The Times West Virginian

October 8, 2006

‘I had no way to buy medicine’

Many without health insurance are low-income people who work

By Mary Wade Burnside

FAIRMONT — Even though Larry Workman had been diagnosed with diabetes, he felt fine, and his job working for the state did not qualify him for health insurance benefits.

“I had no way to buy medicine,” he said. “I was making $6 an hour and I had two kids.”

So for nearly 10 years, Workman did not take the prescription that controlled his condition — until an event occurred that alerted him to the fact that everything was not all right.

Blood vessels in his eyes burst, and he began to lose his sight.

“It finally got bad enough that I couldn’t work, so I went to the doctor,” he said. “They claim that it was all diabetic problems.”

A hospital turned him away because of his lack of insurance, he said, but gave him the name of Milan Puskar Health Right in Morgantown, where he could get free check-ups and medicine.

Laura Jones, now Health Right’s executive director, eventually helped Workman get disability payments and Supplemental Security Income, which qualifies him for a medical card.

But the damage already had been done. Now legally blind, Workman has moved in with his mother in Exchange, Braxton County, and spends his days listening to the news and hoping his children, ages 14 and 15, will have a brighter future.

“I just have to get these kids (grown) up so they can take care of themselves,” Workman said. “That’s all I want out of life.”

As a Braxton County resident living in West Virginia, the chances of Workman having health insurance are less than citizens in most other counties and many other states.

According to data gathered in 2001 by the West Virginia Institute for Health Policy Research in Charleston, of the state’s 55 counties, Braxton County has the third highest percentage of residents who do not have health insurance, at 29.5 percent.

That’s just slightly lower than Mingo and Pocahontas counties, at 29.9 percent and 29.6 percent, respectively.

The median percentage happens to be in Monongalia County, with 19.3 percent of residents without health insurance. Marion County is a few percentage points ahead of that at 22.8 percent, and Harrison County is below the median at 18.2 percent.

Those numbers were gathered five years ago, said Sally Richardson, executive director of the WVU Institute for Health Policy Research, and all indications — statistical and anecdotal — show that the situation is not improving.

Preliminary data gathered by the institute in 2003 as well as statistics from 2005 from different sources show that the number of adults too young to qualify for Medicare is going up.

“The big problem is what you call the adults who are not elderly,” Richardson said. “There, we don’t do nearly as well. In the first survey, about 20 percent of West Virginians from age 19 to 64 didn’t have health-care insurance. That grew from 2001 to 2003, to 22 percent, and the numbers went from 220,000 to 238,000.”

A newer report, released in 2006 by the Robert Wood Johnson Foundation in Princeton, N.J., (www.rwjf.org), cites West Virginia as the top state where uninsured adults are mostly likely to go without health care, at 57 percent. Oregon and Kentucky follow at 56 percent and 54 percent respectively, with the lowest percentage being in North Dakota, at 24 percent.

“There are people who fall into several different categories,” said Health Right’s Jones. “There are people who are working two or three part-time jobs to make ends meet, and because they are working part-time and because of the nature of the work, they are not offered health insurance.”

Then there are people who are employed at places that offer health insurance, but because the premiums are so high, they cannot afford it. According to the Kaiser Family Foundation (www.kff.org), premiums for family coverage have increased by 87 percent since the year 2000.

“For the uninsured, if you look at who they are, essentially two-thirds of them are low-income, and eight out of 10 uninsured people come from working families,” said Jennifer Tolbert, a principal policy analyst for the Kaiser Family Foundation in Washington, D.C.

“Essentially, they are low-income people who are working. The issue is they don’t have employee-sponsored insurance offered to them, either because the employer doesn’t offer it or maybe the employer offers it but because they are part-time or new to the job, they are not eligible.”

Workman fell into that category, considered a part-time employee because his seasonal work kept him from putting in hours year-round.

The medication he had been prescribed back then for his diabetes, Glucotrol, cost about $80 a month, Workman said, which he could not afford without insurance.

“I felt fine,” he said. “I worked through this period and never missed a day’s work.”

During this time, 10 years ago, his wife, Virginia Mae, also was diagnosed with ovarian cancer, which quickly spread to her cervix, and she died within six months. She was treated at several hospitals, running up a debt of $100,000, “if not more,” Workman said.

For the most part, hospitals quit seeking payment, he added.

“I wrote them all letters, explaining the situation,” he said. “Only a few of them threatened to send me to collection agencies. I have no way of paying them off.

“Of course, I could never go buy anything to get credit.”

Now, at the age of 44, instead of having 20 or more good working years ahead of him, Workman draws disability.

Jones, who helped Workman get disability payments, believes the costs of not having affordable, accessible health insurance are numerous.

“If people are not healthy enough to work, they are not healthy enough to pay taxes,” Jones said. “It makes no sense that we don’t have a more preventative approach.”

Health Right was founded 22 years ago, and Puskar’s name was added a few years ago to honor the pharmaceutical manufacturer’s donations of “millions of dollars of free medications” to the clinic, Jones said.

Patients who receive free check-ups and medications from Health Right must be uninsured and no more than 150 percent above the poverty level for their size family.

But even if someone qualifies, Health Right has a waiting list of nearly 200 people.

“We have to have more volunteer physicians,” Jones said.

If Workman had found Health Right 10 years ago, his life might have turned out differently. But even if he had qualified for care and made his way through the waiting list, Morgantown is about a two-hour drive for Workman. Seeking treatment at Health Right would have killed an entire day of work.

Elaine Arkin, special communications officer for the Robert Wood Johnson Foundation, the group that cites West Virginia as the state with the highest number of uninsured residents who do not seek health care, noted some of the reasons for that.

One of them is a person’s inability to take off from work in order to get medical care, “particularly when they have to seek health care in an emergency room where there is a long wait,” Arkin said. “And uninsured people also tell us if they are sick and they know they will need a prescription they can’t afford, ‘Why should I go see a doctor when I know I won’t be able to fill a prescription they give me?’”

Also, rural areas might lack a clinic or even an emergency room where someone could seek treatment.

“Fortunately, there are a lot of places in this country where there are community health centers that do an excellent job of providing care to people who are uninsured as well as those who are insured,” Arkin said. “But they are not geographically distributed across the country.”

Now, when Workman has an appointment at Health Right, a friend or family member must take off work to drive him there. And his mother, Bonnie, and his children, Alicia Mae and Larry Dale, have learned to give him insulin shots.

Being back on medicine has improved Workman’s health.

“I feel tremendously better,” he said. “If it weren’t for my eyesight, I wouldn’t miss a day’s work. I’ve got energy, and I’m not sick all the time.”

But now he has little to do with the energy he has. He used to hunt and fish, but now he fears he cannot even do the latter.

“I’d fall out of the boat,” he said. “Maybe one of these days, I might get the nerve up to sit somewhere and have someone cast out a rod for me so I didn’t hit someone with it.”

E-mail Mary Wade Burnside at mwburnside@timeswv.com.