Editor”s note:
It”s no secret the cost of health insurance has been rising.
In 2006, the average annual cost of an employer-sponsored family health insurance policy was $11,480, an increase of 81 percent since 2000. That was more than four times the increase in worker earnings or the overall inflation rate.
Government programs help insure the elderly, the young, and the poorest of the poor.
But for those who earn too much for government aid but not enough to pay for health insurance, the alternatives are going without care, a safety net clinic or
emergency room, going into debt, or an anxious wait for the illness or accident that could be the ticket to bankruptcy court.
In an effort to put a human face on the toll this problem takes, KHI News Service talked with a variety of uninsured Kansas to see how they are coping. Here are some of their stories.
Heather Parker, center, and her children Ebony Givens, left, and son Tavarous Givens, right, are among the 293,000 Kansans who lack health insurance. (Thad Allton/KHI)
By Dave Ranney and Mike Shields
KHI News Service
SCOTT CITY, March 19
Christy Kirk”s doctor picked a lousy time to find a tumor on her uterus.
Or, perhaps, it was a perfect time.
“It was in early February,” said the 31-year-old Kirk. “I”d been on my husband”s health insurance, but we”d divorced and it was running out.”
Kirk, a grant writer here for the Western Kansas Child Advocacy Center, had surgery Feb. 27. Her insurance ran out the next day.
“I really felt rushed,” to have the surgery, she said. “There were some options available to me and if I”d had more time I may not have had the surgery. But I didn”t have a choice, I couldn”t wait to find out I (needed) the surgery and then not have insurance.”
Kirk tried to buy insurance on her own. The advocacy center”s benefit package did not include health insurance. Experts say a disproportionate share of the uninsured in Kansas and the nation work for small employers.
“It would have cost me almost $400 a month (premium) with a $5,000 deductible and an 80:20 co-pay,” she said. “There”s no way I can afford that.”
“It”s scary,” she said. “If my pathology had come back positive and it was cancer and I had to have another surgery, there”s no way. It”d bankrupt me. And I”m not going to do that, I”m not going to let doctor bills bankrupt me and my family.
Today, Kirk is one of the estimated 293,000 Kansans without health insurance. More than half of those are thought to live in households that have annual income exceeding $25,000 per year.
Kirk”s two daughters, ages 12 and 9, are not counted among the uninsured, thanks to coverage by their father”s policy. But they are among the under-insured, those whose policies don”t entirely meet their needs in an affordable way.
“They”re sort of covered,” Kirk said. “Their deductible is like $6,000 and I”m the one who has to pay it because my ex-husband pays for the insurance.”
Kirk”s daughters are not eligible for HealthWave, the state”s health insurance program for children in low-income families.
“I make too much money,” she said. “But I”m right on the edge.”
Kirk said she has friends who”ve asked their employers not to give them a raise because they would then earn too much for their children to be on HealthWave.
HealthWave eligibility is limited to children in families with incomes at or below 200 percent of the federal poverty level, which for three-person household is $33,200 a year.
Kirk scoffed at the notion that adults in her situation could afford health insurance, if they adjusted their priorities.
“I just moved my kids to a decent house and I”m not working at Wendy”s,” she said. “But there are no shopping trips to the mall. We don”t have a big stereo or a big-screen TV. Nothing like that.”
Too common
Kirk”s plight is not unusual, said Tina Payne, executive director at the Health Ministries Clinic in Newton.
“There”s a stereotype out there that says someone who”s uninsured is unemployed and that”s simply not the case,” Payne said. “Most of the people we see are working one, two and sometimes three jobs. It”s just that those jobs are low-paying and don”t offer health insurance.”
The same can be said about some better-paying jobs, Payne said, noting that church secretaries, real estate agents and cosmetologists are often uninsured or depend on their spouses” coverage.
According to research by Families USA, most uninsured Kansans are from working families; 83 percent live in households where at least one person works full or part time, 53 percent live in homes where there is at least one family member who works full time all year.
And because the trend is that fewer employers are offering health insurance, experts expect that an increasing number of the uninsured in Kansas and the nation will come from working families.
More than half 55 percent of Kansans questioned for a
2003 survey commissioned by the Kansas Health Institute
said they were worried that health insurance would become unaffordable to them.
“Employers are the most common source of health coverage for non-elderly Americans, but many uninsured workers either work for employers who do not offer coverage or cannot afford the coverage that they are offered,” said Sheldon Weisgrau, a senior analyst at the Kansas Health Institute and author of various reports and studies on the uninsured in Kansas. “The share of the uninsured from working families is likely to grow if the percent of firms offering health benefits continues to decline and employee cost-sharing increases. In 2005, only 60 percent of employers offered health insurance to their workers, compared to 69 percent in 2000.”
And research from Families USA based on U.S. Census data shows that the largest number of uninsured in Kansas are between ages 30 and 49, prime productive years. They account for almost one third of the total. Some of them can afford to purchase insurance but choose not to. But most, like Heather Parker, 35, who works in a Topeka beauty shop, can”t afford coverage.
Parker”s children, ages 9 and 11, are on HealthWave, but she is uninsured.
“It”s too expensive to have health insurance,” Parker said. “I live paycheck to paycheck.”
When she becomes ill, Parker said she goes to either the Shawnee County Health Agency or the nonprofit Marian Clinic.
A new primer on health insurance , developed by KHI for the Sunflower Foundation and the United Methodist Health Ministries Fund, notes that the uninsured are “less likely to have a personal physician and receive preventive services than people with insurance. They are less likely to receive health care services when they need them, often postponing care and not filling prescriptions because of the cost.”
Parker knows all that from experience.
“I do worry about not having health insurance and what if something happened,” she said. “I just had some third-degree chemical burns on my hands, and I didn”t go the doctor because I didn”t have any money. And then they got infected and I had to go.”
There also have been times, Parker said, when she”s not taken her medicine for her high blood pressure.
“There are times you get to a point where it”s either “feed the kids” or go without your meds,” she said. “I go without my meds.”
Struggling to cover the kids
There is research that shows some people, particularly those between ages 18 and 34 simply choose not to purchase insurance because they don”t think they”ll need it.
“A relatively large proportion of young adults in Kansas, more than one in five between the ages of 18 and 34 are uninsured,” Weisgrau said “Some of them can afford to buy insurance but choose not to.
They”re young and healthy and with the high cost of insurance, they decide that it”s worth the risk of going without.
Those who are covered are therefore relatively older and sicker, causing premiums to increase.
Higher premiums then make it less likely that the young adults will choose to buy insurance and the cycle continues.”
But there are more people without insurance because they can”t afford it.
“From my perspective, there are two reasons working people don”t have insurance. First, the premiums are simply way out of reach; second, the policy is structured in such a way that if they do get sick, nothing”s covered,” said Corrie Edwards, executive director of the Kansas Health Consumer Coalition. “A bare-bones policy doesn”t do anybody any good. You can put together a plan with a $5,000 deductible, but what good does that do when nobody has $5,000?”
Veri Stroud, center, lost her health insurance after she divorced. She”s not been able to find coverage she can afford. Her daughters, Kristie, left, and Amanda, right, are covered by their father”s policy. “(I)f I ever have cancer or something like that, I”ll just have to die,” Stroud said, “because I don”t have anybody I could borrow money from and you can”t get those kinds of treatments for free.” (Megan Duerksen/KHI)
Veri Stroud, a secretary at the Immanuel Baptist Church in Newton, earns too much to qualify for the state subsidized health insurance that would benefit her children but dropped her own private coverage because of the cost.
“I”m divorced,” she said. “I paid $250 a month to stay on my ex-husband”s insurance for 18 months. But after that, I couldn”t find anything decent for $250-$300 a month, and even if I did, I can”t afford $250 a month.”
Her two children are still on their father”s health insurance.
“I make too much money for them to be on HealthWave,” Stroud said. “I”m just above the line.”
HealthWave, she said, would be a godsend.
“My youngest daughter has a seizure disorder, juvenile rheumatoid arthritis, asthma and migraines,” Stroud said. “She has insurance, but I have a 20 percent co-pay and over the last couple years, I”ve had about $5,000 in out-of-pocket expenses.”
Stroud said she now relies mostly on Health Ministries Clinic for her own health care.
“They”re wonderful. They have a sliding-scale (fee) that I pay,” she said. “But if I ever have cancer or something like that, I”ll just have to die because I don”t have anybody I could borrow money from and you can”t get those kinds of treatments for free.”
Through the clinic, she said, she often can get prescriptions filled at a discount.
“Basically, I only go to Health Ministries for preventive care because it is not always possible to get in quickly if I am sick,” she said. But they do try to help in every way possible. When I am sick, I generally try to wait it out and just get better with time, and if that does not work and I cannot get into Health Ministries then I will go to the other doctors” office and pay their fee that they expect paid in full on that day.”
-Dave Ranney and Mike Shields are staff writers for KHI News Service, which specializes in coverage of health issues facing Kansans. They can be reached at 785-233-5443.