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First Person

Just Another Uninsured American

Posted March 2, 2009

Nearly 48 million Americans are now uninsured, according to the Kaiser Family Foundation, and as many as a million more will join them when the unemployment rate climbs to 8%.

Chuck Slusarczyk is one of them.That’s not his real name, of course. Nobody really would be crazy enough to use a real name when writing about what happens when you’ve got a pre-existing medical condition and a “lapse” in your insurance coverage. When you can’t afford to go to a doctor even though you know you need to go.

Healthcare paranoia seems justified at a time when insurance is out of the reach of so many people and an estimated 1.85 million Americans each year file for medical-related bankruptcy. What’s it like to be out of work, coping with a health-care challenge, and uninsured? Here’s Chuck’s story, which he calls, “I’ve Got the Healthcare Blues.”

I had already been going to the doctor for a few weeks when I was laid off.

My severance package stated I’d remain insured until the end of December. But when my doctor told me he was going to extend my treatment (more on the illness later), I panicked and started asking him the costs of the procedures.

“Oh, don’t worry,” he said, “Your insurance will cover it.”

“But that’s the thing,” I told him. “I was laid off and won’t have insurance anymore.”

Some background: Until this particular point in my relationship with this doctor, I had been scared to mention my job situation, for fear that he would cast me aside like a pair of latex gloves.

As I suspected, my job loss wasn’t exactly the news that he wanted to hear. “Well,” he said as his eyes darted towards the ceiling and around the room, indicating his train of thought. His eyes met mine and he asked, “Have you considered COBRA?”

For those unlucky enough to have been let go from their jobs, COBRA is the government’s way of ensuring that you remain, well, insured. Its cost to you, however, is steep. The same plan that cost me no more than a hundred dollars a month while I was employed was set to rocket up to over $450 per month under COBRA. How a recently unemployed American could be expected to dole out what I consider to be half my rent money on health insurance is beyond me.

A quick digression: Recently, I was happy to learn that the economic stimulus package would help make COBRA affordable, at least for some people. (The rules are complicated, however, and only certain people will qualify for a nine-month subsidy from the federal government. So this is something everybody needs to check out for themselves.)

When I heard that about that, just a few months after have been laid off, I contacted my former HR manager and asked him exactly how “affordable” COBRA now was, and if it was true that I could sign up after having earlier declined it.

Apparently, the situation still isn’t exactly clear cut. I was told by email that my former employer was “putting together new information as it becomes available.” Now that’s comforting.

Thankfully, I didn’t need to rely on COBRA, because my domestic partner was generous enough to add me to his plan. It’s not cheap, either, but this company will allow me to switch to another insurance provider if a more affordable one becomes available. So while I await an update from my former company on whether President Obama’s new plan will make insurance affordable for millions of people like me, at least I’ve got some coverage.

For most of my adult life, however, that hasn’t been the case. Yes, I (briefly) had insurance from my most recent job — that is, until I lost it. But before that, the last time I had health insurance was in freshman year of high school. I’m now in my late ’20’s.

I first lost health insurance because my mother, a single woman raising two kids on her own, was offered a higher-paying job than the one she’d previously had. The one caveat was that if she opted for health insurance for her two kids, her paychecks wouldn’t be enough to cover the rent, utilities, groceries, day care, clothing or car insurance.

So I told her, “Don’t worry about me. I’ll soon be old enough to get a job and pay for my own insurance.” Which would’ve been great if it were true. But the jobs I got as I got older never offered health insurance, or only offered health insurance for those who worked full time and longer than a year.

For 12 long years I was uninsured.

I opted to go to doctor’s offices only when vitamin C and bed rest didn’t cut it. I looked for free clinics and found a gay and lesbian health center (New York City’s Callen-Lorde), where visits and consultation costs were determined based on your monthly income. My most expensive visit, for instance, set me back $50 dollars. But clinics mostly offer general practitioners and not specialists, which I unfortunately ended up needing.

Here’s a little more than you might want to know about me. Sometime around my 24th birthday, I noticed that it took me longer and longer to urinate. The sensation, the need, was there but it would take me a couple of minutes before I could release. I ignored this situation, because the alternative meant I would lose a day of work and might have to pay out of pocket for a visit to a specialist.

I hoped that this problem would just go away or that I would find my way into a job with health-care coverage. A year passed, but still I had no insurance. My condition got worse. Two, three years whizzed by but still I couldn’t whiz properly (excuse the poor pun — I just couldn’t help myself).

Last year I got an office job that finally gave me a chance to sign up for affordable health insurance. I no longer needed to ignore what were clearly warning signs of something or other. For the first time in my life I was able to, upon a referral, visit a specialist.

The urologist tried a variety of medications but, after a month, there was still little progress. Naturally, our discussions turned to the first time I had exhibited these symptoms, three or four years earlier. “You’re telling me you’ve ignored this situation for close to four years?” he asked me incredulously.

“I didn’t have insurance,” I mentioned, giving him an explanation I was certain he had heard before. Eventually, he sat me down and told me, “You know, we’re going to be seeing a lot more of each other.” This brings me back to that point in my story where I broke the bad news to him: I had recently been laid off and was soon to be uninsured again.

As long we’re spending time talking about my health-care needs, I might as well mention this too: Five years ago my knees started to ache and throb whenever I stood on my feet too long. I ignored the condition, of course. It was a financial necessity.

Within months, this situation with my knees deteriorated so quickly that whenever I bent them, they would make a clearly audible grating noise, as if the patella was rubbing itself against broken glass. Yes, dear reader, I was a mess.

Last year, when I was briefly employed and briefly insured, I was able to see a doctor who informed me that I would need several rounds of physical therapy to correct the problem. She asked me why I had ignored the pain for so long. Any guesses?

Here’s my medical bottom line. It turns out that I suffer from ailments that would normally be attributed to persons of a much-older age: weak knees (clinical term: patellar something-or-other) and prostatitis.

What bugs me the most is that if I’d gone to the doctor during an earlier stage, I could’ve staved off the severity of both ailments. But both conditions would have required multiple sessions with a specialist, which would’ve put me thousands of dollars in debt. It didn’t take a medical degree to figure out that these ailments weren’t likely to be cured with a miracle shot or a round of antibiotics. So I ignored them and hoped that one day I would have access to affordable health insurance and affordable care.

Make no mistake, I’m to blame here. I’m the first to admit, I let the situation get out of hand.

But I was aided and abetted by a faulty healthcare system. I’m waiting, Mr. President, for you to fix it so that I can continue to fix myself.

The Whiner wants to know: What’s your own experience been like with health insurance? Have you ever ignored a medical condition because you couldn’t pay for the doctor’s visit or prescription drugs?

Reader Comments

  1. shaman

    wow, it’s a shame about your health. i guess my question is how you survived without a full-time job for so long in the first place? and i guess my second is why or how is it possible that a full-time job does not have insurance?

  2. Chuck

    Shaman,

    I waited tables for a long time (which paid the bills) but was always considered “part time” and thus ineligible for health insurance. I don’t know many restaurant workers (at least in NYC) that have health insurance at all.

  3. amy

    1. To skyhooks! More wine!

    2. shaman, re your second question: I take it you’re a recent immigrant?

    3. Chuck: The #1 rule is Take Care Of Yourself. If you’re broke, you don’t need to worry about medical debt. Can’t pee? GO TO THE DOCTOR. Then throw away the bills and let the AMA complain about it to Congress. Yes, your credit rating will suck, but there are only so many FICO points you can lose before it sucks anyway. Let me repeat: GO TO THE DOCTOR. Money, you’ll eventually find money. But you only get one life.

    Re COBRA — I’ve been paying about $450/mo out of pocket for health insurance for years. Yes, it’s a lot. I probably wouldn’t have done it as a young woman. In middle-age, though — and as a single mom — I see it as reasonable value for money. Around the end of the year I went through my EOBs and added up what being uninsured would’ve cost, and the answer was “a hell of a lot more”.

    The sorry thing is that the Republicans turn out to be right in my case. I’d likely have lived without going to the doctor many of those times. The sprained ankle wasn’t broken. The heart thing was nothing serious. The sinus infection eventually cleared up. The Pap was normal. Migraines suck, but you live. But we got things resolved swiftly, I had good meds and didn’t spend days nauseous in bed, and I didn’t lie awake wondering, “Am I dying? Do I need a rigid cast? Do I have a brain tumor?” Which was very nice.

  4. Zach

    Healthcare deserves to be one of Obama’s top priorities. But let’s see if he can get something done.

  5. Hope

    This is a PERFECT example of how waiting just increases the cost of health care. You have health insurance, but for those who don’t, eventually they get worse and have to see someone…usually in the ER. Then the bill gets passed along to all of us anyway. Seems it would be fiscally prudent to give people access to docs when they have a start up problem. But, noooooo.

  6. Bruce Coulson

    I’ve been fortunate in the later part of my life (which is when I’ve needed health care) in marrying a woman who has health insurance from our state of residence. (Most US governments; city, state, and federal; have good to exceptional health care coverage.)

    But in my youth, I worked full time at many jobs where health was either non-existent, or more expensive than I could afford. And many low-end jobs are ‘officially’ part-time positions, to save a company’s health care dollars. Ditto for ‘independent contractors’.

    For much longer than anyone would like to admit, the rule has been “Your health care coverage is; don’t get sick.”

  7. anita

    If you’re laid off, go with cobra. If cobra is too much, go on it anyway while you look for your own individual insurance. If you apply for individual insurance while on cobra, you don’t have to declare pre-existing conditions, so you’re covered when you swap over.

    Individual insurance ranges from bare-bones catastrophic coverage to 90% coverage with prescription benefits. There’s something to fit everyones budget. Until we have National insurance, it’s up to each of us to be sure that we have the converage that we need.

  8. Crayon

    This article seems to imply you should be able to get a reduction in your Cobra payments. Don’t wait for your former HR to let you know.

    http://www.nytimes.com/2009/02/28/health/policy/28patient.html?ref=your-money

    Your health future depends on thinking of yourself as worth the money for medical care and taking very good care of yourself physically. Don’t jeopardize a bright and satisfying future for yourself by ignoring health issues. There may even be help from some organizations like the Shriners for your physical therapy, or programs with teaching hospitals that you could qualify for.

    Good luck!

  9. Hope

    Amy, your comment to shaman re: being a recent arrival made me LOL. Thanks, I needed that. I can’t imagine how anyone in this day and age assumes a full time job = health care.

    And for what it’s worth, my health care coverage at my full time, professional, white collar job costs me $230 pre-tax dollars every two weeks for myself and my husband, who also has a full time, white collar, professional job. His job has a health care option that is such in name only. If we were dependent on his option, we would be afloat.

  10. The Doctor

    The diagnosis of our health care system is clear: it is a cancer with byzantine regulations that make the financial industry look like child’s play. Despite the fact that we spend more per capita on health care than any other country, we ranked only 37th by the World Health Organization. One in four U.S. citizens have no health coverage. One in three delay needed treatment. Health care is one of the great failings of our society.

    Our health care system is set up to serve the profit-driven insurance and medical industries. The most expensive patients are excluded from the insurance pool and dumped into confusing and limited public programs or forced into bankruptcy. In effect, tax payers subsidize industry profits. If you are not entitled or well educated–education is another neglected area–good luck at getting timely and appropriate care. The cure? We have to believe that quality of life is a public issue and take it out of the control of private entities who are looking out for only their stock holders. Not an easy thing to accomplish.

  11. Crayon

    I wanted to add, if there’s anyone who usually files 1040EZ but had unemployment or cobra payments in 2008, do yourself a $$$ favor and file the 1040 long form and use Schedule A to itemize your medical deductions. That could include the cost of your payments for cobra, drugs not covered by insurance or co-pay, cost of travel to and from med appointments, (subway, cabs, car etc.) and things like eyeglasses, contact lenses and cleaning supplies, crutches, physical therapy aids prescribed by a doctor, dental, chiropractic visits, etc. Once you become acquainted with Schedule A, there may be other deductions you qualify for as well.

  12. dd

    I agree that health care is very confusing, when it should not be.

    Does anyone know how the new law subsidizing health care premiums works if the company goes out of business?

  13. Mletta

    To Amy, who wrote:
    “The #1 rule is Take Care Of Yourself. If you’re broke, you don’t need to worry about medical debt. Can’t pee? GO TO THE DOCTOR. Then throw away the bills and let the AMA complain about it to Congress. Yes, your credit rating will suck, but there are only so many FICO points you can lose before it sucks anyway. Let me repeat: GO TO THE DOCTOR. Money, you’ll eventually find money. But you only get one life.”

    Today, many doctors will not even SEE you, let alone give treatment–which is often extensive, without cash up front (or credit card charges)and many doctors require this EVEN IF YOU HAVE INSURANCE THAT COVERS IT. (They have been stiffed for too long by insurance companies and many of the best doctors no longer take insurance. Period.)

    And this goes for testing, too. Often the testing is the most expensive part to get a correct diagnosis and to monitor treatment.

    You’re dreaming if you think you can just incur debt and ignore bills. You can’t even GET care without a credit card charge of cash upfront. The medical providers have had so many people not pay, plus insurers not paying or very late, that now they won’t give care without $$$ upfront. (And you can’t blame them. They’re not charitable organizations.) Even hospitals are now demanding $$$ upfront before admission and/or surgery.

    For the many of us working people without insurance, who can’t afford it, the only alternative may be a low-cost clinic. However, the care is often limited and sadly, the treatment is not always the best when it comes to those of us who have major problems.

    Basically, many of now feel we simply cannot–LITERALLY–afford to live.

    Because in fact, that IS the case. Without proper diagnosis and treatment, most of us will die earlier deaths and have our quality of life severely limited as a result.

    This is a disgrace in a country with so much wealth.

    Rather than Bill Gates spending his charity money abroad (admirable as it is) better to pump it into giving healthcare to americans who can’t get it when needed.

  14. amy

    Mletta, of course you can’t go to a private doctor’s office and be seen without insurance. (Though if you’re seriously ill, and you show up there, and refuse to leave until they refer you to someplace that will or must see you, I bet the response rate will be pretty good.) But there are still many hospitals which have no choice but to see you, or which have taken on the mission of seeing a certain dollars’ worth of uninsured/indigent patients annually.

    And yes, you can ignore debt if you have no money. Does it make life harder, yes. But ignoring your health is bound to make life untenably difficult and can do it quickly. You must go and work the system when you’re ill.

    The people who really have trouble are the Medicare/Medicaid folks, because they aren’t viewed as uninsured by charities or charitable hospitals, but increasingly docs won’t see them.

  15. Lainie

    “If you apply for individual insurance while on cobra, you don’t have to declare pre-existing conditions, so you’re covered when you swap over.”

    This is only true IF another company will accept you. If you have any kind of health condition, even if highly manageable and you are a mostly healthy person, they are likely to simply decline to cover you rather than take on the “risk.” I know — my COBRA just ended and no company would take me on, though I am normal weight, low blood pressure, take no medications, do yoga and eat organic food every day of my life, normal cholesterol, etc. etc.

    The system is criminally punitive to people outside of a very narrow range of acceptability.

  16. amy

    Lainie, if you were on a group policy, and you tried to buy new insurance within the allowable window (I think 60 days), under HIPAA those other companies MUST accept you without riders or wait times. Go get a lawyer and/or your Congressman’s office involved, because someone needs a strongly-worded letter from the Dept of Labor.

  17. Lainie

    Amy, I’m checking on that with the broker I’ve been working with. All I’ve been offered is possibly a high-risk pool in my state, but I can’t get the necessary “certificate of credible coverage” to apply for that until the old insurer gets paperwork from COBRA, and then of course nothing can start until the first of the month following the application.

    But really, I don’t understand. Every insurer I’ve tried has a lengthy list of very broad questions that must be answered truthfully, so if you’ve had any medical treatment or diagnostics at all, they decline you. And then you become someone who has “been declined.” How is that they can do this if it’s not legal?

  18. anita

    Yeah, what Amy says. I’ve been on Cobra and moved to a private policy several times, the most recent last summer. It is the law that you be accepted on another policy, pre-existing conditions notwithstanding. You shouldn’t even have to fill out the pre-existing condition form. I, too, have preexisting conditions, and I was accepted just fine.

    Please check on this again. If you’re still within the 60 days post-cobra, you should be able to get individual insurance.

  19. Robin

    Healthcare should be a human right, and hopefully Obama will move us in that direction. Employed or not, and at whatever class or level, it is sick that Americans have gotten used to the idea that some don’t deserve this basic human right.

    However, don’t be surprised that the Obama plan will involve *requiring* everyone to buy coverage, sometimes espensive, that they can by some stretch of imagination “afford”. This is a key part of the new system in Massachusetts. Why do we assume it is ok for rent to be about $900 bucks per month but not ok for healthcare to be $450 bucks per month?

    Over the years I have friends have moved home with mom to be able to pay $500 cobra, and others who have said “why would you need health insurance” never had it growing up and their parents died of potentially preventable/earlier treatable illnesses. Um…

  20. amy

    Lainie, the answer is that they are crooks who hope you don’t know your rights. Or, more generously but probably not true, they’re terribly naive about the laws governing their own industry.

    When you separated from COBRA you should’ve gotten a letter to the effect that you’d had group insurance that terminated on [date]. If you haven’t got that, please call your old insurer and ask the person you talk to to fax you a copy of same. Then go back to your new insurer of choice with the letter and say, “Hello, I’d like to buy that insurance, and you have to sell it to me after all. Pthhhbt.” Forget the high-risk pool, you don’t need that.

  21. anita

    Lainie, it could be that your broker doesn’t know what he/she is doing.

    Go directly to your old insurance company and demand a certificate of coverage.

    Go online and compare new insurance rates yourself. When you apply, there will be a tab to click if you were on Cobra. That will enable you to skip any pre-existing condition questions.

    Good Luck!

  22. Lainie

    To Amy, Anita – I am so grateful for this thread and this information. I did go to the state insurance regulatory agency. In my state, private insurers can refuse to underwrite you as an individual since the high-risk pool is available. However, as a self-employed person, they do have to offer me “group of one” coverage without exclusions – which they did not. So as Amy suggested, a strongly worded letter from the state has already been sent. THANK YOU SO MUCH – I wouldn’t have known what my rights were post-COBRA without this blog and this thread.

    And Chuck – I hope you’re able to find a way through the maze and get some care.

  23. anita

    Lainie, I’m so glad!!! Good for you for perservering and getting what you need.

  24. Zhu Bajie

    I remember seeing a poster in a coffee shop, perhaps 12 years ago, recommending various “alternative medicine” witchdoctors on the grounds that they were “good enough for poor people.” I’ll bet there’ll be a lot more of that! Probably Pentecostal faith-healers deal with a lot of uninsured people.

  25. John

    I went for years with untreated bi-polar illness. Holding good jobs when I was manic and losing them on the lows. I was treated in San Francisco(thank you SF General)after a few brushes wit the law. It was a blessing in disguise.
    Fast forward a couple of years and I am stable(considered by my doctor and others), and terrified of working again. I want desperately to work. I have insurance which pays for my medications but I am so untrusting of the governemnt that I don’t want to lose the insurance I have. Strange situation I know but I plan on resolving it. I am told I can keep my insurance now and work, which is what I plan to do. Still I have spent many nights terrified thinking about if I lost benefits what I would do.
    I went for years and years without health insurance. Once in New York I almost got pnemonia and died since I couldn’t pay the doctor on Central Park West out of pocket. I need to remember that. I don’t ever want to be in that position again.

  26. John

    I forgot to add your health is the most important thing you have. Thanks for your article.

  27. bill nichols

    Born in the 1920’s, I grew up in the ‘Great Depression’. When we were asked ‘what does your father do?’, the standard reply among us fellows was generally, ‘he has a job’. He could have been an electrician, but that didn’t count for much if he wasn’t working.

  28. degustibus

    I went without health insurance most of my life, self-employed for the past 30 years. Finally took out some catastrophic health insurance ($5,000 deductible)to keep from going bankrupt or losing my home if I got very sick. That was it for 10-15 years. Now I have the luxury of Social Security and Medicare–the very programs some pols are so eager to destroy. Everybody should have Medicare. I spent on night n the hospital recently, cost to me was $1000, Medicare paid…., ya right, $12,000…(and of course this was after my SEPP bled out close to $20,000 over the past year).

    Reiterate: Everybody should have Medicare.