By Michelle Singletary
Sunday, March 16, 2008; F01

Maria Gomez knows firsthand the devastation that can hit families who don't have health insurance. Gomez is chief executive of Mary's Center for Maternal and Child Care in the District. The clinic serves people who either have no insurance or are underinsured.

Dilian Gomez, 21, who is not related to Maria Gomez, is one. She comes to the clinic for some medical services, offered at negotiated prices. But sometimes Gomez just goes without care to save money.

"I had a very high fever once," she said through an interpreter. "But I just waited it out. The fever persisted for three or four days, then subsided."

What might have happened if her condition had been more serious? It's something the young Guatemalan mother worries about a lot.

"I feel bad because I can't afford health care, but I can't afford health insurance, either," said Gomez, whose newborn son, Edward, is covered by Medicaid. "What am I going to do?"

The fact that 47 million people -- 9 million children -- in this country are uninsured has been one of the top issues in the presidential campaign. Equally troubling is this statistic: The lack of health-care coverage is most acute among Hispanics and African Americans, many of whom work in low-wage jobs without benefits or are employed by small businesses that don't offer coverage.

"Things are getting worse," Maria Gomez said. "What we are seeing is a lot of people coming in who cannot qualify for government programs." These families earn too much to qualify for free care but don't make enough to pay for their own health insurance, she said.

Thirty-six percent of Hispanics are uninsured, compared with 22 percent of African Americans, 17 percent of Asian/Pacific Islanders and 13 percent of whites, according to the Kaiser Family Foundation's most recent analysis of census data.

"The numbers are just unbelievable," said Jennifer Ng'andu, associate director of health policy for the National Council of La Raza. "I'm very excited the discussion about this has been generating a lot of attention. But now our leaders have to start thinking about how we move forward to get people access to health care."

If you have adequate health insurance and are inclined to think this issue doesn't affect you, let me assure you that it does. The cost of insurance for those with coverage is escalating in part because the number of uninsured Americans keeps rising, said Ron Pollack, executive director of Families USA, a nonprofit, national organization that advocates for high-quality, affordable health care for all Americans.

Using data from the Census Bureau, the federal Agency for Healthcare Research and Quality, and the National Center for Health Statistics, Families USA determined that the unpaid expenses for the uninsured added an average $922 in 2005 to the premiums for employer-provided family health insurance. That extra cost could rise to $1,502 in 2010, the group found.

If you have insurance, you know how the costs hit your wallet. Increasingly, employers are shifting a larger portion of their health premiums to employees. You may be able to afford your policy today, but it's possible you may not in the future. Premiums for employer-sponsored health insurance rose an average 6.1 percent in 2007, according to the Kaiser Family Foundation and the Health Research and Educational Trust. The average annual premium for family coverage in 2007 was $12,106, and workers paid an average $3,281 out of their paychecks to cover their share of the cost of a family policy. Since 2001, premiums for family coverage have increased 78 percent.

It may be easy to dismiss the uninsured, especially minority families, as a group of people who just want a handout or who should strive to get better-paying jobs. But these people are the workers and caregivers who provide needed services.

"Me and my husband both work, but we don't have insurance," said 29-year-old Dina Aju, who is nine months pregnant and was getting a prenatal checkup at Mary's Center.

The people without health insurance ring up your purchases at retail stores. They mow your lawns or fix the roofs on your homes. They cook the meals and clear away your dishes in restaurants. They watch your children so you can work at a job that provides you with health benefits. They care for your elderly parents or grandparents.

"This is a problem for all of us. Eighty percent of people who are uninsured are working and some at more than one job. They deserve to have health-care coverage," said Risa Lavizzo-Mourey, president and chief executive of the Robert Wood Johnson Foundation.

The foundation sponsors "Cover the Uninsured Week" ( http://www.covertheuninsured.org), a national campaign that runs this year from April 27 to May 3. The campaign is intended to highlight the plight of the uninsured.

Lavizzo-Mourey said minorities, who disproportionately suffer from chronic illnesses, often avoid getting critical screening or skip treatment because they lack health insurance. She shared the story of Ruth, a diabetic African American in her 50s who came into a clinic with an ulcer on her foot. By the time she sought help, she needed more care than the clinic could offer.

"When we told her she needed to get to a hospital, she burst into tears," said Lavizzo-Mourey, who was working at the clinic at the time. Ruth was reluctant to seek medical attention because she was already trying to pay off other staggering medical bills.

In a sad irony, Ruth is a home health-care aide who couldn't afford medical care herself.

At least one good thing may emerge from the current economic crisis: As more people lose their jobs and join the ranks of the uninsured, it will be harder for our political leaders to avoid a long-term solution.

Research and reporting assistant Charity Brown contributed to this column.

¿ On the air: Michelle Singletary discusses personal finance Tuesdays on NPR's "Day to Day" program and online athttp://www.npr.org.

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