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Health Without a Safety Net
If you’re uninsured, you’re not completely out of luck
December 9, 2003
By Louis Wittig - eCureMe Staff Writer
Physician Reviewed - December 7,2003
If you’re one of the over 40 million Americans
who aren’t part of an employer-sponsored health
plan, buying medical insurance can be
prohibitively expensive. Not buying it can put
your health on the line. There’s not much wiggle
room between those facts.
While there is no government run insurance scheme
that offers universal coverage, individual states
run programs that offer low-cost insurance to
uninsured children from families below certain
income levels. Eligibility requirements vary by
state, but as a rule of thumb most anyone under the
age of 18 in a family of four that earns less
than $34,000 annually is eligible. For low-income
seniors, the federal government has constructed
the Medicare system. Younger people living below
the poverty line can tap into a similar public
insurance system - Medicaid.
If you’re somewhere in between the above
guidelines, you’ll probably be forced to wing
it - improvising ways to get the medical attention
you need without going broke. And while it’s not
the recommended course of action, there are some
tips that can help keep you as safe as possible.
If You Have It, Get It
While most people who are uninsured work for
employers who don’t offer a health plan, about
40% of those without insurance have
employer-sponsored plans - they simply haven’t
enrolled in them. For many, especially younger
adults who compromise a bulk of the uninsured,
insurance is something they’ve never had to
think about - so even when it’s available, it
falls by the wayside. For others, the paycheck
deduction that comes along with most workplace
plans might seem to steep - especially if
they’re healthy - and see insurance as unnecessary.
Either way, the logic of passing on available
coverage doesn’t need disproving. If you have
a plan available through work, but haven’t
signed up - of if you’re not sure if your
employer offers one - talk to your supervisor or
HR rep and get on board as soon as you can.
Know The Resources
For many uninsured, getting medical attention
means arriving at the local hospital’s emergency
room, whether or not their problem is an
emergency. Hospitals can be attractive for two
reasons. Many are under the impression that
certain hospitals - especially public - are
obligated to provide all comers with comprehensive
care. Others, wary of paying major money for
minor problems, let small health concerns go
until they build to a crisis point - and then
the ER is the only option.
Both patterns are destructive in the long run.
Contrary to what’s often thought, hospital
emergency rooms aren’t required by any state or
federal law to provide complete care to anyone
who arrives. Emergency rooms are required to
stabilize patients who arrive with serious
conditions, but not necessarily to provide them
with all the care they need. "If someone comes in
with a heart attack, they’re not going to ask him
if he has insurance before treating him," says
Skip Moskey, Assistant Vice President for
Communications at the National Association of Public
Hospitals and Health Systems. "But if they need
triple bypass surgery after he’s stabilized, they
might not take care of that."
Many hospitals have what are known as "Safety Net
Missions"; mandates or goals set by hospital
directors to treat patients who can’t pay for care.
However, these mandates vary greatly between
hospitals. To know what help the hospitals in your
area can and can’t offer, it’s best to contact
your State, County or City Department of Health.
Departments of Health, along with public health
advocacy groups, can go beyond providing information
on hospitals, and can make referrals to low or
no-cost clinics and health services that handle
non-emergency medical care. Often public or non-profit
clinics operate alongside hospitals, only with a
lower public profile - and can provide some measure
of general or specialty primary care. Getting
acquainted with these resources - such as the
contraceptive and reproductive health services
Planned Parenthood offers across the country -
can help you get the primary care necessary for
small health problems before they grow out of
control.
Take Freebies
Medicine isn’t a field much given to handing
out freebies, but a number of primary care
and preventative health services are provided
for free - you just have to know where to
look for them.
Community organizations and large companies
often offer minor health services - such as
free blood pressure or glaucoma screening.
And while they’re no substitute for actual
healthcare, the information they provide can
help you keep on top of your what’s happening
in your body. Drug store chains and workplaces
sometimes offer low-cost flu shots. Donating
blood through the Red Cross and your donation
is screened for a series of infections - such
as HIV and Hepatitis C - and in the event of a
positive test, the Red Cross will notify you.
Enrolling in the clinical trials that are always
being run by hospital or university to test a new
drug is another, slightly more straightforward
way to get medical attention. Jane, a 45-year-old
homemaker in Oregon who has lived with and without
insurance for years wishes she’d known about them
sooner. During periods when regular visits to the
doctor were out of her reach due to cost, she would
enroll herself in trials; everything from acne to
birth control to pap smear studies have been her
stand in." I get to see a doctor once a month,
receive regular bloodwork, physicals and get free
samples of new prescription drugs." Kept informed
of what was being tested and why, Jane never felt
like a guinea pig.
Occasionally offering stipends, as well as medical
attention, clinical trials are always looking for
individuals from a wide variety of medical
backgrounds. Advertisements routinely run in the
classified sections of major market and
university newspapers.
As of today, major healthcare reform is a distant
speck on the political horizon. Until another
serious attempt to rework the system by which
Americans receive and pay for their healthcare
is launched, millions of uninsured will be a
fact of life. Managing that fact will fall largely
on the uninsured - and continue to be a
dangerous balancing act.
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