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On the cutoff's cusp

A national political fight, one middle-class Southern California family . . . What the debate about children's health insurance looks like up close.

November 26, 2007|Susan Brink | Times Staff Writer

American dream scene: a gorgeous Southern California day. A car-free cul-de-sac on a hilltop overlooking a canyon. A boy and his father, shooting hoops.

But stark reality intruded for a brief moment last summer when 40-year-old Wes Wirkkala tripped, stumbled and almost fell. "Dad, what are you doing? Be careful!" his son Nicholas shouted. "We don't have health insurance."

At 8, Nicholas knows his family cannot risk any visits to the emergency room. He's been told a hundred times, as he dashes out the door with his skateboard, to be careful, to fall on his butt if he has to fall at all because there's no money for broken arms.

Wes Wirkkala, father of three, heard his son's words in front of their Dana Point home and felt shot through with shame. He didn't want this particular family deficiency broadcast through the neighborhood. "It was embarrassing," Wes says. "It kind of makes me feel that I'm not providing everything I should be."

The Wirkkalas, with an income that for five years has hovered around $70,000 and a home they bought in 2004 for $535,000, are a family many would call middle class. But they have been priced out of the private health insurance market, and their circumstances illustrate the core of a political battle over how much a family can earn for their children to qualify for a federal-state partnership called the State Children's Health Insurance Program, or SCHIP. If the outcome of Washington politics goes one way, the children could remain uninsured. If it goes the other way, the children might get health insurance.

Sophia and Wes Wirkkala decided, despite his embarrassment, that they should tell their story of how difficult it can be for a family of modest, middle-class means to maintain health insurance. Sophia is not ashamed, just fearful for her children and angry at a system that has pushed health insurance premiums out of reach.

She lies awake at night, worrying about the health of her three perfectly healthy children. "We're in the boat we're in because I'm a stay-at-home mom," she says. "We chose to have children, and we planned that I would stay home with them and home-school the kids. We want to raise kids that are going to grow up and be great adult citizens. We question that decision all the time. You look at your children sleeping, and you say, 'I'm not providing healthcare for these kids.' "

The Wirkkalas are, by most definitions, doing all right. They live in a four-bedroom house in Dana Point that was starting to sag toward the canyon depths when they bought it three years ago. Because Wes knows what to do with a power saw and a nail gun, the house has been shored up and improved with beamed ceilings, antiques incorporated into bathroom vanities, and a granite-countered modern kitchen. An independent contractor, he says: "This home is my business card."

From the patio that fronts the canyon, one can catch a glimpse of the Pacific. "You look at our home," Sophia says, "and you think, 'They probably have everything.' "

It does not look like the home of a family who cannot afford health insurance. And it's only recently that their insurance has lapsed, canceled one month last year when they simply could not make the premium. They thought it would be temporary, but they haven't had the money since to pick it up again.

Even without employer-sponsored health insurance, the couple managed, for most of their married life, to buy health coverage for the family.

At first, they bought a policy with a $2,500 annual deductible that cost them about $250 a month. As the premiums kept steadily rising, to more than $400 a month, they switched to a policy with a $5,000 deductible. The premiums were lower at first, but continued to rise, despite the fact that no one in the family had major health problems. And preventive care wasn't covered. Every time a child needed a vaccination or a trip to the pediatrician for an earache, the fee came out of their pockets.

When the monthly premium reached $450 last year, the couple decided that the payments were unsustainable.

Sophia thinks herself in circles over medical care. Is it better to try to save up to buy health insurance by skimping on preventive visits to the pediatrician? Once Nicholas had an earache, and they went to an urgent-care center. He was treated, and their bill was about $200. He needed the care, but if the family could count on not having those kinds of outlays, they might put some money aside to pay for a policy.

"When you're trying to save a lump amount to buy insurance, you don't want to spend money on going to the doctor," she says. So the youngest child, Vincent, 2, is behind in his immunizations. And when Nicholas or Olivia, 6, do typical kid things, their parents hold their breath. "When you see your son hop on a skateboard, or your daughter doing cartwheels, you're a nervous wreck," she says.

The children don't qualify for SCHIP, the program now being debated in Congress. Under current rules, the family's income is too high.


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