Many older people neglect health

PHOTOGRAPHER: Sara Foss

The Schenectady Free Health Clinic is a bustling place, and on Thursday the clinic’s waiting room was packed with patients.

The clinic provides free health care services and prescriptions to uninsured people, many of whom don’t know where else to turn.

One man, a Scotia resident named Eric, said he hasn’t had health insurance since he lost his job doing maintenance at an apartment complex two years ago. Until about two weeks ago, he’d always been healthy, but pain in his leg forced him to seek medical attention.

“I was reluctant to go the ER,” explained Eric, 56. “It’s so expensive.” A friend told him about the free health clinic, and he made an appointment. He was informed that he had a blood clot, sent to the hospital and given blood thinning shots. The clinic picked up the tab.

Another patient, an unemployed licensed practical nurse named Sherrie, said she waited a week to get treatment for an ear infection because she couldn’t afford to see a doctor. “It got to the point where I looked in the mirror and my face was pale and I was vomiting,” she said. A friend told her about the free clinic and she decided to visit.

A recent survey by AARP New York found that many New Yorkers between the ages 50 and 64 are taking “dangerous measures” because they can’t afford health care.

The poll found that in the past two years 33 percent of New Yorkers have scheduled fewer routine check-ups with a doctor, while 30 percent delayed seeing a doctor or nurse when not feeling well. Twenty-six percent said they cut back on items such as food, fuel or utilities, 20 percent said they took less medication than prescribed, 22 percent delayed getting a prescription filled and 17 percent delayed physical or mental health treatments.

William Ferris, AARP New York’s state legislative representative, said that the survey results came as something of a surprise. “We were a little taken aback by some of the measures people are taking,” he said. “They’re not seeing medical professionals. They’re not filling prescriptions. We know that people take certain measures to afford health care and other expenses, but the numbers seemed high, and that’s troubling.”

Exchange backed

AARP New York is using the poll to push the state to establish a health benefit exchange.

Under the federal health reform bill, states are required to set up health insurance exchanges, virtual marketplaces where people who do not receive insurance through their employer or a government program can shop for health insurance. The idea is that forcing health care plans to compete for customers will lower the cost of health insurance.

The health insurance exchanges are supposed to be in place by January 2014, and in January 2013 states are required to demonstrate sufficient progress toward establishing an exchange to the federal government. States can seek additional funding from the federal government to build their exchanges, but they can’t pursue that money until a law or executive order establishing an exchange is in place. This year a bill to set up a health insurance exchange in New York failed to pass the state Senate.

Ferris said AARP New York believes a health insurance exchange will make it easier for uninsured people to obtain the health care they need, “and that’s why we’re disappointed the Senate didn’t take up the bill.” He said seniors have been hit hard by the recession and unemployment, and that many of them have lost their insurance as a result.

James Knickman, president of the New York State Health Foundation, a private foundation that seeks to reduce the number of uninsured New Yorkers, said that creating a health benefit exchange is hard work, and that the state can’t afford to lose time. Among other things, the state needs to figure out which drugs and services are covered under the exchange and which insurance companies are eligible to sell insurance on the exchange.

“The exchange really will expand coverage,” Knickman said. “Most of the people who will get policies on the exchange are uninsured right now.”

Joseph Gambino, CEO of Hometown Health in Schenectady, which provides medical and dental care to uninsured and underinsured patients, said that the problems discussed in the AARP survey affect all demographics. Patients of all ages, he said, are delaying treatment and the purchasing of medication because they don’t have health insurance and find health care unaffordable. Many of these people make too much money to qualify for Medicaid, but still struggle to make ends meet, he said.

“This is an area with a great deal of poverty,” Gambino said. “If the difference is between eating and getting medical care, you’re going to give up medical care.”

Older and jobless

William Spolyar, executive director of the Schenectady Free Health Clinic, said that 33 percent of the clinic’s patients are between the ages of 51 and 60, and that another 9 percent are between the ages of 61 and 70.

“We see a lot of people in those age groups who are unemployed,” Spolyar said, while adding that the percentages are slightly skewed because the clinic doesn’t treat or see children. Many of those people “were previously employed and lost their insurance,” he said. “They had a primary care doctor, but after a while they couldn’t continue to see their primary care doctor because they couldn’t afford to pay out of pocket.”

Spolyar said that about half of the clinic’s patients are employed, but do not receive health insurance through their jobs and are generally considered the working poor. “They’re trying to make a living and keep a roof over their heads and food on the table,” he said. “They just don’t have a couple hundred extra dollars for health insurance.”

When seniors turn 65, they are eligible for Medicare.

According to AARP New York, there are more than 2.7 million New Yorkers who are uninsured, and more than 337,000 of those are between the ages 50 and 64. Approximately 1 in 10 New Yorkers responding to the organization’s survey said they do not have any kind of health insurance coverage.

Ferris said that about one third of AARP New York’s members are between the ages of 50 and 64, and that the survey was designed to “get a handle on what their current health insurance status is, and how they’re coping with the high cost of drugs.”

Those surveyed, Ferris said, liked the idea of the health insurance exchange, though many of them were initially unfamiliar with the concept, and had to be told what it was. “There’s support for it once you give people the information,” he said.

Spolyar and Gambino both wondered whether the health benefit exchange would ever have the desired effect.

Right now, the federal health care bill is under legal challenge because of its controversial “individual mandate,” which requires that people who can afford insurance purchase a minimally comprehensive plan, and the case is expected to advance to the Supreme Court.

“God only knows what will happen,” Spolyar said. “I don’t have a crystal ball. The bill helps, but I haven’t seen a whole lot of legislation enacted the way it’s written.” He noted that some parts of the health care reform bill don’t go into effect until 2019.

“There’s so much uncertainty around the new legislation,” Gambino said.