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Northside homeowners protest property tax hikes
Tales of the uninsured
Unprecedented opportunity
Still rising
Tales of the uninsured
Hoosiers held hostage by health care
Illustration by Shelby Kelley
A little more than a year ago, Max had several patents to his name, an engaging job as a chemist, a comfortable income, a superb benefits package and a family that depended on him. Now, in his 50th year, he still has the patents, the family and — knock on wood — the home, but gone is the 25-year career, the steady income and the health insurance. 
Max lost his job when the research and development department at his company closed during the winter of 2002. He hasn’t had a nibble at a job since then. A few months ago, he wound up in the emergency room with an anxiety attack. Fifteen hundred dollars later, the ultimate irony registered: Worrying too much about not having health insurance can send a person to the hospital. His wife, who works for a temporary agency, tries to stay optimistic. “We can make our house payment. We don’t have exorbitant credit-card debt. But the insurance part, that’s what causes anxiety.” A federal “cushion” known as COBRA (Consolidated Omnibus Budget Reconciliation Act) invites laid-off employees and anyone who resigns from a benefited job to continue their health coverage, but premiums are prohibitive for most families. So they do without, and they worry, knowing they’re a step away from bankruptcy if anybody in the family gets really sick. Fifteen percent of Americans, representing 41.2 million people, are uninsured, according to the Kaiser Family Foundation. Three-quarters of them are adults, and 80 percent are in working families where breadwinners are younger than 65. As the number of Americans without health insurance grows, so do health crises. It might work like this: You notice a symptom, but you ignore it since a visit to the doctor costs plenty. Within weeks, you can’t work for the pain, which is made worse by your worry. In the middle of the night you ask to be taken to the emergency room, where your physical symptoms are exacerbated by images of your home being repossessed. Paula knows this pain. (As with Max and the upcoming “James,” Paula is a fictitious name for a real person interviewed for this story.) When Paula resigned from a recent job, she considered signing up for COBRA benefits for her family, but they would have cost $6,000 per year. She investigated a state-sponsored alternative, the Indiana Comprehensive Health Insurance (www.onlinehealthplan.com), but recoiled at a minimum monthly cost of $116 per child and $360 for females older than 19. To insure herself and two children would have cost Paula $592 each month, or $7,000 per year. Next, she applied through a private insurer for a low-cost, high-deductible plan that would protect her family from major medical expenses. Little did she know that an uneventful visit to a specialist six months prior would jinx this idea. The rest of Paula’s family was offered coverage, but she was denied based on the visit to the specialist. Shelving plans for self-employment, Paula spent the next few months finding a benefited job again — and worrying. A growing portion of uninsured, working people take the gamble that Paula avoided. Betting that they’ll stay healthy, more than 6.6 million Americans in families that earn more than $75,000 a year refuse to spend as much as 10 percent of their annual income on insurance they probably won’t need, according to the Kaiser Foundation. They refuse to give up their dreams of self-employment. They refuse to be held hostage by health care. How about Marion County’s Health Advantage? These uninsured middle-class Americans, of course, are vastly outnumbered by the working poor who labor full-time without health benefits. Take James, for example, who works third shift in a health-care facility and attends college. After getting a raise from minimum wage to $8 an hour, James looked into buying health insurance via Marion County’s Health Advantage program, administered from Wishard Hospital. He thought he’d have enough left for insurance after making weekly child-support and car payments, as long as he relied on his girlfriend and his mother for food and a place to sleep. Not so. For James, Health Advantage was out of the question (see sidebar). James and others like him — who spend all they earn on child support and transportation, yet earn too much for Health Advantage — might be surprised to learn that the 5-year-old program is much praised. In March, the program was the top winner of the Indianapolis Business Journal’s Health Care Heroes award, and several speakers during Covering the Uninsured Week praised Health Advantage during a town hall meeting on March 10. The town hall meeting emphasized that uninsured Americans live sicker and die younger because they go without the medical care they need. Dr. Virginia Caine, director of the Marion County Health Department, noted how impossible it is to curtail such problems as infant mortality, heart disease and HIV when so many citizens don’t have access to health care. “People without insurance are up to 70 percent more likely to be hospitalized than people with insurance for conditions such as diabetes, hypertension, pneumonia and bleeding ulcers,” Caine said, and they’ll pay, on average, $3,300 for hospital stays that were avoidable. It’s easy to see that being uninsured is a leading cause of personal bankruptcy. Caine estimates that one in three young adults, age 18-24, went without health insurance at some point in the last 12 months. And, as the economy tightens, the number of uninsured people is bound to rise, especially among minority communities, because they tend to be hardest hit by economic downturns. For children of poor parents, the outlook is better. Under Hoosier Healthwise, qualifying families pay, at most, $25 a month to insure two or more children. Although President Clinton had no success 10 years ago with his plan for universal health coverage, influential Democrats have long predicted that it will be a top issue for the next presidential election. However, with President Bush focused on foreign affairs, and with the economy continuing to sag, universal health coverage might slip to the back burner. Still, for James, Paula, Max and the millions of Americans in similar shoes, health care concerns remain on the front burner. Max spends his days searching for a job and finishing the MBA he started while employed, while his family lives tenuously, prepared to sell the house and uproot at the first job offer. They live more simply than before, and that’s OK for now. Web sites: Health Advantage: www.hhcorp.org/adv.htm Marion County Health Department: www.mchd.com Indiana Comprehensive Health Insurance: www.onlinehealthplan.com Hoosier Healthwise for children: www.IN.gov/fssa/hoosier_healthwise/index.html Health Advantage off limits to $64-a-day workers
Trying to find out how expensive Health Advantage is, this writer unsuccessfully dialed five unhelpful phone numbers at Wishard Hospital (including the “proper” numbers of 655-2255 and 630-7416), next was denied help by Wishard’s public relations staff and finally spent 10 frustrating minutes on an endless voice-mail loop before deciding to simply write this paragraph. When I tried again later, the voice-mail loop eventually connected me to a financial counselor at Wishard who could not tell me the Web address for Health Advantage, details about income qualifications or the name of his boss. He did know that Health Advantage is paid for by taxpayers. Finally, I found Susan Jo Thomas, Health Advantage administrator (at 221-3163), who explained that her program is targeted to low-income adults who don’t qualify for other subsidized insurance programs. Adults might qualify if they earn less than 200 percent of federal poverty levels, she said. The official poverty level for a single adult is $8,980, a number that raised James’ hopes because 200 percent of that is $17,960 ($8.98 an hour) per year, more than his annual income. However, at $8 an hour, James would qualify for only 50 percent coverage, Thomas explained, and, if he worked overtime during the last three months, he likely wouldn’t qualify at all. For James (remember, a fictitious name for a real person), the raise that bumped him from $5.15 an hour — the current minimum wage — to $8 also bumped him out of the running for our city’s free health care program. While he can’t afford to pay rent or buy food without shirking child-support responsibilities, James makes “too much money” to join the 32,000 Marion County citizens who qualify for Health Advantage. Those 32,000 get free medical services, including preventive care, as long as they come to participating hospitals and clinics, including 11 Wishard clinics, five HealthNet facilities and two Shalom clinics as well as Raphael, Citizen and St. Francis clinics. Certainly, Health Advantage is making a huge difference in the lives of those 32,000 people, and city leaders should be applauded for sponsoring the program. While James will not be joining in that applause, perhaps his $6-an-hour neighbor or cousin could qualify for free health care via Health Advantage. To find out, they’ll have to either visit a participating clinic or deal with the ludicrous voice-mail system, because they won’t find answers online. Visitors to the Health Advantage Web site (www.hhcorp.org/adv.htm) are invited to click on the “income guidelines” link, but it’s an empty invitation. The income guidelines page is still under construction. —MD
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