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The New Uninsured

Neither Rich Nor Poor, Many People Who Have Lost Their Jobs In the Deepening Recession Find Getting Health Care Is Something of a Lottery

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By John Fairhall and Kate Steadman
Kaiser Health News
Tuesday, February 3, 2009; Page HE01

People young and old crowd the hallway outside the locked door of the Arlington Free Clinic. They grip small pieces of paper that will determine whether they get in -- or give up and go home.

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It's lottery day, and 45 county residents who lack health insurance and money to pay for medical care are competing for 30 openings on a cold afternoon in January.

Mary Gleason, a clinic volunteer, draws letters from a plastic box. Those holding matching letters will be ushered through the door for interviews. If they meet the clinic's criteria, they'll return in a couple of weeks to see doctors or other staff.

One by one, winners are separated from losers. Gleason plucks a Z, and a man holding a Z strides into the clinic. His broken arm had been set in a hospital emergency room, and he needs to see a specialist for follow-up care.

Another man, who has Parkinson's disease and urgently needs drugs to treat it, leaves disheartened. He will have to return in two weeks and try again in the next lottery.

The lottery is just one example of the fate of the newly uninsured -- the growing numbers who once had jobs and insurance and now seek treatment with neither. Although most of the clinic's clients have low incomes, the nonprofit, privately funded operation and others like it in the region are seeing more people who used to be solidly middle-class. Victims of the deepening recession, they're now wondering where to turn for help.

Neither rich nor poor, this group doesn't readily qualify for public programs such as Medicaid but often can't afford to buy insurance or pay hospital, doctor and drug bills. The Democrats' economic stimulus package would significantly enhance options for the unemployed and their families through insurance subsidies and a possible expansion of Medicaid, a package that some experts say would ease the financial dilemma.

"How many of us can lose our jobs and pay for our health insurance? Not many," says Gail Shearer, director of health policy analysis for Consumers Union, publisher of Consumer Reports magazine.

Where one lives matters, Shearer says. Some states make it easier than others for people with chronic conditions to obtain private insurance. Medicaid serves the poor, especially children, but eligibility criteria vary. Virginia has the most stringent guidelines for adults in the region: Working parents with a child can earn no more than $5,352 annually to qualify for coverage. Uninsured kids and some parents who don't qualify for Medicaid may be eligible for the soon-to-be-extended State Children's Health Insurance Program (SCHIP).

Arlington resident Jean Perry, 57, tried her luck in a clinic lottery because she couldn't afford insurance after losing her $40,000-a-year job as a coffee shop manager last summer. Under federal law, she could have kept her employer-provided policy, but at full cost: $400 a month.

"Of course I couldn't afford that," said Perry, not even with unemployment benefits, which in Virginia top out at $1,452 a month. Buying a cheaper policy also was beyond her means. She put her dwindling funds into prescriptions for treatment of chronic problems, an upper respiratory blockage and high blood pressure. They cost from $29 to $159 a month each. Monthly doctor's visits added $72 more.

Needing help, Perry showed up for the clinic lottery on Dec. 2.


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