Merced Sun-Star
It was supposed to be a simple surgery. Julie needed her gall bladder removed. The operation would be done quickly -- an in-and-out procedure -- and Julie could go home the same day.
Instead, Julie went home, and then her stomach started to hurt. After days of misery and being told that she "couldn't deal with pain," she learned that she was very sick. After a three-week stay in the hospital during which she teetered near death, the Merced woman faced one more disaster.
She lost her home.
Julie and her husband, a self-employed truck driver, had paid off the home where the couple and their three children lived, hoping to retire early. But more than $200,000 in hospital and doctor bills put that dream on hold. Instead, the house was sold to pay the bills, and the couple is still trying to pay off the hospital, even though it's been six years since the surgery.
All because Julie didn't have health insurance. (Because of her family's potentially embarrassing personal losses, she asked that her last name not be used.)
Julie, like millions of other people in the United States, has no access to health insurance. Both Julie and her husband have jobs, but because her husband is self-employed, health insurance for the couple is out of reach. "I have insurance for my kids, but if I got it, the price, just for me, would be $600 a month," Julie sighed.
Vulnerable paycheck to paycheck
The plight of Julie and her husband and family is one that plagues an alarmingly rising sector of Americans.
The working poor, the people who keep the nation running while raising their children and trying to make it -- the folks living paycheck to paycheck -- are the ones hit hardest by the rising cost of health care and health insurance.
Earning too much to qualify for government health insurance, Medi-Cal, and not enough to buy insurance for themselves, they are stuck like flies in amber between health and disaster.
For Julie's family, getting sick meant losing their home. Julie's husband had worked long hours to get the house paid off, but when Julie fell ill, the house was their sole collateral. "I owed about $230,000 total in doctor and hospital bills, so we had to sell the house," Julie said.
In the United States, more than 48 million people lack health insurance.
That's about 16 percent uninsured. It's higher in California and Merced County. The last census in 2005 showed that about 7 million people in California, out of a population of 36 million, were uninsured.
In Merced County, 25 percent of people had no insurance. And 30 percent of Merced residents depend on government-funded Medi-Cal insurance to take care of their health needs.
In other words, nearly six of 10 Mercedians can't afford to take care of their health.
Although Medi-Cal allows patients to see physicians for low or no cost, the reality is that more than half the physicians in Merced County do not accept Medi-Cal as an insurance.
That leaves 55 percent of Merced County residents who are not welcome at most doctors' offices.
"It's a huge, huge problem," said Mike Sullivan. The chief executive officer of Golden Valley Health Centers said his clinics see more than 68,000 patients a year, and most are either uninsured or on Medi-Cal.
Because Golden Valley is grant-funded, its clinics are able to see people who wouldn't be welcome anywhere else.
Sullivan is worried that the numbers of uninsured patients are going to surge in the next few years. "It's very simply becoming more unaffordable for individuals and for employers to pay for health insurance," Sullivan said. "That leaves the safety net clinics like us to take care of people."
Specialists out-of-bounds
Although Golden Valley offers all types of health plans, from primary care to dental care, one problem that Sullivan has watched worsen for his patients is access to specialists. Because of low reimbursement rates, most specialists in Merced County refuse to see uninsured or Medi-Cal patients. Because of the refusal of specialists to see these people, the safety-net clinics are treating more and more extremely sick patients. "It's very, very hard for the uninsured to see specialists. In some cases, it's almost impossible," Sullivan said.
Patients end up being sent out of town -- to Modesto, Fresno and sometimes even San Francisco. Or they just keep seeing a primary care doctor, who struggles to take care of a very sick patient. "The consequence is that a lot of the patients get incomplete care, no matter what we do," he added.
One local primary care doctor who does see Medi-Cal patients faces formidable problems getting his patients in to see specialists. Dr. Leonard Oestreicher, who has been practicing in Merced for more than 20 years, has watched his patients wait months to see a specialist.
Oestreicher's nurse, Rachelle Collins, said that the specialists hardest to get Medi-Cal patients in to see are gastroenterologists, ear, nose and throat doctors and orthopedists. "I have one patient that I've been trying to get in to see a specialist since July," Collins said.
Although Medi-Cal patients may have a hard time seeing specialists, for the uninsured, it's almost impossible.
Unless they are able to pay up front, most uninsured never set foot in the office of a specialist.
Using hospital as a primary care doc
When a person with no insurance gets sick, that person often feels that the only thing to do is to go to an emergency room.
After all, federal laws require that the hospital emergency room has to see anyone, whether they can pay or not. "They come to our hospital because they have no insurance, and that impacts our emergency room," said Barbara Mullin, director of the emergency department at Mercy Medical Center Merced.
When the emergency room is busy, and patients are stacked up in the waiting room, Mullin said that limits the care that some people may receive. On a typical day, with 140 people using Mercy's emergency room, only about 33 actually are admitted to the hospital. "That's a huge amount of patients who could have been seen by a primary care doctor or at a clinic," Mullin said.
In order to help ease the burden of the emergency room, the hospital's rural health clinics, located next to the hospital, are staying open late to see non-emergency patients who may not have insurance. "We don't want to put people in the emergency room that are not true emergencies," Mullin said.
She added that the clinics are seeing more patients now than a year ago, with up to 20 to 30 people a night using them.
Everyone can be seen at the clinics, whether they can pay or not. If they meet certain regulations, a sliding payment scale may be used, or the hospital may write it off as charity.
Getting help for the uninsured
For many people who have no insurance, there is a plan. If you come to Golden Valley or the hospital without insurance, one of the first things done is to see if you qualify for an insurance plan.
Mullin said that hospital employees are trained to help patients find insurance, including Merced County's Medical Assistance Plan, or MAP.
The county receives funding for indigents who have no insurance and no way of getting insurance. These people, who must be living at 200 percent of the federal poverty level or below, can have their health care paid for by the county.
Unfortunately, the money budgeted by the county is only $1.5 million for the fiscal year 2006-2007. Mercy billed the county $21.4 million for MAP patients' care. "That's $20 million we wrote off," said Bob McLaughlin, spokesman for Mercy.
At Mercy's clinics, many illegal aliens who come to be treated don't want to disclose their personal information because they are afraid they will be deported. "We don't ask people if they are legal," said Alicia Bohlke, director of clinics for Mercy. "We can often tell when they need help, and we will guide them. But some are still afraid to sign up for anything, afraid to tell us even where they live."
For self-pay patients at Mercy, who use either the clinic or the hospital, there are options. The hospital will give the same discount to a self-pay person as the hospital gives to health insurance companies. And people can take a long time to pay off any debt, as long as payments are made every month.
Other clinics besides Golden Valley and Mercy are also available to help people who are uninsured or on Medi-Cal. In Livingston, the Livingston Medical Clinic also sees all patients, regardless of their ability to pay.
A sliding scale is used for people without insurance, and some people may qualify for no-pay.
Castle Health Clinics at the old Castle Air Force Base also houses many specialty clinics that see both the uninsured and Medi-Cal patients.
The clinics at Castle are rural health clinics and are able to offer sliding pay scales to the uninsured. Ed Lujano, chief executive officer, said the average fee to be seen by a doctor is about $30 for the uninsured.
Lujano said about 85 percent of the patients at his clinics are on Medi-Cal and 15 percent are uninsured.
The uninsured hurt everyone
The uninsured affect everyone's health insurance costs. At Mercy Medical Center Merced, the hospital made a profit last year of about $1 million.
That was after years of operating in the red, some years losing up to $9 million. Add to that a loss in fiscal year 2007 of $24.7 million on uncompensated care, charity care and bad debt.
Although Mercy is a nonprofit hospital, losing money hurts operations. That causes the hospital to raise fees to insurance companies, who turn around and raise their fees to employers or the self-insured.
So what's the answer? For a lot of people, it's a single-payer health system. Mullin, who spent years in the military, said she is glad to have the insurance she has through the government. "I wish everyone had federal government or national health insurance. I would vote for that in a heartbeat. When you look at the poor and the working poor, to not be able to take care of them is unacceptable."
For Julie and her family, whether government health care ever becomes a reality doesn't help them now.
Every month, the family makes a $260 payment to the hospital and dreams of owning a home again. "My husband worked really hard for us to be able to retire early," Julie said. "I'm hoping that we will be able to pay off the hospital in two years."
Meantime, while Julie's children are insured, Julie said that because she doesn't have insurance, she has only one choice when it comes to her health care:
"I don't go to the doctor. Hopefully, I won't get sick."
Reporter Carol Reiter can be reached at 209-385-2486 or creiter@mercedsun-star.com.
