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SPECIAL REPORT / AN UNEASY REALITY

Coverage, in pieces

Medical insurance can be surprisingly elusive -- and temporary. For many, the safety net now requires compromise and sacrifice.

April 03, 2006|Susan Brink | Times Staff Writer

HEALTH insurance coverage is cyclical. It changes with age, jobs, income, marriage, divorce -- even with sickness itself.

Some stories of what people do to stay covered are whispered in confidence: a marriage of convenience, a divorce put on hold, a person too sick to work kept on the payroll by a compassionate boss.

Others are more obvious: a hated job held onto; retirement ruled out because a worker, or the worker's spouse, is not yet 65 and, therefore, ineligible for Medicare; an economically comfortable couple, thriving on one self-employed income, sending the other spouse to a 9-to-5 job for the health insurance.

The nation's political, business and community leaders are all grappling with the escalating cost of healthcare. But it's not just Medicare and Medicaid budgets that cause concern in the public discourse. Events that once may have been seen as unrelated corporate decisions, such as layoffs at General Motors, are readily linked to the problem of rising healthcare costs.

Among the general public, there is a gnawing uneasiness that anyone, at any time, is a pink slip away from joining the ranks of the uninsured.

But it can happen even without the pink slip. A good job used to mean good health insurance. Since 2001, employees' share of health insurance costs has risen 58% for family coverage, 63% for single coverage. Working people who can no longer afford the bite out of their take-home pay become uninsured. And more companies are dropping health benefits altogether. Today, only 61.9% of working people get coverage through their employers, according to the Kaiser Family Foundation, down from 71% in 1987.

In discussion groups around the country, called for by Congress in a little-noticed provision of the Medicare Modernization Act of 2003, individuals are talking about their worries. A meeting was held last month in Los Angeles, and about two-dozen similar town hall-style meetings are scheduled for other cities. In the fall, these opinions will be added to a mix of reports Congress will receive summarizing meetings held in 36 cities, as well as survey results received on the Internet (www.citizenshealthcare.gov).

"I think many people are starting to feel the slipping-through-the-cracks phenomenon, that it could happen to them," says George Grob, executive director of the Citizens' Health Care Working Group, which is organizing the meetings. "In general, people worry about the cost of care, about access to care for themselves, and for everyone else. A common theme is that it's time to do something about it."

Congress is committed, if not to act, at least to listen.

The stories in this package illustrate the obstacles encountered, as well as the generous doses of creativity required, as people cobble together health coverage in America's often hit or miss system.

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(BEGIN TEXT OF INFOBOX)

The changing face of coverage

PEDRO BARRERA

WHEN a bundle of cardboard boxes headed for the recycling bin fell off a forklift in February 2001 and hit Pedro Barrera, 50, the blow sent him flat on his back and, ultimately, out of the workforce.

At the time he was insured through his employer, Macy's. "I paid $30 a week," he says. But he couldn't afford to insure his whole family, including three children. "They wanted $150 a week. That's a lot of money," he says. He lost his own coverage when he lost his job.

Since the accident, Barrera, a permanent resident in the United States, has bought insurance through the national health system in Mexico -- paying $175 a year for medical, dental and vision coverage. When Barrera needs care, he heads south. "When I need to go to the doctor, I take a trip to Tijuana," he says.

"I am worried," he says. "Not only for myself, but for the whole community. I come from South Central, and probably 90% of the people there don't have insurance. They don't have access to visit the doctor. It's too expensive. So usually they go to USC hospital."

When they go to the Keck School of Medicine at USC, they are not turned away. The hospital has a contract with the L.A. County health department, and although the public dollars don't cover the full cost of uncompensated care, it makes the hospital the biggest provider of care to uninsured people in the county.

About 50% to 60% of outpatient visits are from people without insurance, says Jeffrey Huffman, dean of clinical affairs at the medical school, and 40% to 45% of emergency visits. "We take care of them, regardless of their ability to pay, as they present themselves," he says. "A patient is a patient."

Some, like Barrera, do what they can outside the healthcare system to avoid illness. He is a volunteer for a project he hopes will help keep members of his community healthy: the South Central Community Garden.

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