More lacking good health plans

PHOTOGRAPHER: Sara Foss

When Tom Simpson went to the emergency room seeking treatment for a hernia, the first question was about health insurance.

“They asked what health insurance I have,” Simpson recalled. “I said, ‘I have none.’ ” He was told that his situation wasn’t an emergency, given a painkiller and sent away.

Simpson was homeless at the time and living on the streets of Troy. He’d once worked as a chef for Marriott but had lost his job, family and health insurance — a series of events he attributed to a drinking problem.

He returned to the emergency room a couple more times and finally got a doctor to examine him. “I begged this guy,” Simpson said. “I said, ‘Please help me.’ ”

The hernia was repaired last August, but the surgery resulted in about $3,500 in medical debt “that I can’t pay,” Simpson said. “I have the bills. I can’t pay them.”

In April, Simpson landed at the City Mission of Schenectady, where, after years of neglect, he is trying to address lingering health problems. Right now, he’s dealing with a loss of vision in his left eye.

“I’ve been to three ophthalmologists,” he said. “But because I don’t have any health insurance, they won’t help me. … I’m really afraid. I don’t want to end up blind.”

ALARMING STATISTICS

People who lack health insurance or are underinsured are more likely to go without needed care and to struggle to find good health care when they do need it. They are more likely to rely on a patchwork of programs and services, often cycling on and off of public and employer-based health plans.

According to The Commonwealth Fund, a New York City-based research foundation that focuses on health care issues, the number of people in this predicament is rising. In 2007, approximately 75 million, or 42 percent, of non-elderly adults in the U.S. either had no insurance or inadequate insurance, up from 35 percent in 2003. In particular, the number of underinsured U.S. adults has risen dramatically, up 60 percent from 2003, according to a report released in 2008 titled “How Many Are Underinsured? Trends Among U.S. Adults, 2003 and 2007.”

The middle class accounts for much of this growth. The underinsured rate has nearly tripled among adults with incomes above 200 percent of the federal poverty level — about $40,000 per year for a family, according to The Commonwealth Fund. (Respondents were considered underinsured if they spent 10 percent or more of their income — 5 percent if they were low-income — on out-of-pocket medical expenses or if they had deductibles that equaled 5 percent or more of their income.)

More than half of the underinsured and two-thirds of the uninsured went without needed care, which included not seeing a doctor when they were sick, not getting prescriptions filled and not following up on recommended tests or treatment, according to The Commonwealth Fund. About half of respondents reported difficulty paying bills, being contacted by collection agencies or changing their way of life to pay medical bills. Only 21 percent of insured adults reported financial stress related to medical bills.

LOOKING FOR A LIFELINE

As the national debate over health care heats up, local residents who have lived or are living without health insurance say they wish for a system where they don’t have to worry about how to receive and pay for the medical treatment and medications that they need.

“It seems health care is just for people who have money, and that’s wrong,” Simpson, 52, said. “My health is just as important as the next guy’s.”

In Schenectady County, people without health insurance often find themselves at the Schenectady Free Health Clinic, which provides free health care to people who don’t have health insurance. The clinic is mostly staffed by retired doctors and nurses who volunteer their time. Originally conceived as an urgent care center, the clinic, which opened in 2003, has since become a medical home for people with no place else to go.

Approximately 18,000 Schenectady County residents lack insurance. The clinic has about 2,500 patients, many of whom have jobs.

“They’re the working poor,” said Executive Director William Polyar. “They fall between the cracks. They don’t qualify for Medicaid, but they don’t have enough money to buy insurance.”

Rotterdam resident John Ryan, 45, lost his health insurance when he lost his job in retail management. A Type I diabetic, he takes two shots of insulin every day and several medications; without insurance, these treatments cost more than $100 a month. But at the clinic, he got them for free. And when he was having pain in his knees, the clinic figured out what was wrong — torn cartilage and arthritis — and arranged for much-needed arthroscopic surgery in March.

“I kept going back to the clinic,” said Ryan, who remains unemployed but is now receiving Medicaid. “All of the people were extremely helpful to me. I don’t know what I would have done without them. They saved my life. I’m forever in debt to that place.”

In a recent interview, Ryan said he was bothered by reports of the Schenectady Free Health Clinic’s precarious funding situation. He said he didn’t want the clinic to close because “I might need them again if my Medicaid runs out or if I get a job with no insurance.”

UNPREDICTABLE BURDEN

Slingerlands resident Erin O’Brien, 39, has health insurance in the form of Medicare, which covers 80 percent of her medical expenses, Medicaid, which covers 20 percent of her medical expenses, and a prescription plan. Up until 2005, she was fully employed, with two master’s degrees, and working for CSEA. But that year, she left work and went on disability to get treatment for trauma related to childhood abuse. She was also suffering from arthritis and decided to begin addressing health issues she had long ignored.

“I didn’t always have insurance when I was growing up,” she said. “We were poor and homeless. I began to realize that I had a lot of health problems and decided that as part of my healing, I would start [dealing with them].”

Things didn’t go as planned.

Since 2005, O’Brien has been hospitalized 10 times, and her doctors say she is suffering from an autoimmune disease and a series of mini-strokes. But there are still a lot of unanswered questions, and finding the answers will require more tests and possibly more hospitalizations. Her most recent hospitalization was in June, with pervasive joint pain and muscle spasms.

The trouble began when O’Brien went into the hospital for a routine tonsillectomy and palate reconstruction. There were complications — four seizures and fluid accumulation in the lungs — and she ended up in the intensive care unit. The following year, she found herself in the hospital again for another routine procedure, an endometrial ablation, or removal of the lining of the uterus. Again, there were complications, and O’Brien eventually underwent a radical hysterectomy. But the complications continued, and she spent 15 days in the hospital. When her doctor wanted to transfer her to a rehabilitation wing, Family Health Plus — her insurance at the time — denied the move, saying that she had already spent too much time in the hospital.

“I was in pain,” O’Brien recalled. “I was really confused. I said, ‘I live alone. I don’t think I can go home.’ ”

But she did. Nurses arrived regularly to check on her, and by the third day, she was “completely delirious.” She returned to the hospital, where she was diagnosed with a severe infection — hospital-strain MRSA.

In August 2008, O’Brien declared bankruptcy, unable to pay off $4,000 in credit card debt and also saddled with $2,500 in medical debt. She didn’t declare her medical debt and has since paid that off herself. She said her decision to file for bankruptcy stemmed from the realization that it would be next to impossible to pay off both the medical and credit card debt while living on disability and earning about $10,000 a year. And although her friends held a fundraiser for her, it wasn’t enough.

“If I kept making my credit card payments, I was not going to be able to make my rent,” she said.

“I don’t consider myself underinsured,” O’Brien continued. “I consider myself scared. They kept saying Medicare is going to run out. The other thing that scares me is that Obama talks about Medicare and where costs can be trimmed and cutting down on multiple tests. Well, I need multiple tests and multiple specialists. The whole idea of health care reform is a real concern for me.”

‘HEALTH CARE IS A LUXURY’

Albany resident Deb Cavanaugh, 55, has lacked health insurance for much of her adult life, though she is currently enrolled in Family Health Plus. But in an interview late last year, she was living without health insurance and treating a chronic medical condition — the thyroid condition Grave’s Disease — herself, using herbs.

“I’ve done a lot of reading,” she said. “I went on the Internet and I did a lot of research.”

People with Grave’s are supposed to get regular blood tests, but Cavanaugh had opted to forego the tests, which cost about $100 apiece.

Cavanaugh, of the folk music duo Cavanaugh and Kavanaugh, was diagnosed with Grave’s Disease in 2007 but lost her insurance about a year later.

“A lot of musicians don’t have health care,” she said.

She said she didn’t consider buying insurance as an option.

“It’s so expensive I can’t afford it,” she said. “I never really thought that much about health insurance when I was younger. But as I get older, I have more issues and I think socialized medicine is the way to go.”

Tom Simpson did have Medicaid briefly. But he says his policy was canceled, and when he went to the Schenectady County Department of Social Services to re-enroll, he was directed to the Albany DSS.

“I’m trying to get back on,” he said. “But they want you to jump through hoops.”

He said he also has problems with his feet, the result of living on the streets. He recalled waking up in a park after passing out and discovering that his feet had been lit on fire. He went to the emergency room, where his feet were treated with salve and wrapped in gauze. But his toenails continue to fall off, and he’s also suffered from gout and frostbite.

“My feet are messed up,” Simpson said. “But I’m in a position now where I want to take care of these things — my feet, my eyes. I’m getting older. My body is changing. I have two daughters and a granddaughter. I’m not ready to check out yet.”

Mike Saccocio, executive director of the City Mission of Schenectady, said that most of the people who seek help from the City Mission have a spotty health insurance history.

“Some have had it,” he said. “Some have had it with jobs. Some have never had it. Some have never had a primary care physician. For a lot of the folks who come, preventive care is not part of the mindset. Health care is urgent care.

“For folks who are immersed in poverty, health care is low on the priority list,” Saccocio said. “Health care is a luxury.”

Sara Collins, vice president for affordable health insurance and an author of The Commonwealth Fund study, said that the main thing driving the increase in underinsured/uninsured Americans is the rising cost of health care — 6 to 7 percent each year.

“That’s higher than the growth in income,” she said. “You have a situation where health care costs are rising at a steady rate but you don’t have the same growth in the economy. It’s really hard to see anything that’s going to change that dynamic until we bring down growth.”

With the recession, “more people are having difficulty holding onto a job,” Collins said. “But health care costs are rising at the same rate.”

Employers are trying to rein in costs by making their employees pay higher deductibles — between 2000 and 2008, the size of deductibles tripled, from $157 to $413 for large employers and $210 to $900 for small employers.