Latinos Fall Through Insurance Safety Net

By: Rui KaneyaInside Javier Olea Anaya’s stomach, a time bomb ticks.

Since 1995, the 23-year-old native of Acapulco, Mexico, has struggled with a rare disorder called Budd-Chiari Syndrome, which obstructs the veins of his liver. He has lost 18 pounds since November, though his abdominal cavity has ballooned with liters of bodily fluid accumulated by the disease. One more year, his doctor estimates, and the deterioration of Anaya’s liver will lead to his death.

“I feel exhausted,” he said in Spanish. “That’s the only thing I feel right now.”

Only a liver transplant can save Anaya’s life, said his doctor, Jorge A. Marrero, a gastroenterologist at the University of Illinois at Chicago Medical Center on the Near West Side. But Anaya, who is undocumented, uninsured and speaks no English, needs about $100,000 for post-operative care before doctors will consider an operation.

Anaya’s plight has drawn widespread attention, and Latino charitable groups are raising money for his surgery. But the dangers and frustrations of living on the margins of the health care system are played out in less dramatic ways every day.

Living without health insurance often means ignoring nagging pains until they can no longer be tolerated. It means trying to stay healthy while knowing that a medical calamity can spell financial disaster.

More than 43 million people lack health insurance nationwide, and the number has been increasing by an average of 1 million a year for the last decade, the U.S. Census Bureau reports.

And there is a significant racial gap between those with insurance and those without. In Chicago, the typical insurance have-nots are likely to be Latino or African American, an analysis by The Chicago Reporter shows.

Latinos are at the greatest risk. In 1997, nearly 260,000 Latino Chicagoans lacked health insurance, according to data compiled by the Washington, D.C.-based Employee Benefit Research Institute.

Though Hispanics are 26 percent of the city’s population under age 65, they are 43 percent of the city’s uninsured. At 36.6 percent of that population, African Americans made up 32 percent of the uninsured; whites were 22 percent of the uninsured and 33.4 percent of the population.

The Latino rates remain stubbornly high across job and economic categories, the Reporter’s analysis shows. Among full-time workers, Hispanics get fewer insurance benefits than other groups, and when they lose their jobs, fewer have access to publicly funded insurance. Language barriers and immigration fears leave Latinos reluctant to seek insurance benefits—even for their children, experts say.

The insurance gap underscores society’s reluctance to tackle universal health care, said Aida L. Giachello, director of the Midwest Latino Health Research, Training, and Policy Center at the University of Illinois at Chicago. “The fact that … the poor community and people of color are affected—the society doesn’t seem to care and believe that this is an issue that should be addressed by public policy.”

Working Poor
In 1997, more than 600,000 Chicagoans —about 22.5 percent of the population under age 65—lacked health insurance. But the uninsured typically are not the poorest of the poor, who often are eligible for publicly funded coverage, such as Medicaid.

Of uninsured Chicagoans between the ages of 17 and 65, nearly 70 percent worked at least part time. And more than 70 percent of the uninsured under 65 lived above the federal poverty line of $8,350 a year for one person in 1997. Many are not offered insurance through an employer or cannot afford to pay for it on their own. The average annual cost of health insurance in 1997 was $1,126 per person, according to the Health Care Financing Administration, a federal agency that administers publicly funded insurance.

And those numbers are swelling, even as the nation’s unemployment rates remain low. In addition, more people are moving from welfare to work—and to jobs with few benefits, studies show.

Since June 1994, Cook County welfare rolls have shrunk from 455,328 to 269,500. The federal Personal Responsibility and Work Opportunity Reconciliation Act of 1996 imposed time limits and work requirements on public aid recipients. Whites proportionately have made the largest exodus from the system, with a 56.9 percent drop between June 1994 and March 1999, followed by Latinos with 50.8 percent. African Americans on welfare have declined by 36.2 percent, though they accounted for nearly two-thirds of those who left the rolls, Illinois Department of Human Services data show.

But getting a job doesn’t solve the health care dilemma. In 1997, one in five working Chicagoans between the ages of 17 and 65 had no insurance. More than 40 percent of these 291,113 uninsured workers were Latino, while 26.9 percent were African American and 25.1 percent were white, according to the Benefit Institute.

Latinos are more likely to work in jobs that don’t provide benefits, such as restaurants and other small businesses, Giachello said. In fact, more than one in four employed Latinos in Illinois worked in businesses with fewer than 25 employees in 1997, Benefit Institute data show. Only 8.1 percent of African American workers and 14.6 percent of whites are employed by small firms.

Small firms have few choices, said Kim Maisch, state director of the National Federation of Independent Business/Illinois, a 21,000-member advocacy group.

“Small-business owners want to provide health care to their employees, because providing health care is one incentive that you can use to attract quality employees,” Maisch said. “But they’ve only got so much capital, and [often] health benefits are what gets cut.”

Taking Refuge
Except for three years on public aid, Jeanette White, 38, has never benefitted from the protective umbrella of health insurance. Still, she’s no stranger to hospitals.

In October 1997, White fell from the window of her apartment, breaking her left foot and fracturing her back. She was rushed to Illinois Masonic Medical Center, 836 W. Wellington Ave., and hospitalized for two weeks.

“I fell about 40 feet, people told me,” she said with a smile. “Didn’t I tell you I was truly blessed?”

For 31/2 months, White wore a back brace and a cast on her left leg, and needed a walker to get around. Several times a week, she visits Chicago Health Outreach Inc., a clinic at 1015 W. Lawrence Ave. The clinic provides free and low-cost medical services for about 11,000 clients a year, most of them uninsured, said Executive Officer Heidi Nelson.

White’s stay at Illinois Masonic brought a staggering $60,000 bill, none of which she could pay. The hospital kept sending her bills, she said, until “I told them I was homeless and I had no money.” The bills stopped coming.

When in crisis, the uninsured can take refuge in hospital emergency rooms, where by law they must be treated.

Nationwide, emergency departments recorded an estimated 90.3 million visits in 1996, about 34.2 visits per 100 people, according to a survey by the National Center for Health Statistics in Hyattsville, Md., which examined 21,902 patient records provided by 392 emergency departments.

More than half the visits were not classified as “urgent,” the survey found.

And when patients can’t pay, emergency visits drain the health system. In 1996, 41 Chicago hospitals spent more than $680 million, or 7.8 percent of gross patient revenues, on “uncompensated care,” which includes bad debts and charges for patients who apply for charity, according to the American Hospital Association.

But competition is forcing hospitals to cut back on charity care and straining publicly funded hospitals, said David Dranove, professor of health services management at Northwestern University’s Kellogg Graduate School of Management.

“The amount of charity care the hospitals provide has fallen because of competition, and those patients either go to the county hospitals or just struggle,” he said.

But there are other options. Cook County runs 28 community clinics that provide free care, said Lacy L. Thomas, director of Cook County Hospital. “You don’t have to come to the emergency room whenever you have a condition that requires medical treatment,” he said.

Though Medicaid is intended to provide health insurance for the poor, more than 170,000 Chicagoans living below the poverty line in 1997 were not enrolled in the program and remained uninsured, according to the Benefit Institute. Latinos accounted for nearly half of that group, compared to 28.5 percent for blacks and 19.5 percent for whites.

For some Latinos, the decision to enroll in a welfare program can be difficult. While not an issue for citizenship applicants, the government can deny permanent residency to immigrants who use certain public benefits, citing a “public charge” as evidence they will become a burden on society, immigration experts say

.“One of the very basics of immigration in the United States is that you are supposed to be able to take care of yourself,” said Joseph Daleiden, executive director of the Midwest Coalition to Reform Immigration, a non-profit that pushes for stricter immigration controls. “We don’t want … to have mass immigration of people just to come here and go on welfare.”

Non-citizens accounted for 23 percent of the drop in welfare caseloads nationwide between 1994 and 1997, though they represented only 9 percent of the households receiving benefits, according to a March study by The Urban Institute, a Washington, D.C.-based research group.

“There’s a big paranoia,” said Francisco Ramos, executive director of the Health Advocacy Project of Little Village. “It’s really not clear what benefit is counted [against immigrants], so a clear-cut decision many people make is just don’t use them.”

Covering Kids
Inside the main entrance of the Ames Middle School, at 1920 N. Hamlin Ave. in Logan Square, a makeshift booth covered with stacks of application forms greets parents arriving on April 14 to pick up their children’s report cards. A new campaign in the city’s 591 public schools is promoting the state-run KidCare program, which provides free or reduced medical coverage to children from low-income families.

Nitza Figueroa, 38, who came to Ames that day with her 8-year-old daughter, Adamaris, has been living without insurance since moving to Chicago from Humacao, Puerto Rico, six months ago.

Soon after arriving, Figueroa developed a severe allergy, and her daughter got the flu, but they couldn’t afford to go to the hospital. “Even just for a shot, it would cost so much,” she said in Spanish.

KidCare was launched in January 1998 to zero in on the plight of low-income working families. Nearly 3.5 million Illinois children live without insurance, according to the Benefit Institute.

KidCare is part of the federal Children’s Health Insurance Program, which provides states with more than $20 billion over five years. Illinois was allocated $620 million through 2002, and the Illinois General Assembly allocated nearly $117 million to help 200,000 children in fiscal year 1999. But as of March, only 31,820 children had signed up. And Latino children, who make up 28.4 percent of the state’s uninsured population under age 18, have been among the hardest to reach, child advocates say.

Critics charged that the Illinois Department of Public Aid lacked adequate staff to handle the increased application load, and that poorly trained staff were turning away eligible applicants. About 40 percent of applicants were rejected, said department spokesman Dean Schott, adding that most of them already had Medicaid or their incomes were too high.

Gov. George H. Ryan, who took office in January, said he was “very disappointed with KidCare” and held a press conference on April 12 to kick off a new promotion drive, which includes posters, the school sign-up booths and radio ads.

But problems persist. At Ames, for example, Figueroa struggled with her English as she tried to fill out the application and needed help from a school staff member who speaks Spanish.

The goal is to have 40,000 people signed up by June, and at least 80,000 by next April, said Department of Public Aid Director Ann Patla. Her department has increased the number of staff processing applications from 17 to 60, and required additional staff training.

The office also cut the application form from eight pages to three, and eliminated a section asking applicants for the names of other family members.

Child health advocates say the program is now heading in the right direction. “The new administration has really done a wonderful job taking up the slack,” said Alissa Strauss, program associate at the non-profit Illinois Maternal and Child Health Coalition. But she urged “more outreach needs to be done in specific, hard-to-reach populations on both the grass-roots level and in the media.”

Universal Care
In the Nov. 3 election, 83 percent of Cook County voters approved an advisory referendum calling for passage of the Bernardin Amendment, which would change the Illinois Constitution to guarantee health coverage for all residents. In April, the proposal, named for the late Chicago archbishop, won similar support in two counties and 27 municipalities and townships. But the measure faces a tough fight in the Illinois General Assembly, where a constitutional amendment must pass by a three-fifths vote before being submitted to voters.

State Sen. Barack Obama, a South Side Democrat and an amendment co-sponsor, predicted it will eventually pass, but said its chances of passage in the next two years are “zero to none.” The sponsors’ “strategy has been to pass advisory referendums and to make the public aware of the lack of health care and to keep building the momentum,” Obama added.

State Sen. Miguel del Valle, a Northwest Side Democrat, expects a long fight ahead. “There will still be people without coverage or not adequate coverage. The mind-set [in the legislature] is that we are doing something,” with KidCare, he said. And “therefore a universal health care plan is not necessary.”

Ryan’s goal is “to improve the current system,” said Press Secretary Dave Urbanek. “I have seen proposals similar [to the Bernardin Amendment] and none have gotten very far because people don’t read the fine print,” he said.

Christopher Hamrick, director of communications for the Illinois Association of HMOs, said such a plan would be very difficult to pass at either the state or national level. “You will never get a ‘no’ to the question of whether a universal plan is needed, but define ‘universal coverage,’” he said. “Who will pay? How will it be delivered? What are the residency requirements?”

State Sen. Dave Syverson, a Rockford Republican, said he believes the plan could triple state income taxes for Illinois residents.

Del Valle supports a thorough cost analysis, but added that “even if we work with credible numbers, those numbers will be attacked by the insurance industry.”

Insurance company political action committees, organizations and individuals donated more than $1.7 million to state political campaigns during the first six months of 1998, according to an analysis by The Illinois Campaign for Political Reform and the Center for Responsive Politics.“

At a minimum, money buys access,” said Kent D. Redfield, director of the Sunshine Project of Illinois, a campaign finance watchdog group. “Someone with money is on your radar screen, people without [money] are not.”

Obama said much of the cost already shows up in bad debt, uncompensated care and higher insurance premiums. “If you calculate the money already being spent on health care in this state—we have the money,” he said. “The question is how to allocate that money.”