the employer be allowed to choose a health plan that would be portable if an individual changed jobs.
The United States is the only developed country without universal health care, noted Dr. Quentin Young, a Chicago internist and an officer of Physicians for a National Health Program, a 9,000-member organization founded in 1988 that advocates national single-payer health insurance.
“Every one of the 18 industrial, democratic societies from France and Scandinavia to Canada and Japan have come to believe and act on the premise that it is important to the whole society that its entire population have health care, that leaving it to individuals is self-defeating,” Young said.
“The relationship between illness and ability to pay is inverse,” he added. “The sick get poorer and the poor get sicker.”
A dose of help
Depending on family income levels, children, at least, may not have to do without health-care coverage.
The State of Illinois offers an insurance program known informally as KidCare, for children up to age 18 and pregnant women, and helps in paying premiums of employer-sponsored or private insurance plans.
KidCare has several insurance plans whose costs depend on family income. Under its “assist plan,” for example, all of the children’s health-care costs would be paid for a family of four with a monthly income of about $1,956 or less. Under the “premium plan,” a family of four with a monthly income of $2,207 to $2,721 would pay a $3 to $5 co-payment for medical visits and prescriptions in addition to a $30 monthly premium.
For information about KidCare or other state health insurance programs that may help, call 800-226-0768.
The Campaign for Better Health Care, a local advocacy group, provides a hot line for locating free health-care clinics. Call 888-544-8272.
