Ghosts of Midnight: Tom, Karen and the rest of them

This is the last of a 6 week series entitled, "Summer at the County Fair". It is a synopsis of 6 hours I spent meeting and speaking with people who were visiting a county fair in western PA. Over the next few weeks you will see the human faces that mirror our national statistics regarding the uninsured and underinsured. Thanks to the Pennsylvania Health Access Network (PHAN) for their assistance in this series.

Photo by "Mule" Symons

It was approaching midnight in late summer as I made my way home.  I’ve always found the interstate to be a lonely place, but on this particular night it was especially forlorn.  The blackness of the night hung over me like a blindfold, unable to distinguish the landscape of the passing miles.  Was it mountain, valley or field?  I didn’t know.  The night left me abandoned.  My dawn departure from home seemed like light-years away and I still had a long way to go.  I felt lost.  Within the horizon of the black night all I could see were the faces of the people I had met in the summer of 2011.  I was haunted by their images.  I never believed in ghosts.  I did now.    What did they want from me?

I was grounded back to reality by the sour convenience store coffee I purchased at my previous stop off Pennsylvania I-80.  As home became closer, the ghosts began to emerge from the darkness and their picture became clearer.  They were beckoning me to tell their story.  Each of them was a brush stroke in a painting that blended together to create the perfect portrait of the uninsured.  I knew the data and the human images of the data appeared before me so willingly this summer.  The puzzle came together on a remote interstate that night.

The Department of Health and Human Services overview of the uninsured states that they primarily live in a family with at least one full time worker, often work in small establishments (such as Brianna), are often young adults between 19-24(like Bill and Tyler), self-employed (like Susan), low wage workers (such as Braianna and Tyler), non-unionized and part-time workers (like Shontell).[i]  This data also highlights another unexpected group, retirees.  Workers that leave their careers but are not quite old enough to qualify for medicare are another cohort that has fallen into the trap of the uninsured.

As dusk began to settle on the day just before my lonely drive down I-80, this statistic carried a human face.  Within a few hours of each other I met Tom and Karen.  Tom is a 63 year old retired guidance counselor from Mercer County.  When he retired at the age of 58 he was left to utilize COBRA at the monthly cost of $1600 a month or $19,200 a year.  While Tom was paying for this policy and isn’t considered uninsured, for many low income individuals, this is an impossibility.  Similarly, Karen is a 64 year old retired notary from Butler County who explained that she was now working part-time solely to pay for her health insurance until she reached the infamous “milestone age” of 65, the age to qualify for medicare.  After a lifetime of being a contributing members of society, are these the “golden years” we promised our retirees? 

It was approaching 1am and home was getting closer.  As I thought about Tom and Karen, I knew that retirees like them would benefit from the Patient Protection and Affordable Care Act because of their eligibility for the individual exchanges.  However, Tom, Karen and the other ghosts were still sitting on the passenger seat beside me.  We were traveling on an unfamiliar road.  We were on our way to experience and see the implementation of the PPACA.  The haunting of these ghosts will not end until we achieve access to health care that is not stratified.

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[i] Department of Health and Human Services, Research in Action, Issue #17, September 2004

Thank you for joining the "Summer at the County Fair" series.  Please follow me next week into the fall of 2011 as I explore other aspects of the Patient Protection and Affordable Care Act and how it will impact groups and institution in Pennsylvania.  On 11/4 meet Theresa BrownGold:



Bill's Story

This is the fifth of a 6 week series entitled, "Summer at the County Fair". It is a synopsis of 6 hours I spent meeting and speaking with people who were visiting a county fair in western PA. Over the next few weeks you will see the human faces that mirror our national statistics regarding the uninsured and underinsured. Thanks to the Pennsylvania Health Access Network (PHAN) for their assistance in this series.

The mist of the late July morning stubbornly hung over the mountains of western Pennsylvania when I arrived in Punxsutawney, a town that proudly proclaims itself as being the “capital of weather”. Punxsutawney is home to the infamous character and Pennsylvania icon, Punxsutawney Phil, the immortal groundhog.  Known to the world every February 2, but revered by Pennsylvanians as the state mascot.  I’ve often wondered why this seemingly annoying “pest” has become so cherished and preserved.  As I explored the streets of Punxsutawney, I found a town enshrined in the legend.  The groundhog museum, dozens of groundhog statues scattered about the town and “Phil’s Burrow”, the place the groundhog calls home 364 days of the year.  Every February 2 however, Phil will emerge from his burrow in order to execute the 18^th century Pennsylvania German tradition of predicting the end of winter.  So guaranteed is this event that an entire town proclaims it, our state honors its actor and the nation tunes in each year to hear the results of an oversized rodent as he pursues his own shadow.  Predictable, Guaranteed, Expected, Certain and Secure-all adjectives that could describe Phil’s annual ritual.

As I left Punxsutawney and crossed the counties that lie in the northwest of Pittsburg, I thought about these values.  I thought about the guarantees of our culture.  Hours later I met Bill.  Bill is the full-time manager of the park where the day’s county fair was being held.  He is a 22 year old college graduate with a degree in recreation management.  He is uninsured.  At $23,000 a year, Bill explained to me that he had a choice to make each month between health insurance or food and student loan payments.  As he explained his situation my mind dizzied with confusion.  The quintessential guarantee that many of us have been promised for generations was being torn apart.  Wasn’t a college degree supposed to be our ticket to lifetime security? 

1.2 million College graduates can proclaim this reality.  The uninsured with a college degree now represents 9% of our youth population between the ages of 19-29[i].  So much for guarantees.  Unfortunately this number is only going to get worse as we embark on an economy that has fewer jobs and a job market that relies even more on part-time workers, subcontractors and temporary employees.  Additionally, if a young college graduate is lucky enough to get a full time job, they are less likely to be offered health benefits.  The rate of employer sponsored health care has been declining for the past decades[ii] .

The evolutionary changes in the dynamics of our workforce have left us with outdated guarantees, indicating the societal need for the Patient Protection and Affordable Care Act.  Under the PPACA, Bill can stay on his parent’s health insurance until age 26.  Those over 26 will be eligible for the individual exchanges that will provide them access to health care with guarantees of essential benefit.   Since most youth starting out in their careers fall in a low income bracket, many of them will also qualify for the premium tax credits.  Another reason this cohort has such a high rate of being uninsured is the perception that they are “invincible” and not subject to ill health.  While their rates of illness are lower than their older counterparts, access to preventive care that is now guaranteed by the PPACA will ensure that they enter later adulthood in a healthier and therefore less costly state of health.  Bill and his generation can also expect the other standard benefits guaranteed by the Patient Protection and Affordable Care Act such as medicalloss ratio, basic patient protections and rate review.

Like Punxsutawney Phil, our country has emerged from its burrow to realize that the season of old guarantees has changed. 

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[i] Schwartz, Karyn; Schwartz, Tanya,  The Kaiser Commission and Medicaid and the Uninsured.  Uninsured Young Adults:  A profile and Overview of Coverage Options.  June 2008

[ii] Cohen RA, Makuc DM, Bernstein AB, Bilheimer LT, Powell-Griner E. Health insurance coverage trends, 1959–2007: Estimates from the National Health Interview Survey. National health statistics reports; no 17. Hyattsville, MD: National Center for Health Statistics. 2009.

Shontell's Story

This is the fourth of a 6 week series entitled, "Summer at the County Fair". It is a synopsis of 6 hours I spent meeting and speaking with people who were visiting a county fair in western PA. Over the next few weeks you will see the human faces that mirror our national statistics regarding the uninsured and underinsured. Thanks to the Pennsylvania Health Access Network (PHAN) for their assistance in this series.

Artwork by:  San Suzie

Upon her chest Doris proudly wore a button that was 5 inches in circumference and bore the picture of her daughter, Shontell.  Under typical circumstances this would seem an odd accessory, but today was different.  In the photo button that this prideful mother showed off to the world, Shontell was wearing her nurse’s whites for a photo taken in preparation for her upcoming graduation from nursing school in October. 

Shontell, a 34 year old married mother of 2 from Clarion County had finally made it.  Standing dignified on her own honor she assertively told me how she had done it all on her own.  When she was turned down for scholarships because she was making too much money at her pharmacy technician’s job, she paid her own way through nursing school at the area community college.

As Shontell takes the final sprint towards the finish line to reach the goal she has been intensely striving for she has one final hurdle.  Just as she is about to grab the golden ring and position herself in a place of financial security, she lost her health insurance.  Just days before I met her, Shontell was informed by her employer that they would be cutting her hours back and she would therefore no longer be eligible for health insurance benefits.  Is this the reward for working hard and doing the right thing by society?  Shontell is merely another example of the force the crack in our system has which has increasing grown wider, hungrier and swallows up its victims indiscriminately. 

Shontell’s story is a rather typical one that has evolved quickly over the past half century.  According to the National Center for Health Statistics, in 1980 the number of Americans who were being insured by their employers peaked at 71.4%.  However, 1980-2007 the rates rapidly declined, leaving the number of Americans with employer provided health insurance at 62% in 2007.[1]  As healthcare expenditures ballooned 8 times in this time period and more employers stopped providing it, the crack that sucked up Shontell grew.[2]

The Patient Protection and Affordable Care Act will allow someone who has lost their coverage because an employer is no longer offering it to go on the individual exchange.  The exchange will guarantee Shontell essential benefits and because of her income she will qualify for a premium tax credit that will ensure that she does not pay more than 4% of her income on premiums.   The Kaiser Family Foundation also states that the PPACA’s implementation of the Medical LossRatio and the expansion of Preventive Care will also help alleviate the rapid increase in healthcare costs that have partly contributed to employers no longer offing insurance to their employees.

Shontell is commencing into one of the few, yet rapidly growing industries in our aging country.  What incentive will there be if our nation’s caregivers lose their own health security in their pursuit to help others?

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[1]  Cohen RA, Makuc DM, Bernstein AB, Bilheimer LT, Powell-Griner E. Health insurance coverage trends, 1959–2007: Estimates from the National Health Interview Survey. National health statistics reports; no

17. Hyattsville, MD: National Center for Health Statistics. 2009.

[2] Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, National Health Care Expenditures Data, January 2010

Brianna's Story

This is the third of a 6 week series entitled, "Summer at the County Fair". It is a synopsis of 6 hours I spent meeting and speaking with people who were visiting a county fair in western PA. Over the next few weeks you will see the human faces that mirror our national statistics regarding the uninsured and underinsured. Thanks to the Pennsylvania Health Access Network (PHAN) for their assistance in this series.

Artwork by: Norman Rockwell

According to our recent census, roughly 800,000 Americanswill be living into their second century, a unique and growing group we dub “centarians”.   Taking care of this growing cohort is Brianna, a 28 year old home health aid from Clarion County,PA.   For 35 hours a week, this mother of 2 lifts, bathes, dresses, feeds and provides medical oversight for her 91 year old patient for $15,000 a year, a salary consistent with many in the profession.   Brianna reports liking her job which is reflective in the fact that she worked for the mentally handicapped prior to her service with the elderly.   In fact, the vast majority of home health aides do report job satisfaction. With 2011 signaling the year the infamous “baby boomers” have officially reached retirement, there is no disputing that our society’s needs for the selfless services of people like Brianna are going to be in greater demand.

The altruism that Brianna and home health aides like her are a priceless commodity as we watch our population rapidly age, but the question our society needs to ask ourselves is what value do we place on them and the vital services they provide? The day I met Brianna, she was riddled with concern. She had just received word that she would no longer be eligible for Medicaid.   Apparently, a home healthaide with 2 children that works 35 hours a week and makes $15,000 a year is too high of an income to qualify for Medicaid.  Unfortunately, Brianna is not alone.  According to a National Health Statistics report released in 2011, 25% of home health aides are not offered health benefits from their employers, of which 18% end up with none at all. This number is significantly above the national average of 15% for the general population. Even more alarming, among health aides, the ones like Brianna that provide home only health aide in private homes as opposed to institutional care, are at even greater risk of being uninsured (34%).

Brianna and those in her situation are left treading the waters of a ruthless system that has no qualms about sucking them down. What incentive is there for them to stay in a profession that appears to be so devalued by our society?   What would happen if the Brianna’s of the world chose to climb out of these waters and swim to a more secure shore. The numbers are evidence to the value we place on those that serve our elderly.  In a profession that is prone to injury, as they service our society’s vulnerable, they themselves are also becoming the most vulnerable.

Fortunately in 2010 with the passage of the Patient Protection and Affordable Care Act, a life preserver was thrown to keep these valuable citizens afloat. Brianna will now be covered because the PPACA will expand Medicaid up to 133% of the Federal Poverty Level.  For those that fall above 133%, there is the individual exchange that will provide premium tax credits if they are below 400% of the Federal Poverty Level.   Additionally, now employers, such as the private home health aide company that Brianna works for, will have to harbor more responsibility by paying a $2000 fine when they don’t provide health insurance for their employees, instead utilize the public system as their “benefits package”.   The PPACA will also take a step in recognizing the toll our rapidly aging population is having on our health care system and health care costs by including a provision which funds Work Force Development and Training Opportunities for Direct-care Workers . Brianna can also expect to enjoy the other standard benefits guaranteed by the Patient Protection and Affordable Care Act such as preventive care, medical loss ratio, basic patient protections and rate review.

As the “centarians” embrace their new century in greater numbers, they will sense the security that permeates from people like Brianna.   Brianna is the ship that will carry them through their golden years.

Source:

Bercovitz A, Moss A, Sengupta M, et al. Anoverview of home health aides: United States, 2007. National health statisticsreports; no 34. Hyattsville, MD: National Center for Health Statistics. 2011.