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Texans trying to survive
without health insurance
The one-quarter of Texans without medical policies look a lot
like most of us: working-age residents with jobs.
http://www.statesman.com/news/content/news/stories/local/01/20/0120healthinsurance.html?cxtype=rss&cxsvc=7&cxcat=52
By Corrie MacLaggan
AMERICAN-STATESMAN STAFF
Sunday, January 20, 2008
Katonya Price, 26, couldn't buy health insurance at work even if
she could afford it. As a contract employee at a building supply
company, she is not eligible. So she tries to buy some peace of
mind by constantly cleaning and dusting her Houston home to
control germs and allergens.
Austinite Susan Hammack, 59, lost her state job in 2003 and
didn't have health insurance when she needed surgery for breast
cancer three years later. When she got insurance again, she was
afraid to use it to pay for chemotherapy because she was worried
she'd lose her job — and insurance — again if the drugs made her
unable to work.
Ralph Barrera
AMERICAN-STATESMAN
Cynthia Pacheco, elementary teaching assistant
Ralph Barrera
AMERICAN-STATESMAN
Katonya Price, office manager
A contract worker with no medical benefits, she found premiums
too costly for her and fiancé Nick Williams but tries to keep
her kids, from left, Cameron, Kennedy and Corey, enrolled in
federal or state programs.
Ralph Barrera
AMERICAN-STATESMAN
Susan Hammack, Austin technical writer
The cancer for which she had surgery while she was between jobs
and insurance coverage is in remission, but she did not get
recommended chemotherapy for fear it would threaten her current
situation.
David Grose, 39, a Paris, Texas, welder, had a cancerous growth
on his nose but couldn't get treatment without insurance. In
desperation last fall, he took a bus 300 miles to one of the
country's premier cancer centers in Houston, only to be turned
away because he didn't have insurance.
These are just three of the 5.7 million people in Texas who did
not have health insurance in 2006. Many Texans may know that
their state has the nation's highest portion of residents
without insurance, 25 percent, a figure that has remained
constant for several years.
But the stories of Price, Hammack and Grose illustrate some
common characteristics of the uninsured that might seem
surprising:
Most are employed. Two-thirds of uninsured Texas adults younger
than 65 have jobs, according to the U.S. Census Bureau.
"It's not an issue of not working," said Anne Dunkelberg,
associate director of the Center for Public Policy Priorities,
which speaks for low- and middle-income Texans. "For many folks,
it is simply just completely unaffordable."
Most are of working age. Thirty percent of Texans ages 19 to 64
have no insurance, compared with 3 percent of those 65 and older
and 22 percent of children.
Most are U.S. citizens. Even if all noncitizens — legal and
undocumented — were not considered at all, Texas would still
have the country's highest portion of uninsured residents, 20
percent, Dunkelberg said.
Being uninsured is not a static condition. Texans cycle on and
off insurance with changes in jobs, incomes and marital status.
Insurance status varies not only within neighborhoods but within
households.
Some people, for example, are covered by employers' plans but
can't afford to add their children to the coverage. Others, like
Price, go without insurance, while their children are covered by
government programs.
"Without it," Price said of her family, "we're playing with
fire."
Texans aren't alone in worrying about health care: It's one of
Americans' top concern, polls indicate. Nationwide, 47 million
people are without health insurance, according to the U.S.
Census Bureau, up from 40 million in 2001.
"Increasingly, this is becoming a matter of self-interest,
because they or a family member or a close friend has
experienced (being uninsured); it may have been for a short
period of time, but they've experienced it," said Ron Pollack,
executive director of Families USA, a Washington-based nonprofit
that advocates making high-quality, affordable health care
available to all Americans. "This is not just about somebody
else; this is now about me and my family, and that's changing
some of the political dynamic."
Democratic presidential candidates mostly talk about insuring
everyone; Republicans tend to talk about improving the current
system.
Families USA attributes the growing number of uninsured
Americans to rising health insurance premiums, changes in the
labor market and underfunded government programs.
Several states are working to extend health care coverage to
more people. Three states — Massachusetts, Maine and Vermont —
have enacted universal coverage plans and 12 others — including
California — are considering them, according to the Kaiser
Commission on Medicaid and the Uninsured. Texas is not among
them.
Why does Texas have a higher percentage of uninsured people than
other states?
Workers here are less likely than those in other states to get
insurance from their jobs, Dunkelberg said.
Compared with other states, Texas has a higher percentage of
people who want full-time jobs but are working part time, a
lower percentage of unionized workers and a lower share of
manufacturing jobs, which makes workers in the Lone Star State
less likely to have job-based coverage. That is according to
federal labor, economics and census statistics cited in a report
from the Center for Public Policy Priorities.
"Our employer-sponsored coverage has never been as broad as you
find in other states because we have not just more small
businesses but more people who work in small businesses," said
Albert Hawkins, Texas' health and human services executive
commissioner.
Another thing that sets Texas apart is the way it runs Medicaid,
the federal-state health insurance program for low-income
people.
"Historically, the Texas Medicaid program has focused on the
poorest of the poor adults and poor children," Hawkins said.
"For low-income adults, the principal strategy has been to
provide health care, not coverage, through safety-net systems"
including hospital emergency rooms.
But Texas is trying to shift resources away from emergency room
visits and toward prevention. Hawkins has asked federal
officials to approve a plan to redirect federal Medicaid dollars
toward a pool to help low-income people pay for health
insurance. He said he expects the plan to reduce the number of
uninsured, but key details have to be worked out.
Mary Katherine Stout, vice president of the Texas Public Policy
Foundation, said the national focus on the uninsured is
misguided because insuring everyone wouldn't guarantee they'd
get great health care. Instead, the debate should be about how
to create a robust, competitive marketplace for health care and
health insurance, said Stout, whose group supports limited
government.
She said state and federal regulations should be scaled back to
allow more choices and better quality.
"When you address those things, you take care of the uninsured,"
she said.
cmaclaggan@statesman.com; 445-3548
Additional material from staff writer Mary Ann Roser
By the numbers
47 million: About 16 percent of the population of the United
States is uninsured.
5.7 million: About 25 percent of the population of Texas is
uninsured, a higher percentage than any other state.
$11,500: Average annual health insurance premium cost for family
coverage in Texas
KATONYA PRICE
Katonya Price, 26, works 8 to 5 Monday through Friday as an
office manager for a building supply company. But because she's
a contract worker, the job she's had for more than four years
does not include health insurance. And she says she can't afford
to buy any.
"The cost of health insurance these days is more than a person
can actually make," said the mother of three. Price bought
health insurance on the individual market two years ago but
dropped it just a month later because of the expense: about $300
a month for her and currently unemployed fiancé Nick Williams,
27.
Price earns $16 an hour. But without benefits like sick days or
maternity leave, she earned nothing when she took six weeks off
after giving birth to son Corey last year.
Corey, now 5 months old, and son Cameron, 7, and daughter
Kennedy, 2, are now covered under Medicaid. But for stretches of
several months they've been without insurance, such as when a
raise put Price over the eligibility limit for the Children's
Health Insurance Program a year ago. While the children were
uninsured, Price struggled to pay for her son's asthma
medication and her daughter's emergency room visit for a hip
problem. Price has not paid the hospital bill. "That's money I
just don't have," she said.
The two older children's Medicaid coverage, which is free, will
expire in February, and the baby will no longer qualify in
August. She hopes to get all the kids on CHIP. But she'll skip
preventive doctor visits for herself, she said. Too expensive.
Instead, Price said, she constantly cleans and dusts her
apartment to cut down on germs and allergens. "I do a lot to at
least try to prevent. If something were to happen to me, my
children would have nothing."
SUSAN HAMMACK
Austin technical writer Susan Hammack had been working for the
state for more than a dozen years when she was laid off from her
$40,000-a-year job at the Texas Department of Health during a
state budget crunch in 2003. That left her without health
insurance.
Hammack, 59, a breast cancer survivor, said she was always
diligent about getting mammograms. But working temporary jobs
and living on credit cards, she skipped some screenings. So by
the time she learned in late 2006 that she had breast cancer
again, it had spread to her lymph nodes. Her doctor told her she
needed surgery immediately.
By then, Hammack had landed a full-time editing job she still
holds at the Texas Historical Commission, but her health
insurance hadn't kicked in yet. She now owes tens of thousands
of dollars in bills.
Her doctors told her she needed chemotherapy, she said, but she
declined, afraid that it would leave her too weak to work, that
she'd lose her job and be uninsured again.
Her cancer is in remission. But she said doctors have told her
she's at high risk for the disease returning. "I'm not going to
live as long as I would have," Hammack said, fighting back tears
in the light-filled living room of her house off Cuernavaca
Drive.
Hammack, who was born in Vienna, Austria, to "a G.I. Joe and a
Viennese fräulein," has lived in the United States since she was
a toddler and has bachelor's and master's degrees from the
University of Texas. She said she marvels at the difference
between her life and that of her relatives in Austria, where
insurance is mandatory for workers.
"My cousin doesn't have any degrees, and she gets taken care of
with top medical care," Hammack said. "I'm sitting here in
America with a master's degree and dying."
DAVID GROSE
David Grose of Paris, Texas, was desperate: He had a cancerous
growth on his nose, his doctor said he needed surgery right
away, and he had no health insurance.
The doctor, Richard Swint, told him to go 300 miles to the
University of Texas M.D. Anderson Cancer Center in Houston for
the complicated surgery and the reconstruction he needed. But
Grose, 39, said he couldn't even get an appointment.
Grose rode the bus for eight hours from Paris to Houston on Oct.
19, arriving at 3:30 a.m, with his medical records, pathology
slides and money his doctor gave him for the trip. But no doctor
would see him, and Grose said he had no choice but to get back
on the bus.
The hospital has a procedure, said Wendy Gottsegen, a
spokeswoman for M.D. Anderson. "Before you get the appointment
... you need to understand your options for financial aid,"
Gottsegen said. "We are not a charity hospital."
Grose, who had worked until October when he left his job as a
welder to take care of his cancer, wasn't eligible for Medicaid.
But that changed when his 16-year-old son moved in. The son had
been staying with his mother, from whom Grose is divorced. Once
he became Grose's dependent, Grose qualified for Medicaid, and
then M.D. Anderson accepted him.
Grose had his first surgery Nov. 28, he said. He faces more
operations but is grateful. He praised the hospital for the care
it provides but says he found the experience unsettling.
"It was pretty upsetting," he said. "Before they would even look
at my slides, they wanted to know how much money I had. It makes
you feel all alone out there."
CYNTHIA PACHECO
At 3:30 p.m. each school day, nearly nine hours after she
arrives at Houston's Herrera Elementary School, teaching
assistant Cynthia Pacheco begins her second shift. Year-round,
she stays at an after-school program until 6:30 p.m.
The 55-year-old with 18-year-old twin sons said she works the
overtime shifts to pay her bills. But those extra hours put her
family's income — which includes her husband's disability
payments — just over the limit to qualify for the Children's
Health Insurance Program, she said. The limit for the program —
which costs $50 a year or less per family — is $41,300 a year
for a family of four.
"I have to (work overtime) just to make ends meet in order to
live," said Pacheco, who has health insurance through her job.
She said she can't afford the $360 a month it would cost for a
plan that includes her sons. That's about what she pays for her
electricity in the summer. Her husband is covered through
Medicare.
Pacheco's sons, John and Ruffino, haven't had health insurance
since they were cut from CHIP two years ago. If her boys got
really sick, she said, she'd take them to a doctor, though that
might mean being late on a car payment.
"They're strong children," she said of the high school seniors.
"So far, everything's been OK."
Pacheco, whose family attends Lakewood Church, the megachurch
led by televangelist Joel Osteen, said she relies on her faith
to get by. Before she sends her boys to school each morning, she
blesses them, praying that God will keep them strong and
healthy.
"We have insurance, we're blessed; we don't have insurance,
we're still blessed," she said. "I consider myself very blessed.
At least I have a job."
RALPH ROMERO
In 1997, El Paso firefighter Ralph Romero, then 36, was helping
carry a hose during a house fire when he slipped on some tile
and landed on his back.
A decade later, he said, he made the difficult decision to
retire because of lingering back problems from the fall.
Because he's not working, he fell behind on his mortgage
payments and learned last year his house was in foreclosure, he
said. And although worker's compensation pays for health care
related to his accident, he said he doesn't have money for
health insurance to cover anything else.
"If I go outside and slip and break a leg," he said, "hello!
"I'll just be real careful."
When he was sick with a cold recently, going to the doctor
wasn't an option. "I just stayed home, really nursed myself big
time, and I got over it," he said.
Romero, 46, said he wonders how he could have ended up in this
situation.
"There's something wrong with the system," said Romero, who was
with the El Paso Fire Department for 19 years. "How can someone
get hurt as a firefighter on duty and later, from the same
injury, end up almost losing his house? It's incredible."
Meanwhile, he counts his blessings. He recently got approved for
disability retirement, meaning he gets a pension. And with that
income, he was able to modify his home loan. The house is no
longer in foreclosure. He said he hopes that with physical
therapy paid for by worker's compensation, he'll be healthy
enough to work a desk job — ideally, with health insurance.
"I actually have decent luck," he said in late 2007. "Just this
year has not been my year."
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