Desperate Enough to Perform Surgery Survival of the fittest has a real meaning here.

A young Latino business owner cut his hand while working. The cut was deep enough that required stitches. The only insurance I have is for catastrophic coverage in the event that I become really hurt, he said. So, I had a few shots of vodka and stitched the cut myself and taking off the wounds dressing he proceeded to show off with pride his almost perfectly healed hand. An uninsured Latina who lost her job due to her employers downsizing had to get COBRA coverage. COBRA does not come cheap. However, she was fortunate enough that the American Recovery and Reinvestment Act (ARRA) created subsidies for anyone laid off after September 1, 2008. Mini-COBRA, the subsidy from ARRA, paid 65% of her health insurance coverage. A Teachers Assistant in the DC school system is not that lucky. Over the summer vacation, she does not receive a salary or benefits. In the summer of 2010, she purchased health insurance only for her son, as she was unable to pay coverage for herself. Like these Latinos stories, there are many more that put the individual at risk of losing soul and limb for lack of affordable health coverage. In September 2010, the U.S. Census Bureau released a report revealing that the number of people without health insurance in 2009 had risen sharply to a record high of 50.7 million people. The Health Policy Fact Sheet of the California Policy Research Center states that the foreign-born U.S. population is about 2.5 times more likely to be uninsured. The uninsured Latino population ratio to the rest of the U.S. population is 33.3% to 13.3%. U.S. employers count for about 60% of the health insurance coverage of the insured U.S. population. Since health insurance coverage is mostly paid by employers, it is not common for part-time and seasonal workers to be offered health insurance. The facts speak for themselves when, over 25% of immigrants, 16 years old and over, employed part-time, seasonally or unemployed, are consequently uninsured. Undocumented immigrant workers make up 26% of the foreign-born population and are barred from government insurance programs. The Pew Hispanic Center and the Kaiser Family Foundation state that only 58% of foreign-born Latinos have health insurance. Latinos who spoke English were 1.5 times more likely to have health insurance than the Latinos who spoke predominantly Spanish. In the DC Metropolitan area the breakdown for the uninsured population is as follows: Maryland 653,000, Virginia 774,000 and DC 70,000. Considering that 1

Latinos represent 15% of the U.S. population, the uninsured in Maryland are: 97,950, in Virginia 116,110 and in DC 10,500. A brief overview of the most commonly insurance programs is provided below. 1. Health Maintenance Organization (HMO) is usually the least expensive coverage. The HMO consists of a group of doctors that provide primary care and specialty coverage, when necessary. Using a practitioner outside the HMO network makes you liable for the entire cost of the care. 2. The Preferred Provider (PPO) is a more flexible HMO allowing the use of out of network practitioners visits while maintaining some coverage 3. Point of Service (POS) is a combination of the HMO and PPO limiting the use of only primary care physicians within the network. Here again, utilizing the services of out of network doctor requires you to pay the difference between the network doctor fees and fees for care provided by an out of network practitioner of our choice. And, 4. The most expensive insurance coverage is fee-for-service where you can select any doctor of your choice. Trying to get a grasp of the cost of someone that is uninsured the following model was put to the test. The criterion involves a 45 year old, single female, non-smoker and living in Montgomery County, Maryland. Data obtained from eHealthInsurance.com pointed out that the main driver which made health insurance coverage expensive was pregnancy. The coverage for a POS for maternity benefits, a $1,500 deductible, zero coinsurance for doctors visits and prescription drugs was $234 monthly. The fee for a specialist was an additional $20. The best priced coverage had a $10,000 deductible with a lifetime limit of 1 to 3 million dollars. There is a strong price correlation between high deductibles and low monthly premiums. Although there is no universal coverage for the uninsured, the list of resources provided herein will assist you obtaining information of healthcare assistance programs. There are some clinics where, regardless of the persons immigrant status, the individual is treated. Some clinics even offer dental coverage which is a plus. The payment in some of these clinics is based on the persons income and the number of people in the household. If COBRA coverage applies to you, as long as you pay the premium, you are guaranteed 18 months of coverage. Under special circumstances you may be able to extend it to 29 or 36 months. If you decide to get a cheaper coverage than COBRA, you may not be covered for any pre-existing conditions. To learn more about your COBRA rights visit: www.dol.gov/cobra and 2

www.familiesusas.org/issues/private-insurance/understanding-cobrapremium.html If you lost your job due to trade policy, e.g., jobs moved overseas, you may qualify for help through the Trade Adjustment Assistance Reform ACT (TAARA) and it may cover 80 percent of your health care premium. For more information visit www.irs.gov and type HCTC in the search box. HCTC stands for Health Coverage Tax Credit. If you are an early retiree 55 or older who lost health care coverage and your pension benefit is paid by the federal Pension Benefits Guaranty Corporation, you are eligible to receive assistance with 80 percent of the cost of your health insurance until you are eligible to receive Medicare. You can also go to www.irs.gov and search for HCTC. For those people that do not qualify for COBRA there are other options. If you work and have low or moderate income and are uninsured, please take a look at the information and links below. For some of this assistance, there are income, asset limits and legal status requirements that must be met. A publication that will provide health insurance information when you lose your job can be found on line at www.familiesusa.org/assets/pdf/gettingcovered.pdf For more information go to: www.familiesusa.org/issues/privateinsurance/understanding-cobra-premium.html. There are centers called Federal Qualified Healthcare Centers that receive federal funds and these are found in many cities in all the states in the U.S. For more information, please go to: http://findahealthcenter.hrsa.org There are some charity organizations that offer health care together with Rx, please go to: http://www.needymeds.org/ For Rx drugs, you may get assistance by going to: www.rxassist.org and www.pparx.org Check the Free Clinic Association website: www.freeclinics.us/freeclinic.php The Foundation for Health Coverage Education has an excellent and helpful website. In here, you will find the Health Insurance Coverage Matrix Guide which provides a detailed list of telephone numbers and websites of private as well as public sponsored health insurance programs. www.coverageforall.org

In DC, I visited Marys Center located on Kalorama Road. They help the insured as well as the uninsured. They provide health and dental coverage and have three offices in DC and one in Silver Spring, Maryland. Please go to: www.marycenter.org La Clinica del Pueblo provides medical care, HIV/AIDS testing, mental health and substance abuse counseling services. La Clinica is located in DC, for more information go to: http://www.lcdp.org Unity Health/Upper Cardozo Clinic also in DC offers medical and dental health care, for more information go to: http://www.unityhealthcare.org/HealthCenters/ServiceUpperCardozo.html For selected conditions there is assistance at: http://clinicaltrials.gov Also, the National Health Institutes Library provides information in Spanish and it is a great resource: http://www.nlm.nih.gov/medlineplus/spanish Faith based health care centers through the US is listed here: http://www.familiesusa.org/resources/faith-based-resources/keycontacts.html There is hope to find health care, just like Marys Center and the other clinics mentioned here, if you have a health care issue reach out and see what type of help you can get. Do not give up, there are many places where your immigrant status does not matter but your health does. The Foundation for Health Coverage Education published a report on May 9, 2011, Solving the Enrollment Dilemma, A Guide to Health Care Access. On page two of this report, it states: There was an alarming statistic garnered in 2002 by the Blue Cross Blue Shield Associations study of the U.S. Census Bureau data that indicated that nearly one-third of the uninsured were eligible for government-sponsored health coverage programs yet had not signed-up. There is hope for many of the uninsured to be covered. Reach out to the clinics that offer health care regardless of your legal status. You can get help and you will pay according to your income and the number of members in your family. In some cases, you may even qualify to get help for free. Your most precious possession is not money but health. If you have good health you can make money, if you do not, you cannot.