A large group of Americans are especially concerned about how Washington might act on healthcare reform this year. They are 45 million strong and commonly known as the uninsured, but who are they really?
"It's a flowing river of people," explained healthcare expert Grace Marie Turner, founder of The Galen Institute. "People are losing their health insurance when they lose or change their jobs because we tie health insurance to the workplace."
An Oct. 2008 report by the Kaiser Foundation revealed 70 percent of the uninsured come from families with one or more full-time workers.
The problem? Many times their employers don't offer health insurance or they find they simply cannot afford it.
Healthcare and Employers
Jamie Isbell and his family have found both scenarios to be true. They narrowly escaped Hurricane Rita four years ago and settled in Virginia. But when Isbell took a new job as an auto mechanic he found one major problem.
"It wouldn't cover me because of pre-existing injuries--asthma and then I had back surgery when I was 24, 25 years old so I switched to another job and it was Optima," he explained to CBN News. "It would have been perfect except it was like $900 a month."
So Isbell joined the ranks of the 45 million uninsured, all under 65.
Dr. June O'Neill, former director of the Congressional Budget Office, said 43 percent of the uninsured are "voluntary." That is, they choose to be without insurance.
O'Neill said this 43 percent makes two-and-a-half times above the federal poverty line. That translates into about $55,000 a year for a family of four. That's enough, O'Neill maintains, to afford health insurance.
Free Clinic Movement
Dr. Juan Montero saw just what happens to the uninsured. He founded the Chesapeake Care Clinic in southern Virginia. It's part of a growing movement of free clinics across the country that serve the uninsured exclusively. About 70 percent of the patients work full-time.
Montero said U.S. health care makes life especially difficult for the working poor, because the poorest have access to government insurance.
"It's better to be real poor in this country, to be indigent," he said. "Because you have access to doctors."
Montero's staff is all too familiar with their patients' common story: insurance today, gone tomorrow.
"We've seen lots of people who've had good jobs," nurse Tricia Anderson said. "But (they) have poor health and something has happened--a heart attack--where they've lost their job--where then they've lost their insurance and they have nowhere to go. And then their health deteriorates more because they have no health care."
Patients with chronic, potentially life-threatening conditions are perhaps most vulnerable.
Diabetic Barry Parker receives hundreds of dollars worth of life-saving drugs from the Chesapeake clinic each month. But his greatest sympathy lies with diabetics who are uninsured and have no access to a free clinic.
"I don't know what somebody in my situation would do if they had diabetes and need the medication," Parker told CBN News.
As conflicted as Washington is right now over healthcare reform, both sides can agree that helping the uninsured is a top priority. That is because both sides recognize that a lack of insurance affects health.
The Institute of Medicine of the National Academies researches medical issues for the federal government. In a Feb. 2009 report, it noted just some of the ways that adults without insurance suffer.
They include: fewer preventative services, fewer prescription drugs and a greater likelihood of dying from trauma or other serious acute conditions such as heart attacks or strokes.
Ophthalmologist Massoum Moayer at the Chesapeake clinic said some of his patients could go blind without the proper medication.
"They skip going to doctors and they take risks with their health and often they pay a healthy price with that," he explained.
But going to the doctor often means huge financial risk for the uninsured. Medical debt is common.
Jamie Isbell now owes $19,000 after his doctor ordered emergency back surgery this spring.
"He told me 'You've got to have this surgery--it's going to be an emergency package.'"Isbell said.
Isbell said his creditors would like him to follow a payment schedule of $400-$500 a month. But he believes $100-$150 is the best he can do in his new job as a house painter.
For now, how much help the uninsured can expect from Uncle Sam depends on the powers that be in Washington. The current House bill requires everyone to be insured and every employer to provide insurance.
Liberals like Peter Harbage, a fellow at the Center for American Progress, say the president's proposed public option plan would make health care affordable for everyone.
"A public option isn't going to have the same administrative costs," Harbage said. "Right now in private insurance you have administrative costs that can be anywhere from ten to thirty percent of every dollar you pay them going towards paperwork."
But conservatives like Grace Marie Turner counter that government health insurance would crowd out private insurance. She would like to see more subsidies for people to buy their own.
Amidst the political divide however, a growing census about the need to provide for the uninsured seems to be emerging.
"If people on Capitol Hill can understand that the American people really want a solution to this," Turner said. "And they don't want a political winner or loser. Then we can be more careful, more thoughtful, more deliberative--take the problem apart and solve it, the way a good physician would."
There is no doubt Congress has the diagnosis. But whether it can provide a treatment plan in a timely manner for millions of the uninsured is perhaps one of this summer's hottest questions.
*Originally published August 5, 2009