Flatlined: Resuscitating American Medicine

Chapter 5. Handed Health Care’s Leftovers

One Sunday afternoon in 2004, I sat with other members of a panel on a dais before a large audience in a Houston church auditorium, listening as a group of people without health insurance shared their experiences. I heard two stories that illustrate the predicament of the uninsured. The first was told by an attractive woman, about forty years old and a single working mother. Speaking in Spanish, she told her tale with composure but with controlled anger. Her older son was serving on the front lines in Iraq. Her eleven-year-old son had recently lost his eligibility for the State Children’s Health Insurance Program (SCHIP), a combined federal and state program providing health insurance for poor and near-poor children. His asthma attacks went untreated because without insurance she could not afford to pay for care. She feared losing one son in war and the other from asthma. She concluded by saying that she felt betrayed. The second speaker was also a mother—an Anglo about fifty years of age. She was clearly embarrassed to be standing at the podium in the public eye but nevertheless resolutely told her story. Her husband, a technical writer, had lost his job when his company laid off three-quarters of its employees. Since then he had supported the family by contract jobs, earning on average 50,000 dollars per year. He had not found full-time work, and she believed this was because employers did not want to pay for family health insurance. The speaker herself would have raised the health insurance rates of a small firm: she could not work outside the home 35 5 Handed Health Care’s Leftovers It is an injustice for uninsured Americans to go without medical care that is standard for the insured and for citizens of other developed countries. CH005.qxd 10/7/08 9:52 AM Page 35 because of a chronic medical condition. Initially the family bought individually purchased insurance at 325 dollars per month, a premium that increased to 725 dollars per month within two years. By 2004 the deductible was 2,000 dollars, and coverage was not affordable for all family members. What else could she and her husband do but drop it? She concluded her talk with “I have a little seven-year-old with a respiratory condition, and I am worried.” No Small Problem These are common stories. On any given day there are more uninsured people in the United States—47 million—than there are people in all of Central America or in the combined populations of our nation’s three largest metropolitan areas: New York, Los Angeles, and Chicago. In other words, 15 percent of the population is uninsured. One-third of the nonelderly population (82 million people) loses insurance at some time during a two-year period.1 According to Jeffrey Passel at the Pew Hispanic Center, only12.5 percent of the uninsured are illegal immigrants, although that percentage is much higher in states such as Arizona, Texas, and California. Mostly the uninsured are the working poor. Eight in ten live in working families. More than half cannot afford to purchase insurance, and their employers do not provide it, while 20 percent earn enough money to purchase insurance but choose not to do so.2 Twenty-five percent of the uninsured are eligible for public programs but are not enrolled. Most low-income parents know about Medicaid, the combined federal and state program that provides health insurance for poor children in all states and their parents in some states, but many fail to sign up because they think they are ineligible or cannot manage the enrollment hassles. For example, leaving work on a weekday every six months to spend all day at the Medicaid office would cost a janitor a day’s pay or his job. Contrast this situation with Medicare, where everyone eligible for Social Security receives an enrollment package in the mail at age sixty-five. States do not go looking for people who are eligible for public programs such as Medicaid and the State Children’s Health Insurance Program, and many states deliberately erect barriers, such as requiring WHY THE UNINSURED SHOULD BE COVERED 36 CH005.qxd 10/7/08 9:52 AM Page 36 frequent face-to-face reenrollment. The states pay 30 to 40 percent of the cost of these programs, the federal government covering the...