When you hear that millions of adults in this country lack health insurance, whom do you picture?
The unemployed, certainly. And the underemployed: those twenty-somethings working at McJobs and earning less than [DOLLAR]20,000.
But here's the picture we often miss: 48 million adults went without health insurance in 2005 -- and 67 percent of them are in households in which at least one family member is working full-time, according to a study conducted by the Commonwealth Fund, a foundation that researches health-care issues. More than 9 million of these working adults make more than [DOLLAR]35,000 a year -- yet they can't afford or don't qualify for coverage. More and more, they're people just like you.
They're new parents like the Barrs, in Denver, small business owners who, because they don't qualify for group-rate policies, paid for maternity, delivery, and postnatal care with credit cards. They're like the Duckworths, in Mi Wuk Village, California, parents of five who make too much money to be eligible for state aid but who can't afford private insurance and are now postponing medical care while they wait for a new employer-based plan to kick in. They're fathers like Eric Woodland, in Springfield, Ohio, who's lucky enough to have a job with a major corporation that provides health insurance for his family -- only it doesn't cover his daughter's asthma care.
In short, they're parents who are doing everything possible to provide for their children's health and well-being, but when it comes to that most fundamental of safety nets -- health insurance -- they're helpless to stop the unraveling. Read on for their stories.
Melinda Marshall, mom of three, is the author of Good Enough Mothers: Changing Expectations for Ourselves, published by Peterson's.
Paying for childbirth with credit cards
[TOUT_IMAGE "/1106_insurance_1.jpg" "150" "200" "Barr Family" "right"]
Who: Layla and Emmet Barr
Where: Denver, CO
Insurance status: Uninsured
Isabela Barr, born in July 2005, was the one plus in a year of minuses for Layla and Emmet Barr, owners of a catering business in Summerland Key, Florida. Hurricane Dennis that month, then Katrina and Rita, devastated the local economy. Wilma, which caused [DOLLAR]40,000 in damage to their home that October, was "the straw that broke the camel's back," says Emmet. They wound down their business and moved to Denver.
A [DOLLAR]22,000 hernia
Five years before, when Emmet was working as a chef, he got a hernia. The surgery went fine; it was their [DOLLAR]360-a-month health insurance that failed. Despite securing preapproval for Emmet's care, insurance paid only [DOLLAR]1,800 of the [DOLLAR]24,000 bill.
"I felt swindled," says Layla, who spent months arguing their case with not only the insurance company but also a state watchdog agency. "I thought, what's the point of paying for insurance if they don't cover what they say they will?"
The Barrs wound up putting [DOLLAR]10,000 of the debt on their credit cards. A hospital charity took care of the balance. Then they canceled the policy.
Pregnancy is a "preexisting condition"
In 2004 they again looked into getting insurance. They'd bought a house, launched their catering business, and learned they were expecting a child. "A lot of things can go wrong with a pregnancy, and I was thirty-four," Layla says. "We realized that with a child, we had to think beyond ourselves: What if something were to happen to one of us that we couldn't work or couldn't care for her? We both had very physically demanding jobs."
But their business didn't qualify for group insurance, and when they applied for an individual policy, they were turned down because the pregnancy constituted a preexisting condition. Layla's doctor suggested she look into public assistance, but they earned too much to qualify. "I felt abandoned," she recalls. "I started to think, maybe we can't even afford to have this child. Because if something happened, what were we supposed to do?"
By agreeing to pay up front, the Barrs managed to get prenatal care, delivery, and hospitalization costs down to about [DOLLAR]13,000. Not included was an extra [DOLLAR]2,000 in postnatal care for mother and baby. Except for [DOLLAR]500 in cash for the anesthesiologist, they put it all on credit cards. Fortunately, Layla delivered without complications and Isabela was born perfectly healthy. But then came the hurricanes. The Barrs got a second mortgage to finance repairs to their Florida home, which they rent out but haven't yet sold. They're paying [DOLLAR]1,100 a month toward owning the Denver home. And they're carrying [DOLLAR]50,000 in credit card debt.
Just too expensive
Now health insurance can only be a distant goal. With Emmet currently working a [DOLLAR]20-an-hour construction job, the couple is in no position to shell out [DOLLAR]400 a month for a policy with a [DOLLAR]4,000-per-person deductible for hospitalization, to say nothing of the [DOLLAR]2,500-per-person deductible for standard care, which are the figures they were most recently quoted.
Layla is, however, taking an activist role. This past spring, after a friend referred their case to the Robert Wood Johnson Foundation, the foundation flew the Barrs to Washington, DC, to make their case to Congress in person, as part of "Cover the Uninsured Week," the private endowment's advocacy initiative. "My taxes pay for every government employee's health care," Layla said she told them, "but I don't have enough money to pay for my own -- and even when I do, I can't get covered."
Postponing health care -- to qualify for health insurance
[TOUT_IMAGE "/1106_insurance_2.jpg" "200" "150" "Duckworth Family" "right"] Who: Shannon and Michael Duckworth
Where: Mi Wuk Village, CA
Income: [DOLLAR]60,000 (approximate)
Insurance status: Between policies; coverage pending at Michael's new job
April was the cruelest month for Shannon and Michael Duckworth, parents of five, ages 5 to 16. In March Michael had lost his job selling cars at a nearby dealership, and the family struggled to pay their bills.
Things began looking up in May, when Michael landed a new job selling carpet. With commissions, he expects to make even more than he did last year. Better yet, after a six-month probationary period, he'll be able to enroll in the company's health-insurance plan -- a safety net the Duckworths haven't had since 2000.
But Shannon is not yet breathing easy. For the time being, the family is without any medical coverage.
"It's so frustrating," she says. "Do I try and get my kids enrolled in some state program in the meantime? Or do I wait until I can get all of us on one policy so that we can have consistent care and not have our records and tests all over the place?"
Trapped by the system
The family's situation is more than frustrating -- it's frightening. For Shannon and Michael to become eligible for the employer-based insurance, they must not present any "preexisting conditions" -- the kinds of chronic and potentially costly problems that prompt insurers to deny coverage.
"It's terrible," Shannon says. If she or her husband gets ill or injured, they're faced with tough questions: Should they seek help, or wait and risk things getting worse? If the problem is "preexisting," will they just have to pay more when coverage starts? "I don't know who to call to find out, without tipping our hand," Shannon says.
As a consequence of this, Michael has been postponing the repair of a torn rotator cuff since July. He'll have it fixed when his insurance kicks in, but until then he's working through the pain.
Shannon also spent several long months worrying that the family's new insurer would refuse coverage for their son Mike Jr. due to his chronic condition -- he suffers from seizures, likely the result of scar tissue from surgery to remove a brain tumor when he was 11. Recently, Shannon learned all her anxiety was for nothing: Because he's a minor, her son's condition would not have precluded his coverage.
For now, though, getting Mike the treatment he needs is a challenge. Medication can control his seizures, but he has to see a neurologist to get a prescription. For months Shannon resisted making the appointment because they lacked the cash or credit to pay for the doctor or the medicine. (Debt from past ER visits cost the Duckworths their credit rating.)
But when Mike suffered three seizures in one week, Shannon took him to a doctor. "I couldn't take the chance that he'd hurt himself." She paid [DOLLAR]70 for the doctor, [DOLLAR]108 for blood work, and [DOLLAR]56 for a month's worth of medicine by cashing an unemployment check her husband received belatedly.
Taking real risks All other health-care concerns are on hold until the family gets coverage. When Matthew, 14, hurt his leg during a school wrestling match, for instance, the family couldn't afford to have it checked -- even after two months of swelling.
Shannon's experience is in part prompting her to rethink her future. She's planning to go back to school for a degree in ob-gyn nursing so she can get paid for doing something she loves and also get the peace of mind that comes with having a safety net.
"Once you've got a job and your insurance is secure, you don't have to worry anymore," she says. "And that's what I want: not to worry anymore."
Fully insured, but not fully covered
[TOUT_IMAGE "/1106_insurance_3.jpg" "150" "200" "Woodland Family" "right"] Who: Melissa and Eric Woodland
Where: Springfield, OH
Insurance status: Insured
On the face of it, Melissa and Eric Woodland are among the rising middle class of their mostly blue-collar community. Eric works in an International Fiber factory in Urbana, a job that extends health-care insurance to him and Melissa and their two kids, Kaylynn, 8, and Caleb, 3.
But Kaylynn, born with asthma and severe allergies, has been suffering from significant health problems. She takes medicine to keep her airways clear every day -- steroids she inhales with the help of a nebulizer -- plus multiple medications for her allergies. Even so, she's been having such trouble breathing that Melissa has rushed her to the emergency room several times recently. Three times in the past year she's needed hospitalization and invasive procedures when her airways have suddenly collapsed.
The cost of being insured
One deductible and co-pay at a time, the Woodlands are falling into debt. While they are insured, they must pay [DOLLAR]15 to [DOLLAR]25 for doctor visits and prescriptions, [DOLLAR]35 for ER visits, and [DOLLAR]500 per hospitalization.
They don't feel they have a choice. It's care they can't live without. "If Kaylynn starts gasping for air, I run her to the doctor," says Melissa. "I can't worry about money when she can't breathe."
Kaylynn's hospital visits alone have cost the family [DOLLAR]1,500 in the past year. Doctor appointments have totaled about [DOLLAR]120 a month in co-pays; prescriptions add another [DOLLAR]100 per month. Some of the pediatric and specialist care Kaylynn has received has turned out not to be covered -- about [DOLLAR]600 worth. In addition, Melissa has debt she incurred before Eric's insurance covered her, for recurring ovarian cysts: One local hospital sued last year for [DOLLAR]1,200, and another came after her for [DOLLAR]1,250. She offered to pay the collection agencies about [DOLLAR]20 a month, but they wouldn't accept her terms. She looked into state and federal aid but found her family didn't qualify because Eric's hourly wage is too high.
"The collection agencies threatened to garnish Eric's wages," says Melissa. "I was really scared about that, because if they garnished his wages he'd lose his job. It's in his contract. And then where would we be, since he's our sole source of income?"
The Service Employees International Union (SEIU) intervened on behalf of the Woodlands just in time. After working on Melissa's case for the past year, Jamie Carlton, then program director for SEIU's Care for Ohio Project, succeeded in getting all the hospital debt written off. "I don't know what we would have done without her," says Melissa. "There wasn't any way we were going to come up with that money. We're making it day by day here."
Even with past medical debt relieved, however, the Woodlands can't afford the ongoing co-pays. Eric is working the night shift, because it pays more, but has missed out on overtime opportunities because he needs to be home should Melissa have to rush Kaylynn to the ER. Melissa, a nurse's aide, would like to get a part-time job to keep ahead of the bills but can't see how she'd keep it with her daughter in and out of care.
"Kaylynn is my priority right now," she says. "We're finally learning what triggers her episodes, all the things she's allergic to. She's got to be on a special diet, and when we get the money, we're going to put an air-filtration system on the heater. Then I think she will be better. And that's all I can focus on. Getting her better, and taking care of my youngest -- I don't know what else I can do."