The Combined Family Medicine and Psychiatry Program On the Road!

Doctors on a dime

How to get affordable health care after losing employer insurance.

By Erin Glass
Monday, March 23, 2009

The Mobile Health Clinic provides free medical care in neighborhoods five days a week.

On a recent Friday, Daniel M. Sanchez, 57, returned to the Mobile Health Clinic for the results of a test he had taken the previous week. For almost a month, home has been in the bushes a few blocks away in the Chula Vista neighborhood. It is not a residence he anticipated. But after 35 years as a truck driver with employer health insurance, Sanchez suddenly found himself homeless, penniless and with a devastating kidney condition.

“The news was not good,” he said, stepping out of the Mobile Health Clinic, a local program that provides free care to the uninsured. “If I don’t see a specialist immediately, that’s it.”

For many, the loss of a job has meant the loss of health insurance. Studies show that a one percent increase in the nation’s unemployment increases the number of uninsured by 1.1 million. With a 3% rise in unemployment in the past 12 months, 3.3 million have lost job-based health insurance nationally in the last year.

COBRA, the program which allows for employees to keep their health coverage after job loss, does not seem to be alleviating the problem. Statistics show that only 1 in 10 employees choose COBRA, whose cost is particularly challenging to those who have lost their income.

“Most unemployed workers just can’t afford COBRA,” said Kamal Muilenburg, executive director of San Diego Business Healthcare Connection. She estimates COBRA costs families an average of $13,000 a year, whereas the same coverage cost employed workers $3,200 a year.

Charity, a single mother of two who wished to withhold her last name, worked in the marketing industry for 10 years. She lost her job a little over a year ago. Though her company contributed to COBRA expenses for the first year, she now cannot afford the $1,300 monthly COBRA bill with funds from her unemployment check.

“There used to be a stigma attached to welfare moms. But I have a college degree. I’m a professional and now these are service I have to rely on,” Charity said.

Her children do not meet eligibility requirements for public assistance programs like Healthy Families or Medi-Cal, and have been refused coverage by health insurance carriers because they are diagnosed with behavioral disorders. Even when she had COBRA, the copays for their prescriptions cost Charity hundreds of dollars a month.

“The insurance companies told me that because of their pre-existing condition, they will never be eligible for insurance outside of employer insurance,” Charity said. “I’m really kind of stuck.

“If you smoke, you can be denied, if you have had a series of doctor’s visits, you can be denied,” said Mulienburg.

In San Diego, estimates of uninsured citizens range from 750,000 to 1,000,000.

Sanchez had COBRA coverage as well, until he could no longer afford the expenses. He was laid off in October, and like Charity, cannot find work. Money ran out in January, causing his household to dissolve. He has an engineering degree, is a certified heavy equipment operator and despite having health insurance before, is still trying to pay off $15,000 in medical bills. (He found out the hard way about his diesel allergy.) Once a business owner and provider for 18 biological, adopted and foster kids, he now spends his time looking for a place to shave.

“It’s like being a prisoner of your own mind,” Sanchez said. “There is nothing else to do but walk the streets. And people look down on you because the drug addicts give us a bad name.”

It’s a story that repeats itself among those waiting for care at the Mobile Health Clinic. A couple who wished to remain anonymous found themselves unexpectedly uninsured, unemployed and homeless after 12 years of employment at the same company. Both in their late 50s, and with escalating health problems, it was a difficult situation to reconcile. They spent three weeks living in their car before moving into a shelter.

Then, about a year ago, they visited the Mobile Health Clinic for the wife’s appointment, but it was the husband who was sent straight to the emergency room. He hesitated, afraid of losing his bed at the shelter.

“Dr. Searles saved his life,” the wife said. “He would’ve died within 48 hours of congestive heart failure.”

Now the couple visits the clinic monthly for checkups and prescription refills that otherwise they wouldn’t be able to afford.

The Clinic operates out of a high-tech van outfitted with lab and pharmacy capabilities. The van stops in different neighborhoods five days a week to administer care to the uninsured. It’s a demographic that the clinic’s staff has seen swell dramatically in the past few months.

“There is a large increase of people finding themselves in need of care in a place like this,” Dr. Christopher Searles said. “Unfortunately, business is booming.”

When the clinic is unable to provide the necessary care, they work to get the patient in a hospital or with a specialist, finding them coverage through avenues many patients are unaware of.

“I can’t tell you how many people I’ve sent straight to hospital because they were going to die,” Searles said. “People are afraid of the bill.”

Most of the cases he sees are serious, but he thinks all of them could have been avoided by basic preventive care.

“I’m not talking about the most expensive cardiac catheterization, just basic regular preventive care on the cheap would’ve kept these people much healthier,” he said. “It would be much more cost effective to not have to wait for people to have kidney or heart failure before they can get treated. We’re stamping out disease where the community has failed them.”

However, the fate of free clinics is uncertain in these economic times. Funding has decreased for the UCSD Student-Run Free Clinic Project, leaving them at risk of service cutbacks. The clinic provides continuous care for more than 1000 San Diegans who have no access to care and don’t qualify for public programs.

Steve Escoboza, president of the Hospital Association of San Diego and Imperial Counties, said hospitals are feeling the effect of the economic downturn as well. A study from last November showed a 73 % increase in consumers having difficulty paying out of pocket health care costs. There has been a 33% increase in uninsured patients visiting the emergency room where law requires that they are treated regardless of ability to pay. It’s a financial burden harder to bear as elective procedures, a large source of hospital revenue, are experiencing a 30% decrease.

“Losing job-based health insurance is really leading to a decline in the financial health of hospitals,” Escoboza said.

Unfortunately, the emergency room continues to be the most enticing option for those who can’t pay. Most low-cost or free health care providers have strict eligibility requirements. Assets are often calculated in addition to income, so recently unemployed individuals might have a harder time qualifying.

“For the folks in the middle, it’s very difficult,” Muilenburg said.