Dealing with no health insurance

    If you’re uninsured, this might be just the beginning of tough decisions.

    Millions of people live without health insurance, and they deal with it in different ways. WHYY’s health and science reporter Kerry Grens spoke with people living without insurance. It could be just the beginning of tough decisions they will have to make. (Photo: The Smith family)

    Listen: [audio:091026kgchances.mp3]

    Andrew Thompson is about to hop on his bike and wade through mid-day traffic in center city Philadelphia.

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    Thompson: Every now and again there will be a near miss with an opening car door and you just thank god you didn’t hit it. And it happens a little more often than I would like it to.

    Biking is particularly risky for Thompson, because he doesn’t have health insurance. He’s been uninsured for a few months, after the benefits he had during college expired. Yet Thompson takes two medications for chronic conditions. They were covered by his previous benefits. He’s now shopping for a new insurance plan.

    Thompson: Right now, I’m trying to draw out the medication i have for as long as I can…

    Grens: Up to what limit are you willing to pay for insurance?

    Thompson: I would say that $150 is the maximum I would pay.

    That’s $150 a month. Few, if any, plans available to individuals are that cheap — especially for someone with pre-existing conditions. So Thompson seems destined to remain among the 46 million people in the country who don’t have insurance.

    Field: There are a lot of myths out there about who the uninsured are.

    That’s Robert Field, a professor at Drexel’s Law School.

    Field: They range from people thinking they’re all undocumented aliens to people thinking that they’re all young people who think they are healthy and invincible and don’t need insurance at all.

    If you want to sort reality from myth, talk to Karyn Schwartz. She is a senior policy analyst at the Kaiser Family Foundation, which tracks insurance numbers.

    Schwartz: The vast majority, about 80 percent, are in families with at least one worker. But most of them are low income.

    Grens: So they’re in families where people work and they may work themselves, but why don’t they have health insurance?

    Schwartz: Uninsured workers tend to work in the types of jobs that are less likely to come with an offer of health insurance. They tend to work for smaller firms or, say, in the service industry where workers often aren’t offered coverage.

    There’s also the growing number of people who are out of work.

    Castillo: Mi nombre es Crucita Castillo….yo tengo triente y dos anos…

    Thirty-two year old Crucita Castillo holds her year-old son.

    She lost her job in a factory recently. She receives unemployment checks as she searches for a new one, but no longer has health insurance.

    Castillo (translator): The offer that I got was health insurance for about $300 a month, so I can’t afford that.

    Castillo is a citizen — she’s from Puerto Rico. Hispanics make up a disproportionate share of the Americans who go without insurance. The Kaiser analyst says that’s because they are more likely to get those low-paying, service jobs.

    Castillo’s hoping her next job will give her benefits.

    Castillo (translator): If I have to go to a hospital, I might have to go to an emergency room and just take the bill and who knows what will happen.

    Smith: This one’s called I’ll take my chances…

    Gerand Ernest Smith plays some of his music in his home recording studio.

    Smith: That’s me, singing….

    Smith spent more than two decades touring Asia as a musician. He returned to the states several years ago, and his wife and daughter followed behind earlier this year.

    They moved into a house in the Cobbs Creek section of west Philadelphia, and were about to expand their family.

    Smith: She got pregnant. And things were going fine for the first two months or so. And then after the 3rd month then she had a miscarriage.

    Smith has insurance through work, but his wife Wasana doesn’t. Her husband was shocked when he got the bill for her hospital care.

    Smith: From that she’s got like a 2,000…well how much is it altogether? $2,600 bill for two visits.

    Smith says he can’t afford to pay it. Already he skips out on some of his diabetes medications because he says the co-pay is too much an expense.

    Grens: Are you worried that that’s going to make you more sick and then your hospital bills are going to be even more?

    Smith: Sure! But what can you do? What can you do.

    Affordability is really a relative thing — people like Smith have to decide what they’re willing to sacrifice to pay for health insurance, or accept the risk of going without.

    If a healthcare overhaul bill passes, Smith may have to make a different cost calculation: either buy health insurance or pay a penalty.

    Robert Field at Drexel says there will likely be a group of people who won’t be able to afford either one.

    Field: Those are people who are too rich for the subsidies, but too poor to be able to afford insurance. And you end up hitting them with a new cost of probably a couple thousand dollars a year and in return they get nothing, they don’t even get insurance.

    Field says there’s a solid reason for government to mandate that people carry medical insurance, the same way it insists drivers get auto insurance. The more people who pay into the health insurance pool, the lower the premiums should be.

    But can penalties and subsidies be set in some perfectly meshed way, so that no one ends up in the bad place Field describes: fined by government for failing to do something they truly can’t afford to do?

    That difficult goal is going to require a lot of energy from would-be reformers in the U.S. Congress for the rest of the year.

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