No insurance? No surprise in North Central Washington [The Wenatchee World, Wash.]

<p>Feb. 20--WENATCHEE -- Health insurance. Here in North Central Washington, about one in six of us don't have it.

That's 39,320 people who live in Chelan, Douglas, Grant and Okanogan counties, according to the state Office of the Insurance Commissioner.

Per capita, it's 16.5 percent of our population without medical insurance coverage -- higher than the national average of 15 percent, and well above the state average of 13.5 percent, the state agency says.

In addition, one in four people who do have insurance are underinsured.

That means their insurance won't cover a major medical problem, says Insurance Commissioner Mike Kreidler.

"They're one diagnosis away from what, for many of them, will be medical bankruptcy," he says.

Going without health insurance is literally a life-and-death issue. "Numerous studies have found a marked increase in illness, disease and premature death among the uninsured," a November report from Kreidler's agency says.

The uninsured send a ripple effect throughout the economy, according to Tihamiyou Baba Moussa, regional labor economist for the state Employment Security Department.

"What's the effect of having more people healthy?" he asks, then answers:

"They will be able to work. A healthy economy is an economy that's using its potential. If we have some people willing to work but not able to work because they get sick, society is losing."

When people work, they have an income. They buy goods and services, Baba Moussa says. That helps keep other people employed, he says.

Officials offer a variety of reasons for the higher rates of uninsured here.

First, far fewer people work for companies with 50 or more employees, which are most likely to offer health benefits to their employees.

We also have more seniors and more low-income families who get insurance through Medicare or Medicaid -- 40 percent compared to the rest of the state's 29 percent.

That leaves fewer people in the market for private health insurance, and fewer insurance companies willing to compete here for the scant amount of business.

"Not surprisingly, the biggest single factor that determines whether a person has coverage is income," says a report from the Office of the Insurance Commissioner. And incomes in this region are just not as high as they are in the more urban areas of the state.

In addition, more people who live here work in one of the industries least likely to offer insurance.

"Uninsured workers are especially common in retail, entertainment and recreation, tourism, agriculture and administrative support," such as temp agencies, the report says.

But people who have no insurance are not numbers. They all have their own stories. They are as diverse as the people enjoying Lincoln Park in Wenatchee on a Saturday afternoon.

Some are young, others are approaching retirement. Some work full time, others are part-time employees, and still others are unemployed.

These are the experiences of just some of the people who have no insurance in North Central Washington. The statistics are for Washington state only, and were provided by the Office of the Insurance Commissioner.

They're young, healthy, and uninsured

People 20 to 29 years old are in the age bracket with the highest number of uninsured -- 30.7 percent, or nearly one in three young adults.

--Angie Hurtado, of Wenatchee, is 20 years old, and a new mother. Her daughter, Aiiliyah, is 3 months old.

"She's covered, I'm not," Hurtado says simply.

Hurtado had coverage through the Community Health Plan until she turned 18. The insurance -- established by a network of nonprofit community health centers in Washington state -- covered her again when she was pregnant. But three months after Aiiliyah was born, Angie no longer qualifies.

Hurtado works full time for a small jewelry store in Wenatchee that doesn't offer insurance to its employees.

She says she definitely delays care when she doesn't have insurance, hoping the problem will go away on its own.

"I had a toothache. A major, major toothache, to the point where I was crying," she recalls. But she put off seeing a dentist because she couldn't afford it.

"I tried everything. Oragel, everything. It would come and go," she says of the pain. "Later, I had to get it looked at."

She says she really appreciates the sliding scale fee at Columbia Valley Community Health, the nonprofit community health center in Wenatchee, but mostly, she just tries not to get sick.

"You never know what can happen. Being a single mommy, and not having that extra financial support," she says.

"I worry more now that I'm a mom. I have to be well."

--Aaron Florea also lost his health insurance due to his age. The minute he turned 25 years old on Dec. 31, he was no longer eligible to be on his parents' insurance plan.

Florea graduated from Cascade High School, and is now a senior at Central Washington University in Ellensburg, where he majors in exercise science.

He's generally healthy, but takes an expensive medication. He plans to get insurance, but finding a new plan hasn't been easy.

Florea says there are plans for students that are reasonably priced, but they also don't cover much.

"Really, it's only going to be an insurance plan for if I get in a car crash or something extreme," he says.

The real frustration, he says, is that the insurance plans won't tell him whether they'll cover the medication he needs to take.

"The only way that I'll know for sure if I'm covered, I'll have to buy it myself, send them the bill, and if they reimburse me, then I'll know I'm covered," he says.

Even if the medication is covered, he says, the maximum drug benefit is $2,000 a year, and that won't cover all of his medication expenses.

As a student, he says, he really can't afford any insurance coverage.

"Fortunately, my parents are helping me with it. I'm very lucky that way. If it wasn't for my parents, I wouldn't be covered. I would just go without it."

Insurance depends partly on what you do for a living

People who work for government -- a school district, a state office, a city or county department -- are highly likely to have insurance. Only 4 percent do not.

On the other end of the spectrum, about 94 percent of part-time retail workers, and 50 percent who work full time in retail do not have insurance.

Similarly, 67 percent of people who work in agriculture, forestry or fishing full time have no health insurance, which rises to 84 percent for part-time workers in those industries.

--Doug Shirk, 61, had health insurance for most of his working career. But now that he needs it, he's not covered."I've gone through a quadruple bypass and a mini-stroke without insurance," Shirk says.

He and his wife Dora each hold two part-time jobs as retail grocery merchandisers. They work for the same employers. Doug is also a city councilman.

After two major medical episodes, Shirk worked out a plan that included some charity care, in which the hospital and clinic forgave part of his bills. That helped cut what he still owes to a more reasonable size.

Still, he'll pay $450 a month for the next six years on the remaining debt.

He still can't afford health insurance. Catastrophic coverage alone would cost them $600 a month, each, he says.

"The goal here is to stay healthy until Medicare kicks in," Shirk says.

Shirk says he's not in dire straits over the lack of medical insurance. He and his wife make enough money to live comfortably and pay for regular doctor visits.

"Between my wife and I, we have a decent job. Our income would be fine, if it weren't for this damn medical bill," he says.

He adds, "This whole insurance problem is a massive inconvenience. It's nothing that's going to lead me to leap off the Tallahatchie Bridge."

--Fernando Guadalupe Flores also has no insurance. He's 54, and lives in East Wenatchee, and works in nearby orchards.

He speaks Spanish, and Christina Medrano, who works in patient services at Columbia Valley Community Health, translates.

Flores is here to see a doctor. He had a stroke on Dec. 23, and ended up in the hospital.

At home, he has huge stacks of medical bills that he cannot pay. He's applied for charity care, but hasn't heard anything yet.

And the bills keep coming.

He also applied for other non-medical financial help through the state Department of Social and Health Services, but his applications keep getting returned. He has not been able to get any additional assistance, and has no money coming in.

Flores feels frustrated. He's not sure what he's going to do. He would like to return to work, but he cannot. He still has problems from the stroke. His left arm is numb. Half of his body is affected. He can't go up and down the ladders to prune the trees.

He wants to know why applications for help are not processed in a shorter amount of time. He thinks there should be help for all people in need.

It's hard to be insured if you're unemployed, or work part time

At least half of the people who are unemployed are also uninsured. And for part-time workers, more than 90 percent have no insurance, including those who work close to full-time hours.

--Cindy Hamilton, 37, of Wenatchee, used to have insurance. But then the recession hit, and she lost her job at a local car dealership more than a year ago.

She says without a regular paycheck, she couldn't even begin to buy the health insurance that she once had through her job.

"I have to weigh going to the doctor with, am I going to be able to afford food next week?" she says. "Of course, food for my children is going to win out."

That's her decision, even though Hamilton knows it's dangerous for her not to see a doctor regularly. And a counselor.

She suffers from severe bipolar disorder, exacerbated by a thyroid condition.

After she discovered her condition, and found medications that work, she's been able to keep her depression under control. But she needs regular blood tests, because lithium can hurt her liver and kidney, and the amounts she takes needs to be adjusted.

Hamilton says it's a gamble for her not to get her blood tested regularly. But it would be a bigger risk to go off her medications.

"I've been there before. I refused to go to a doctor before I knew I had this problem. It ended with a suicide attempt," she says.

"I'm afraid. If I go down that road again, I know what will happen. It's a proven fact of my condition."

Now, because she can't afford a counselor, she goes to Internet chat rooms to talk to other people who have bipolar disorder. She says she doesn't want to go back to that place where she isn't seeing a doctor or a counselor, and stops recognizing the things she needs to do to keep her condition under control.

--Rick Waller, 56, is also putting off care because he lost his job, and his insurance, a little over a year ago.

Waller is an electrician who gets jobs through International Brotherhood of Electrical Workers Local 191.

He worked on many of the large industrial projects, including many of the new data centers in Quincy.

When he stopped working, he had the choice of continuing with the same insurance plan through COBRA, a federal program that allows employees to stay with their insurance plans, as long as they're willing to pay for it.

Without work, he says he can't afford the $831 a month it would cost him to continue his Blue Cross Blue Shield plan.

"My insurance premium is more than my mortgage payment," he says. With insurance costs so high, and climbing, "How in the world are young people ever supposed to capture the American dream of owning their own home?" he asks.

His wife is covered, but it would cost him about $600 a month to be added to her plan.

Since he became unemployed, Waller has put off dental work, and has tried to ignore problems with his neck and elbow.

He says besides the teeth that constantly remind him they're there, and the orthopedic issues, having no insurance has convinced him to limit his activities to milder sports, like fly-fishing.

"It affects and impacts everything," Waller says. "Activities you might have thought of doing, you don't because there's an element of risk you can't afford. You just don't."

Small businesses just can't offer what big companies do

The size of the company you work for makes a difference, when it comes to health insurance.

Less than half of those who work at businesses with fewer than 10 employees are insured. Nine of every 10 jobs at firms that do not offer medical insurance are in businesses with fewer than 50 employees.

--Bob Hill, 39, is head coach for Barracuda Swimming, a small nonprofit organization in East Wenatchee.

He hasn't had comprehensive health insurance since he moved to East Wenatchee from California four years ago.

His wife, Christina, 33, just lost her insurance along with her job at a local car dealership.

Hill says he did have limited health coverage for emergencies, but when his wife lost her job, they couldn't afford to keep that anymore.

Generally, the Hills are fit, and use their insurance for checkups and annual vision exams.

Hill worries a little about getting skin cancer, being out in the sun as much as he is.

"The occasional spot that shows up, I check it and check it and check it," he says.

But he doesn't get it checked by a doctor.

"When you don't have insurance, you don't go to the doctor unless you absolutely have to," Hill says.

That includes injuries.

When he pulled a ligament in his foot, he went online to diagnose his injury, and talked to friends to figure out how to take care of it.

"I couldn't afford to go to a doctor, so I just followed what was said online," he says.

He doesn't think the outcome was different, in this case.

"It healed as well as it's going to be healed," he says, "I just didn't have to spend the 60 or 80 bucks for an appointment."

But his wife, Christina, says it could have had a long-term impact on his health, if he had misdiagnosed his injury.

Not having health insurance also changes their outlook on life, she says.

"I'm 33, and all I can think is, when I'm 60, what's going to show up because of what I didn't do 30 years ago?" she says.

She says her husband chose to get life insurance instead of a 401K benefit, and when he explained why, she choked up.

"He said, 'I don't have a doctor. At least I'll know my wife is taken care of.'

"It's one of those things that you don't think about until it smacks you in the face."

K.C. Mehaffey: 997-2512

mehaffey@wenatcheeworld.com

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