No job, no health insurance: How to survive tough times

Just two weeks after getting laid off from his job, Ashish Desai sprained his ankle and knee playing tennis. No paycheck and no health insurance meant no doctor for the Buckhead resident. Desai bandaged the injuries the best he could and left them to heal.

“It doesn’t feel great by any stretch, but it feels good enough,” said Desai, 32, a former securities analyst who lost his job in October with only two weeks of severance pay. He turned down COBRA, which extends an employee’s health benefits but often at a higher rate, because it was “too darn expensive,” and will go uninsured until he lands another position.

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Joey Ivansco/jivansco@ajc.com

Ashish Desai with ice packs and generic ibuprofen – his way of dealing with injuries after getting laid off from his job. He sprained his ankle and knee playing tennis, and with no health insurance, he wrapped both injuries in bandages to help them heal on their own.

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“In a choice between your health and your finances, when times are bad, you choose your finances,” he said. “When times are good, your health comes first.”

Even as many people resolve this year to take better care of their health and schedule routine doctor’s appointments, more people will forgo such visits because they can’t afford the co-payments and out-of-pocket costs. An increasing number of people such as Desai will take health matters into their own hands.

Forty-seven percent of Americans report a family member has sacrificed medical care because of the cost, according to a recent poll by the Kaiser Foundation. More than a third say a family member delayed care, and 30 percent say someone skipped a recommended test or treatment.

“People have less money, and health insurance is not any cheaper; it’s the perfect storm,” said Robert Gresham, an insurance agent who operates www.georgiahealthplans.net, a Web site that helps Georgians shop for health insurance.

Gresham’s site has experienced a 30 percent to 40 percent increase in traffic over the past six months as more people have been dropped from employers’ insurance plans. More than 1.6 million Georgians are uninsured and more than 100,000 jobs in metro Atlanta are expected to be lost before the economy rebounds.

“People who would normally have a job and insurance will now go without,” Gresham said.

‘Have to make do’

Lithonia resident Nyima Burnett, 28, has never been insured and last saw a doctor in June for prenatal care covered under Medicaid. Prior to her pregnancy, she visited the emergency room in 2004 for flu-like symptoms. From her savings account, the child care provider paid $400 for the ER visit and has paid $200 for routine visits and as much as $1,400 in 2001 for dental work.

“I understand that it’s a big risk, but until I can afford some insurance, I’ll just have to make do,” said Burnett, who soon hopes to get insurance to cover medical care needs.

Even with insurance, many people find paying deductibles and co-payments a financial pain.

A third of Americans reported challenges paying medical bills in the past year, with 18 percent citing problems with medical bills of more than $1,000, according to the Kaiser Foundation.

Christina Goodwin, an Ellenwood college student who is covered under her father’s insurance through his employer, could not afford frequent $45 co-payments. A recurring condition required monthly monitoring last year, and Goodwin rescheduled several appointments because of cost. She hoped the condition would not worsen before she returned to see her specialist.

Her health was at risk, but “I had no money to pay,” said Goodwin, 18, who now sees her doctor every three months and plans to keep scheduled appointments.

Playing Russian roulette

Skipping doctors visits and delaying care equates to playing Russian roulette with your health, warn health-care professionals. When left untreated, even minor ailments such as hernias can lead to more serious and costly complications.

Emergency room physician David Schwegman knows firsthand how minor concerns can become life-threatening conditions. He recently treated a man whose mild kidney problem, when left unmonitored, elevated his blood pressure and produced a tear in his aorta, a condition that could result in permanent kidney failure and even death. Some conditions such as hypertension and diabetes don’t produce outward symptoms, so people can’t rely solely on how they feel, he warned.

“They don’t show up [in the ER] with high blood pressure, but they’ll show up with kidney failure or a stroke,” said the Northside Hospital physician.

Schwegman, who described health care as “extraordinarily expensive and virtually out of reach for many people,” said he understands why so many people take risks with their health care.

“It’s a gamble; if they’re successful and everything is fine, then they’ve won,” he said. “If not, there’s no point in having money if you’re dead.”

Kevin Bloye of the Georgia Hospital Association agreed and said that people should never neglect their health.

Routine care at a doctor’s office costs far less than critical care in a hospital, and even during a good economy, hospitals will work with patients who cannot pay the total fee, co-pay or deductible, he said.

Still, just last week, Grady Memorial Hospital proposed to tighten free-care limits. The health care system sent letters to 1,400 people telling them they no longer qualify for discounted or free services and began screening finances more carefully for deserving patients.

“Patients want to pay less for services,” said Joe Taylor, vice president of ambulatory services at Grady, who noted a decrease in payments at the time of care and an increase in negotiations. Grady has experienced a 10 percent increase in volume since 2007 with more patients who previously had other options now seeking treatment.

“If the numbers continue to increase, it will strain our capacity,” Taylor said. “Right now, we’re managing.”

Taking better care

For some people, doing all they can to stay healthy remains the best way to avoid costly health care bills. The difficult economy provides incentive for them to manage their preventive health by consuming healthier foods and exercising more.

According to recent survey by Cigna, a leading provider of health benefits, 55 percent of people say they are taking better care of their health because of the economy, compared to 41 percent who say they are taking worse care. Of those taking better care, 60 percent say they are exercising more and eating healthier.

Southwest Atlanta resident Tammi Moore got laid off in October, but she refuses to sacrifice her health. The former IT project manager now spends more money on green vegetables and organic products instead of fast foods. She plans to purchase private insurance soon, and says that she’s willing to pay for health care on a credit card.