'I work sick all the time'

from the Fort Worth Star-Telegram

For families without health insurance, illness can lead to lost wages as well as high medical bills

Ninth in a yearlong series on the struggles of Tarrant County's working poor.

Ofelia Luevano prays that three of her children don't get seriously hurt or ill.

Not only for their well-being but also because they don't have health insurance.

The four children she and her husband, Antonio, took in about three years ago qualify for Medicaid, but the couple's natural children don't.

So Ofelia said she stockpiles over-the-counter medications for when Carlos, 17, Antonio, 12, and Omar, 11, get colds and other illnesses that "I can fix."

The three Luevano youngsters are among the estimated 9 million children living in the U.S. without health insurance, according to the Kaiser Family Foundation, a Washington, D.C., nonprofit healthcare research organization. Of those children, 75 percent come from low-income families.

If children don't get routine medical care, their parents probably don't either, according to Jennifer Tolbert, Kaiser Family principal policy analyst. In Texas, more than 39 percent of working-poor parents are living without insurance coverage, according to foundation research. Ofelia isn't covered, but her husband, the family's main wage earner, has health insurance through his employer.

"If he gets insurance for the rest of the family from his job, we'll end up with no groceries at home," Ofelia said. "We can't afford it."

A growing problem

Vedat Lika, who teaches low-income people how to cook, earns $40,000 a year and pays $29.16 a month to insure himself through his employer, the Tarrant Area Food Bank. A family medical plan that would cover Vedat and his two 5-year-old children would cost $422.18 a month, or $194.85 per two-week pay period, so he pays for his children's immunizations, checkups and other medical bills in cash. He believes it's cheaper.

He hopes to boost their immune systems by giving them vitamins, forbidding junk food and preparing organic meals.

But he spends $41.80 a month through his employer to put his children on his dental insurance.

Vedat, 52, applied for Blue Cross Blue Shield medical insurance for his children. It would cost about $180 a month, if they get approved.

His daughter, Madison, is generally in good health, though she needed fillings. But his son, Arman, has Asperger's syndrome. The Fort Worth father worries that the pre-existing condition could make Arman uninsurable. His son receives special services from the Fort Worth school district, but Vedat said he is also talking to specialists at Cook Children's Medical Center and at the Child Studies Center in Fort Worth to get additional help for Arman.

"The teachers are fine, but there are so many kids with problems," Vedat said.

Vedat struggles to balance his budget. He is still repaying loans from relatives and friends who sent him money during the eight months he was unemployed before he got his job May 1. Vedat also declared bankruptcy last summer and must make monthly payments toward his debt. And he wants to make sure to have enough in the bank for emergencies, such as a recent $500 car repair.

The issue of high healthcare costs has not been lost on the electorate. About 61 percent of likely American voters rated healthcare as very important, according to a Rasmussen poll released Feb. 3.

Between 2003 and 2006, the number of uninsured people in the U.S. grew about 8 percent, from 43 million to 46.5 million, because of rapidly rising health premiums and lost or stagnant wages, Tolbert said.

"Certainly the problem has been getting worse over time," she said.

The Luevanos, whose annual income is about $31,000, receive Medicaid, the federally subsidized health insurance program, for four of their children -- Victor, 5; Juan, 8; Fabian, 6; and Juliette Martinez, 7. The Martinez children were provided with Medicaid, which covers health and dental expenses, with the help of Texas Child Protective Services.

CPS is helping the Luevanos adopt the Martinez children because the youngsters' family cannot care for them, said Fort Worth attorney Frank Adler, who is handling the adoption.

Ofelia, 40, who works part time at a bridal shop, said she has tried to get Medicaid for her other three children but was denied. The Haltom City couple earns too much money. She never applied to the Texas Children's Health Insurance Program, which has more generous income limits.

"I didn't apply because I don't think I would qualify for it if I didn't qualify for Medicaid," she said.

Even though Antonio has health and dental insurance, his co-pays can still sink a budget. He recently had a tooth and a silver bridge in his mouth break, requiring surgery.

"Out of pocket it cost him about $800, although the insurance paid the rest," Ofelia said.

Antonio, 38, a welder, was fortunate to have dental insurance. About a third of adult Americans don't, according to 2004 figures provided by Kaiser.

Sick days

With three children and five sick days, Terri Rushing, 49, of Grapevine has to use her time carefully.

The single mother will often suffer through work with a hacking cough or a hammering headache.

"I work sick all the time," said Rushing, a trainer at the Gaylord Texan Resort & Convention Center. "You just have to put yourself aside when money stretches thin."

Her son, Caleb, 11, was sick with strep throat for several days last month and went to an urgent-care clinic this month for the flu.

That day, Rushing had to take off work to take care of him, forfeiting her pay because she had used all her sick time.

She was four days shy of the anniversary of her start date, when her annual sick time would have been replenished.

She spent her allotted week of vacation traveling with her children on overnight school field trips and to Oklahoma for Thanksgiving. She also has to take time off over other holidays because day cares are closed.

To try to pre-empt colds, Terri refers to her dog-eared book of natural-healing treatments for an herbal remedy.

For quick fixes, Terri carries a bottle of colloidal silver for when her kids are sick and drops the serum on her tongue to boost her immune system at the slightest sign of a sore throat or runny nose.

Still, she's better off than many in her income level of $27,600 a year. Her children are covered under an insurance policy paid for by their father.

But expenses not covered by insurance, such as Tamiflu received at Caleb's recent hospital visit, can add up to hundreds of dollars quickly.

Terri estimates that she paid $1,200 last year for medical expenses that insurance didn't cover, including prescriptions, urgent care, and part of the cost for glasses and eye exams for her daughters, Gabriella, 12, and Hannah, 11.

Terri hasn't been to a medical doctor in years but carries insurance for herself in case she falls dangerously ill.

In the coming year, Terri hopes to earn enough money to put her children on her plan.

That would cost an extra $400 out of her paycheck per month.

Costly cuts

Bobby Lockwood cut his leg Dec. 30 in the family's back yard while installing a swing set that a friend had given his children.

The two gashes, each about 12 inches long, didn't require stitches. However, the pain caused Bobby to miss 2 1/2 days of work.

His family nearly had to seek emergency food assistance, said Edwina Lockwood, Bobby's wife.

Bobby's job in the shipping area of an Arlington industrial plant doesn't come with paid sick days.

He used his one week of annual vacation time in August, so he misses a day's pay for each day he stays home.

That can spell big trouble for the Arlington family of five, which gets by on $29,000 a year.

"I tell myself, 'No, I can't afford it,' and I go to work," said Bobby, 38.

His wife stays home to take care of the couple's three children: Michael, 13, Robert, 5, and Clayton, 3.

Since May, they have had private medical, dental and vision insurance through Bobby's job, for about $160 a month. The deduction from his checks was initially a shock, but the couple is glad to have the coverage.

When Bobby started his full-time job in November 2006, he waived insurance coverage because Medicaid covered the children.

But the family lost Medicaid coverage in February because Bobby was making too much money.

So Edwina just prayed that the kids would stay healthy until the family's private insurance kicked in. They were among the 15.8 percent of Americans and 24.5 percent of Texans who have no health insurance.

During that time, a prescription to treat 13-year-old Michael's attention problems topped $200. Edwina sought and received help from his school.

With insurance, the pills now cost only $15 a month. That came as a relief to Edwina, who says her son is "a totally different child" without Adderall.

Bobby, who has had all but eight teeth removed because of dental problems, would like to get dentures.

He fears that the co-pays would be too much if he gets the procedure through his new insurance.

"I haven't really looked into my dental, the full extensiveness of it," Bobby said. "But I don't think they do pulls unless it's emergency root canals. It's hard because some of the foods I like the most -- I love the raw carrots, and I love my celery -- but with my teeth as bad as they are, I can't bite into stuff."

Getting medical help

Low-income families have several low- or no-cost options for healthcare. But the regulations can be cumbersome, and some programs cannot meet demand.

Government programs

Medicaid: The federal health insurance program will cover most children whose family income is no more than 100 percent of the federal poverty level, or $20,650 a year for a family of four. In Texas, Medicaid will not cover the vast majority of low-income adults.

For information, call 877-543-7669 or visit www.chipmedicaid.org.

Texas Children's Health Insurance Program: Children in families that earn less than 200 percent of the federal poverty level, or $41,300 for a family of four, are eligible for CHIP. However, families that make more than 150 percent of the poverty level, or $30,975 for a family of four, are subject to an assets test. Assets such as cars and most bank account balances are considered when determining whether a child will be accepted. There may be enrollment fees. For information, call 877-543-7669 or visit www.chipmedicaid.org.

Private or nonprofit programs

Albert Galvan Health Clinic, 2106 N. Main St., Fort Worth. The clinic provides medical care, immunizations and management of chronic diseases. The clinic accepts Medicare and Medicaid and charges a sliding fee based on a family's income and size. Call 817-625-4254 or visit www.aghc.org.

Cornerstone Medical Clinic, 915 E. Peach St., Fort Worth, is a free clinic in the Cornerstone Community Center. The faith-based operation for underprivileged Tarrant County residents is headed by doctors who volunteer five times a month. About 40 patients are given full medical exams, prescriptions, mammograms and other medical services at each clinic. Eligibility depends on space and a phone interview. Call 817-336-1922 or visit www.canetwork.org.

JPS Health Network, which includes John Peter Smith Hospital in Fort Worth, provides low-cost medical services. Eligibility is determined by the household's size and monthly income. JPS Connection is available to those who don't have Medicaid, Medicare with a prescription plan, or any medical coverage that covers all or part of medical services and prescription costs. People must also provide proof that they live in Tarrant County. For information, call 817-222-2577 or visit www.jpshealthnet.org.

Mission Fort Worth, 4401 Vermont Ave., Fort Worth, is open from 11 a.m. to 2 p.m. on Wednesdays and Thursdays, two Tuesday mornings a month and one Saturday morning a month. Call 817- 207-0229.

The Allan Saxe Dental Clinic and the Bob Mann Medical Clinic at Mission Arlington/Mission Metroplex, at Mission Arlington's campus at 210 W. South St. Patients are seen at the free medical clinic on a first-come, first-served basis. For medical clinic hours, call 817-277-6620. Come to the Mission's front office to make appointments at the dental clinic and to inquire about free eye exams.

Dental Health for Arlington, 201 N. East St., Arlington, treats children through its programs in elementary schools. The nonprofit program also operates a low-cost clinic for families that have no insurance and earn 125 percent or less of the federal poverty level, or about $25,812 for a family of four. Dental Health takes new appointments every two months. Call 817-277-1165 or visit www.dentalhealtharlington.org.

GRACE Outreach to Health Community Clinic, 837 E. Walnut St., Grapevine, provides medical care, lab work and medications. Patients must live in Grapevine, Southlake or Colleyville; have no insurance; and live at or below 200 percent of the federal poverty level, or about $41,300 for a family of four. Call 817-488-7009, ext. 100, or visit www.gracegrapevine.org.

About the series

Four Tarrant County families who live at or near the poverty level have agreed to be a part of a yearlong Star-Telegram project that examines the hurdles facing the working poor. The families were contacted on the paper's behalf by social service agencies, churches or charities. Today's installment looks at the cost of healthcare.