Health-coverage woes worsen - Catholic Courier

Health-coverage woes worsen

WAYLAND — From a hospital bed situated in his cramped living room, surrounded by medicine bottles, Neil Fox spoke in hushed tones while recalling the day his wife learned that their health-care benefits were in serious jeopardy.

“I had gotten so far toward being better,” he said, his eyes closing and brimming with tears.

Over the past 10 years, Fox, 44, has been afflicted with severe rheumatoid arthritis. He can’t get out of bed, much less earn a paycheck.

“I worked hard all my life until this happened. My knees, hips, shoulders are gone,” he said. “Sores have been on me for over a year.”

He also has endured pneumonia, congestive heart failure and a couple of minor strokes. Though he’d been feeling better as of late, Fox and his wife, Bonnie, 38, are now gauging which of his medications they might have to cut out.

Bonnie received a letter in late May from the Steuben County Department of Social Services stating that since health insurance is offered through her workplace — where she earns $9.25 per hour — Neil’s Medicaid benefits would be cancelled and she must obtain the employer-sponsored insurance. The letter doesn’t take into account that the employee share of coverage would cost the Foxes $537 per month above their current insurance costs, and the plan wouldn’t cover nearly as great a percentage of Neil’s medication expenses.

“It’s insane. What do they want us to do? When those drugs are $400 to $2,000 a month — I don’t even make that much,” said Bonnie, throwing her hands in the air. “We can’t pay for his drugs. I’ll be paying for his funeral. We’re getting punished for getting sick.”

Bonnie said the family has been able to keep their heads above water, but fear going under soon. That’s a feeling that Bob Loepker, 66, and his wife of 42 years, Yvonne Comfort-Williams, 71, know all too well.

The couple’s son was born in 1976 with one kidney. Comfort-Williams said a major operation was covered by their insurance, but their son’s post-surgical care and his medication — which cost $1,200 a bottle, three times a month — were not.

“You would guess what happened. We lost everything,” Comfort-Williams remarked, noting that she and her husband went bankrupt and had to sell their house in Wayland. For the past decade they’ve lived in a trailer in Cohocton.

The stories of these two families illustrate that you don’t have to travel the country — as documentarian Michael Moore did for his new movie “Sicko” (see movie review on page B15) — to find people who suffer physically, emotionally and financially due to the inadequacies of the U.S. health-care system. Plenty of examples exist right in northern Steuben County, according to Sister Mary Jean Smith.

“What a terrible situation and awful need so many are experiencing. It’s both heartbreaking and outrageous,” said Sister Smith, who along with fellow Sister of St. Joseph Barbara Kuhn provides rural ministry in the area.

The Southern Tier is a microcosm for a nation in which many millions of people are uninsured and underinsured — people who struggle to come up with cash for employee health-plan contributions, copayments, deductibles and prescription costs. Many folks opt to take their chances with no insurance at all, which certainly saves money but often brings about a tragic ending.

“They just don’t get the services, the treatments they need. They die early,” Sister Kuhn remarked.

Who’s at fault?

The most impoverished Americans are covered by such government-sponsored public-insurance programs as Medicare and Medicaid providing for the poor, disabled and elderly. However, according to the Employee Benefit Research Institute, some 62 percent of the nation’s uninsured, non-elderly population in 2005 were in families in which the head of the household worked a 12-month, full-time job.

According to the U.S. Census Bureau, the total number of uninsured people stood at 44.8 million in 2005 — and that figure doesn’t include the countless others who are underinsured. The consequences for both categories are inadequate access to prevention, screening and therapy, leading to diagnosis in more advanced stages of illness. Several surveys and studies show the U.S. as being consistently low in world overall health-care rankings, despite spending the most money on health care.

In his film “Sicko,” Moore contends that the current crisis had its origins in the early 1970s when President Richard Nixon began to promote the establishment of health-maintenance organizations under the assumption that competition among for-profit health insurers would bring about cheaper overall care.

The HMO Act was passed in 1973. Insurers profited, costs soared, the number of uninsured grew and a serious debate — one that continues today — arose as to whether insurers were more interested in saving money or helping patients.

Moore contends that Congress and the White House have been bought and paid for by health insurers as well as pharmaceutical companies, which impose domestic drug prices several times higher than what they charge in other countries. His movie contrasts the U.S. health-care system with those in Canada, England, France and Cuba, which provide seemingly solid government-run programs at little or no cost to residents. Conversely, he spotlights U.S. residents who encounter reams of red tape along the way — people denied coverage due to pre-existing health conditions; patients whose claims are denied; HMOs that reap financial rewards by keeping the sick away. Moore claims to have received more than 25,000 responses in the first week after posting a request on his Web site for “health-insurance horror stories.”

Adding to the escalating costs are advances in medical research and treatment — “and you’ve got us that are going to pay for it,” remarked Mary Bauer, diocesan director of human resources. Bauer observed that “we have great access to care within our 12-county diocese. The health care is so wonderful, but it’s expensive.”

To absorb the increases, employee contributions toward health plans have escalated. Whereas employers once routinely paid for 100 percent of insurance costs for their full-time employees, Bauer said she doesn’t know of any that pay the full shot today. She added that when employee contributions to their coverage became commonplace 15 to 20 years ago, “people would say, ‘Oh, what’s six bucks a week? That’s nothing.’ Now it’s $35 or $40 a week — and that’s something.”

As a not-for-profit entity, the diocese does its best to keep insurance affordable for employees, but premiums have risen at least 10 percent for each of the past five years, Bauer said. She added that the diocese now offers its employees an option of more limited coverage at lower premiums, because having no health insurance at all is “not a very good decision.”

Coping

Uninsured and underinsured people struggle to pay for doctor appointments, medicine, ambulance trips and emergency-room visits, not to mention surgeries that could run several thousand dollars. Unlike a mortgage or car, such expenditures often are impossible to shop or prepare for.

Take the case of Loepker and Comfort-Williams, for example. They quickly racked up bills of nearly $100,000 for their ill son after he was born 31 years ago, putting them in a permanent financial hole.

“We owe the electric company $2,000 from 10 years ago — bankruptcy doesn’t cover utilities. Our credit is zero. We can’t even buy a car, can’t do anything,” said Loepker, the pain obvious on his face.

Bonnie Fox, meanwhile, works at Gunlocke, a furniture factory in Wayland. She and Neil have been married for seven years; they and her children reside in a modest rented farmhouse on Route 21 for $300 a month. Their combined monthly net income is approximately $2,000, based on her paycheck and Neil’s disability payments.

They now stand to lose Medicaid coverage, for which they’ve been paying $185 a month. If Bonnie were to take the insurance offered by Gunlocke, her employee contribution would be $722 a month, not counting many of Neil’s drugs.

“We’re up the creek without a paddle,” she said. And yet, in the eyes of the powers-that-be, “we make too much money” for Medicaid, she remarked sarcastically.

The double-whammy for many is that such financial crises can lead to other health issues. Bonnie Fox has ulcers due to stress, and Loepker and Comfort-Williams each have suffered heart attacks as well as other ailments in recent years.

“I can’t do this anymore. There is a tremendous strain here,” Comfort-Williams said, pointing at her head.

Commenting on other people facing similar plights, Comfort-Williams observed, “They look so much older than they really are.”

Is there a solution?

Catholic advocacy groups continue promoting the need for federal and state health-insurance programs that are free or low in cost, such as the State Children’s Health Insurance Program — known in New York as Child Health Plus — and Family Health Plus. Meanwhile, the two Catholic hospitals in the diocese, St. Joseph’s in Elmira and St. James Mercy in Hornell, teamed up for Cover the Uninsured Week this past April to enroll people who are qualified for this special coverage but had not previously enrolled. The Census Bureau reported that more than 1 million such people live in New York state.

Other efforts to assist the uninsured and underinsured include such church-sponsored clinics as St. Joseph’s Neighborhood Center in Rochester and Southern Tier Health Ministry in Corning, Bath, Elmira and Watkins Glen (see related story on pages B1 and B2). Yet Comfort-Williams contended that “We should not have to rely on volunteers to take up the slack.” Instead, she suggested rerouting government military expenditures toward health care, saying “it’s going to benefit the nation in the end. Why should you defend a nation of sick people, instead of helping them so they can defend themselves?”

The good news, if you will, is that things have become so bad that the issue is gaining momentum politically. Jack Balinsky, diocesan health-care coordinator and director of diocesan Catholic Charities, cited a New York Times Magazine article from April 1, 2007, noting that prominent leaders of the business community have now begun to push for universal health care, which also is advocated by several presidential candidates. This represents the first serious focus on universal health care since early in the Clinton administration.

Michael Moore is a strong advocate of universal health care, but concedes that opposition from many politicians and leaders of the health-care industry leaves little chance for a government-run health-care system. Critics of universal health care also cite consumers’ loss of freedom to make choices about the types of medicines to purchase and health-care companies to utilize.

Toward the conclusion of “Sicko,” Moore observes that other countries are successful because “they live in a world of ‘us,’ not ‘me.'” In the same vein, Balinsky said he believes that everybody must play a part in improving the overall situation.

“It is a responsibility, equally, of families to do what they can with preventive health measures, employers, government, insurance companies, hospitals,” he said.

As this controversy swirls across America, Neil Fox lies in bed in his Wayland home, unable to influence other people’s decisions about the care he needs to keep going.

“I just want to survive,” he said.

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