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For Guericke, a bartender, 2002 was all of the above.
"This past winter ... I had a flare up, and it cost me about two weeks of work," Guericke says. "We tried going to the public health clinic. They said they wouldn't take me. I remember them saying that I should just go to the emergency room.
"I was sick enough at that point that I was having a hard time breathing. I could barely move. A simple cold, whatever, just blew up into this whole respiratory infection, fever. All I wanted to do was sleep, but then when breathing became a problem, sleep wasn't quite happening."
Guericke was forced to go to the emergency room of a local hospital. "As we walked in," Guericke recalls, "it was funny because they give you one little piece of paper to fill out with your name and symptoms and everything. And the triage nurse came out, and she just took one look at me -- my lips were purple because I couldn't breathe -- and she was just like, 'Don't do that. Don't worry about that. Just come sit down. Let's get you going.'"
The visit to the ER cost her $4,000 -- and she's still paying for it. But at least she's paying. In 2001, the country spent about $35 billion on care received by the uninsured that was not compensated. Two-thirds of that amount was paid for by hospitals. And insured consumers, no doubt, wound up picking up part of that tab in the form of higher medical costs. Then there were federal grants to community health centers, which Bush increased recently, state and local taxes that go to public hospitals and clinics, and numerous other federal and state health care programs that taxpayers already fund as part of the so-called safety net for the uninsured.
To get an idea of how the burden of the uninsured has grown for hospitals, consider that in 1983, hospitals paid $6.1 billion for uncompensated care. In 1999, that figure was $20.7 billion, according to the American Hospital Association. The irony is that if the uninsured had regular medical care from a family physician, many wouldn't wind up in the emergency room in the first place.
"The uninsured are 30-50 percent more likely to be hospitalized for an avoidable condition," according to "The Costs of Preventable Hospitalizations among Uninsured and Medicaid Adults," a 2001 report by the Kaiser Family Foundation. "And the average cost of an avoidable hospital stay in 2002 is estimated to be about $3,300."
And all of those avoidable hospital stays snowball into the $35 billion in uncompensated care, not to mention lost wages and tax revenue.
Yes. Tax revenue. The uninsured aren't wandering minstrels. More than 80 percent of children and adults who don't have health coverage live in working families. The problem is that many work for small employers that can't afford to cover their employees. Just 31 percent of Americans working in firms with fewer than 25 employees had coverage carried by the employer, as reported by an Employee Benefit Research Institute survey.
Some 44 percent of uninsured workers are employed, like Guericke, by the service industry -- busboys, barristas and copy clerks.
But, as expected, the younger you are as an adult and the less money you have, the less likely you are to have health insurance. For instance, more than 31 percent of Americans in the 21-24 age bracket don't have health insurance, along with 23.6 percent of those age 25-35, according to the Employee Benefit survey.
Meanwhile, 25.3 percent of Americans earning $20,000 and $29,000 lack coverage. Some of these individuals may have been offered health care through their company, but couldn't afford to have the premiums taken out of their paycheck. In 2001, for example, 16 million people had access to employer-based insurance but declined it, according to a report by the non-partisan Center for Studying Health System Change.
If you were thinking that families earning $10,000 and $15,000 -- a group in which nearly 34 percent lack insurance -- would obviously qualify for Medicaid coverage, you'd be wrong -- especially if they live in Georgia. When Congress enacted welfare reform, it allowed the states to make it easier for families to get Medicaid assistance. Georgia didn't bother to change its rules, notes Tom Underwood, the executive director of the Georgia Partnership for Caring Foundation.
This state has reasonably generous Medicaid rules if you're pregnant. You can earn up to 235 percent of the poverty level -- $21,132 -- and still qualify. And there's no assets test. If you're not an expectant mother, however, the income requirements become extremely tough. If you are an able-bodied adult between 18-64, with no children, you can't get Medicaid. If you're a single parent with one child, for example, you can't make more than $7,908.
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