Uninsured ranks in U.S. include more than poor

from The Rockford Register Star

By Julie Appleby
Gannett News Service

Susan Squire lost her health benefits in 2000 when her company downsized and she was laid off. A few years later, she had a heart attack — leaving her with a $92,000 hospital bill.

Dianne Stewart, who once had a six-figure income and health insurance benefits as an advertising saleswoman, now relies on the generosity of a group of doctors in her town near Charlotte, N.C., for low-cost medical care.

Joe Cesa, owner of a Philadelphia coffee shop, put a $3,000 emergency room bill on his credit card when he accidentally cut off the tip of his thumb. He can’t afford insurance for himself or his employees.

While each of their backgrounds is different, all have one thing in common: Through choices, circumstance, bad luck — or a combination of all — they are among the more than 46 million people in the United States, nearly 16 percent of the population, who lack health insurance.

For the first time in more than a decade, the debate over how to provide health care for the uninsured is moving back to center stage in Washington and many state capitals. After languishing as a major issue since President Clinton’s health care plan failed in 1994, health reform is back on the agenda — from President Bush’s State of the Union speech to stump speeches from presidential candidates. “It’s amazing and extraordinary,” says Drew Altman of the Kaiser Family Foundation, a non-partisan research group based in California. “This issue was nowhere as a top political priority four or five months ago. Now it’s front and center again.”

And it’s not just Washington lawmakers: In recent weeks, business leaders, including those from Wal-Mart and the Business Roundtable, have teamed with their traditional opponents — labor unions — in calling for health system change. Several states, including Massachusetts and Vermont, have enacted laws aimed at covering the uninsured, while more than a dozen others have some type of proposal under debate.

For the uninsured —whose ranks include the poor and the well-off, the employed and the jobless, the young and the middle-aged — the issue is more than just a political debate: Those without insurance face financial difficulties and are less likely to get comprehensive care for chronic conditions. The Institute of Medicine, in a series of reports published in 2004, concluded that 18,000 people in the U.S. die each year because they lack insurance.

Lela and T.J. Robichaux’s son has autism, for which he needs ongoing physical and occupational therapy. While Trenton, 8, once qualified for Louisiana’s Medicaid program, the family’s income rose and he has not been eligible for more than a year.

So the Shreveport family relies on what therapy he can get at school, which Lela Robichaux says is barely adequate. “He gets an hour a month of occupational therapy and 30 minutes of speech therapy a week,” says Robichaux, 33.

Lela, an internal quality-control officer at a company that does not offer health benefits, is the family breadwinner, earning about $750 a week, or $39,000 for the year. That amount puts them over the $34,340 annual income limit to get Trenton care through the state’s Medicaid program for children.

As in the majority of states, Louisiana limits family income to no more than 200 percent of the federal poverty level, or $34,340 for a family of three, to qualify. In nine states, the upper limit is less than 200 percent, and in 17 states and the District of Columbia, families can earn more than 200 percent of the federal poverty level and still qualify.

The couple looked into private insurance for their son. But, with his health conditions, the cost was prohibitive, she says. “There’s no way we could afford a private policy,” she says. “When my son was 3, we applied for a policy just for him. It was $700 a month.”

T.J., 33, is working toward becoming a physical therapy assistant and expects to complete his training in a year. The couple hope he can land a job that comes with insurance.

“My husband and I don’t go to the doctor unless it’s absolutely necessary,” Lela says.

She takes her son to see the doctor when he needs care and pays cash. They have no credit cards, having survived a bankruptcy several years ago.

“A lot of the doctors are very good working with us,” Lela says. “They don’t demand full payment right then. I know that some of them have adjusted their pricing.”

When Trenton was born, the family did not have insurance. “We took out a loan from the bank,” Lela says, “because the hospital wanted a down payment. We paid the rest off a few years after that.”

She says the Medicaid program needs to be more flexible.

“The system is designed to keep people down,” she says. “If you start stepping up, (and) accepting raises (you don’t qualify). People will actually get divorced to get service. ... The whole system needs to be looked at.”