Cover Story: Got Coverage

Kim Guericke is 30 years old and she radiates the kind of health you see in Caribbean vacation brochures. Her skin is flawless and her body looks like it was made to sprint around and bruise on a soccer field.

You wouldn’t know from looking at her that she suffers from Lupus, a chronic and occasionally fatal inflammatory disease that targets the skin and blood, and various organs — especially the kidneys.

Guericke’s body lacks the ability to distinguish between foreign agents that cause illnesses and her body’s own cells and tissues, so it produces excess antibodies to fight against itself. “Every day you wake up, and you feel like an old woman,” she says of living with the disease.

Guericke is one of at least 500,000 Americans living with the illness, but she also belongs to a larger and more diverse extended family, one that keeps getting bigger and reaching deeper into the middle class. She’s one of the 44 million people performing the daily high wire act of living without health insurance.

You’re going to be hearing a lot more about people like Guericke in the year and a half leading up to the 2004 presidential election, as Democrats try to whack President Bush in a pretty obvious weak spot.

Stories similar to hers — thousands spent on a single trip to an emergency room, the financial Russian roulette of living with a chronic illness and without health coverage — won’t be hard to find. Indeed, new people join her clan every day as medical costs and health insurance premiums continue to increase at a double-digit rate. Meanwhile, wages for the lower and middle classes stagnate, more people lose their jobs, and states, caught in a budget squeeze, cut back programs such as Medicaid.

The uninsured population rose by 1.4 million between 2000 and 2001, according to the most recent data available, and “if you’re not insured, the likelihood that you can afford getting health care is much lower than it was years ago,” says Ron Pollack, executive director of the health care advocacy group Families USA.

Of course, there was a time when Guericke’s plight was the cause celebre of the left. Giving everyone a more equal chance at good health — and therefore good economic health — through universal, government-funded health insurance was the American thing to do. It’s been in the Democratic platform for decades, but since President Clinton’s massively complicated health care proposal flamed out in the early 1990s, it’s become rare for mainstream candidates to mention single-payer health insurance.

If you look at the numbers objectively, however, health care for all shouldn’t be a political football. The crisis of the uninsured, which continues to dig into the middle class, is becoming an economic issue that represents a drag on the U.S. economy.

America currently spends as much or more per capita for health care than any other country in the world. Total health bills were about $1.4 trillion in 2001. Meanwhile, people who have insurance are paying higher deductibles and higher co-pays, and worrying whether their employer will keep their coverage.

Stranger still, the failure to cover people like Guericke increases the very medical costs that drive premiums higher for people who are covered and sometimes force hospitals to cut back services or close altogether.

There are signs that politicians are finally starting to pay attention to the crisis. At every stop the nine Democratic 2004 presidential hopefuls make, they stump on health care. So far, three of the top-tier candidates have released their own universal or near-universal insurance plans.

And President Bush has done the same. The only problem? It’s for Iraq. Part of the $74.7 billion initial allocation for the war in, and reconstruction of, Iraq contains a provision for “rapid, universal health service delivery to the Iraqi population,” according to the Washington Post.

For Americans, Bush has offered slightly less visionary proposals for medical savings accounts and market-based Band-Aids.

One thing’s for sure, with almost 75 million Americans who, based on census data, went without health insurance for part or all of a two-year period spanning 2001-2002, more people than ever have a stake in the debate. And if Bush continues down an economic path that reduces revenues in the form of tax cuts, the tens of millions of luckless, insurance-less people will be offered a stark choice: a chance at the country’s first real health care plan, or a steady increase in the have-nots of health care.

“Being uninsured represents triple jeopady: You receive less medical care than the insured, you pay about as much out-of-pocket, and what you pay represents a bigger burden on your family’s resources,” noted Jack Hadley, a principal research associate at The Urban Institute in testimony before Congress in May.

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.

Not surprisingly, with Medicaid plans like Georgia’s, the 44 million number doesn’t even tell the whole story. Recent studies suggest that close to 60 million Americans will go without health insurance for at least part of this year, and the separate 2001-2002 study that concluded that about 74.7 million people went uninsured for part or all of the two-year period represents “almost one-third of all non-elderly Americans,” Pollack says.

So what are the solutions?

The hip plan among conservatives is medical savings accounts. And they sound good until you start getting into the actual details. To qualify for a medical savings account, a consumer must have a high-deductible health insurance policy. The theory is that high-deductible policies are cheaper, and so more employers would be able to cover their employees. Then you would be able to set aside 75 percent of that deductible, tax free, in a medical savings account every year.

The fear is that wealthy citizens would simply use the accounts as tax shelters, because money can be withdrawn, without penalty, for non-medical purposes upon retirement. So it acts as a new-fangled IRA. What’s more, the high-deductible policies would only appeal to healthy people, thereby pulling them out of the standard insurance pool. And that stands to increase premiums for the people stuck in regular plans because insurers reduce their risk by pooling the healthy and the sick together. With fewer healthy-policy holders, insurers would likely have to increase premiums.

That leaves plans to allow small businesses to enter into collective pools so that they can act together to qualify for lower insurance rates. The problem with that is that there’s nothing to force the businesses into these pools.

What’s been proven to get more people covered and improve medical care is government-sponsored insurance. And it does it better than simply pouring more money into an already busted system.

In an ongoing study, Urban Institute’s Hadley reported to Congress, his group compared the effects of expanding insurance coverage versus expanding the health care safety net for poor people that already exists. Simulations suggested that increasing insurance coverage only 10 percent would reduce the number of people putting off or failing to get medical treatment by 25-30 percent. Spending a comparable amount of money on expanding the safety net would reduce that same number by one-third to half as much. Hadley reported that if insurance coverage were universal, the percentages failing to get treatment would be the same that experts see with people who have insurance through their employers.

What’s more, the last increase in the percentage of Americans covered by insurance came during the economic boom of the late 1990s. But it didn’t come from the private sector, where rates remained flat. Instead, the increase in the number of insured occurred because of an expansion of the federal State Children’s Health Insurance Program. Enrollment of low-income children in the program increased by more than 10 percent in 2001 to 31.3 percent, and uninsured numbers nationwide fell by 5 percent, according to numbers from the Center for Studying Health System Change.

It’s statistics like these that no doubt encourage groups such as Georgians for a Common Sense Health Plan GCSHP. It’s paying for a study by an independent group to determine whether the state can offer universal health insurance for its citizens for the same or less money than it currently spends on health care.

If the study works out as it has in other states, that will indeed be the conclusion. If it ultimately saves money, it will allow Georgians for a Common Sense Health Plan to make its case — even if it’s a case that the current governor might have trouble hearing.

“We’ve got to take the long view,” says Henry Kahn, an Emory emeritus professor and board member of GCSHP. “I’m trying not to be delusional. I know it’s not going to pass during the next budget session.”

The effort by Georgian’s for a Common Sense Health Plan, though, reflects the national political discussion where all of the candidates vying to unseat President Bush are expected to offer governmental and quasi-governmental health insurance plans in the next year. That should force Bush, who Pollack says has “really treated this issue area with significant neglect,” to push for solutions.

The question is whether it will result in action. To hear many pundits tell it, it’s a difficult issue for candidates to communicate to voters, and the voters don’t yet care enough about the problem. But the plans that have been put forward by the candidates so far differ from Clinton’s, and are surprisingly easy to understand. One wonders whether the learned commentators - most of who are old and rich and don’t have to worry about insurance (hello, Bob Novak) — aren’t still considering all the proposals through the prism of the Clinton plan.

People like Guericke would beg to differ. She’s a Gulf War vet who faces the possibility that she could soon have a better chance of receiving health insurance if she were an Iraqi citizen instead of a former member of the army that just conquered Iraq.

“It kind of makes me mad because, you know, there’s all these other countries in the world that can give their citizens health care and take care of their people, and we’re supposed to be the biggest, best country in the world,” Guericke says. “I spent six months of my life in a desert because I believed in this country. And we can’t even take care of our own people, and yet we’re so concerned with everything else going on around the world.”

For now, Guericke contents herself with searching for affordable insurance — the best she’s found is about $200 per month — and trying to control her illness by controlling her lifestyle.

“I eat right,” she says. “I don’t drink alcohol. I don’t do drugs. I exercise. I get sleep because I know what my body needs.”

Until someone offers something better, that’s just about all she can do.

kevin.griffis@creativeloafing.com