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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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