Photos by Gordon Chibroski/Staff Photographer
UNEMPLOYED? SOME HEALTH INSURANCE POSSIBILITIES
• Find out if you can get coverage through your spouse's or domestic partner's employer.
The Health Insurance Portability and Accountability Act provides a 30-day window even when it is not
open-enrollment season. The same situation may apply with a parent or domestic partner's plan.
• Find out if you can continue your coverage through COBRA.
COBRA requirements do not apply when a company has fewer than 20 employees or when the company goes out of business and no longer offers a plan. Workers fired for "gross misconduct" are ineligible.
• Find out if your state has laws or programs that could help you.
For information on Maine programs, go to the Maine Career Center's Web site and Consumers for Affordable Health Care's Web site.
• Find out if you are protected under the Health Insurance Portability and Accountability Act.
For more information, go to www.familiesusa.org and
• Find out if you are eligible for Trade Adjustment Assistance and the Health Coverage Tax Credit that comes with it.
If you recently lost your job because of trade policy, you may be eligible to have 65 percent of the cost of your health insurance paid for up to three years. For information, go to www.doleta.gov/tradeact
SOURCES: Families USA and staff reports
GRAY — When Deborah Pyne Young's job ended last fall, she lost her health insurance, too. As her budget got tighter, she began cutting her daily dose of cholesterol medication in half.
Young knew better – she's a registered nurse. But she found herself doing it anyway. She figured at least she was getting part of the drug's benefit.
Like a lot of Mainers, Young and her husband, Phil, a commercial fisherman on disability, are "not screaming wealthy, and not dirt poor." They have been living simply in a mobile home tucked back into the woods in Gray and setting aside money regularly for a rainy day.
Now it's pouring. In addition to paying for groceries, heat and other necessities, the couple has to come up with $400 a month for their medications.
"If I had a catastrophic event – a heart attack or major surgery – it would wipe us out financially," said Young, 52. "I don't dwell on it. I try to stay positive, and I try to stay well."
Young is one of thousands of Mainers who have become unemployed during the recession. In December, Maine's economy shed 3,400 jobs, bringing the total loss for the year up to 11,700. The unemployment rate reached a 16-year high of 7 percent in December, the latest month for which figures are available.
It's not clear how many Mainers are uninsured because of lost jobs. Some may be able to get coverage through a spouse's employer. Others may qualify for MaineCare, the state's version of Medicaid, or are continuing employer-based coverage temporarily through the Consolidated Omnibus Budget Reconciliation Act.
But the dramatic rise in unemployment, an increase in charitable care at hospitals and a spike in traffic at free clinics all indicate that Maine is following a national trend: More people are going without health insurance.
A help line run by Consumers for Affordable Health Care fielded 183 new calls in January, a record for the organization.
"What we're really seeing is the people who are falling through the cracks, those middle-income people," said Cherilee Budrick, spokesperson for the Augusta group. "They make just a little too much to qualify for public assistance that's out there, but they don't make nearly enough to buy their own insurance or purchase a COBRA plan.
"A lot of those people are generally in the younger adult ages, 21 to low- or mid-30s, and that's kind of alarming, because that's a lot of our work force that we're talking about. More and more, we're dealing with a lot of people who have lost their jobs, and they don't know what to do."
FEW AFFORDABLE COVERAGE OPTIONS
A new survey released last week by the Kaiser Family Foundation indicates that Americans are delaying doctor visits, surgeries and preventive care.
In a telephone survey of 1,204 adults, 53 percent said they had cut back on health care in the past year because of concerns about costs. Thirty-eight percent said they are very worried about affording needed health care. The figure is higher – 56 percent – among those who worry that someone in their household will lose a job this year. The survey had a margin of error of plus or minus 3 percentage points.
Mainers are facing those same fears. Although there are alternatives available to employer-funded insurance, for many, they're too cost-prohibitive.
In Maine, the average monthly COBRA premium for family coverage eats up 99.4 percent of the average unemployment benefit, according to a study released in February by Families USA.
DirigoChoice, the state-subsidized insurance program for small businesses and individuals, is not an option for newly laid-off workers because enrollment was capped about two years ago. About 2,000 people are on a growing waiting list, according to Trish Riley, director of the Governor's Office of Health Policy and Finance.
At the Portland Community Free Clinic on India Street, staff members "definitely have seen an increased number of calls from people saying they are calling because they just lost their jobs and lost their health insurance," said clinic director Katie Addicott.
Appointments are being booked two months ahead instead of the usual two weeks, she said. That's a first.
"We've seen a lot of people who were our patients who were unemployed, got jobs, and they left us because they got health insurance," Addicott said. "And then because they're recent hires, they're the first ones to get cut, so they come back."
At the Oasis Health Center, a free clinic in Brunswick, patients are being booked into May. The clinic is limiting new patients to three a week, because the specialty clinics are all full.
"Chronic diseases are what we're seeing," said Dr. Peter McGuire, medical director of the clinic. "These people who are losing their insurance are losing their ability to get medications, and their diabetes and depression all get out of control."
McGuire added that people are putting off medical care as well.
"We see people who, instead of taking one pill a day for their high blood pressure, are taking it every other day," he said. "We see a husband and wife that are both diabetics, and the wife takes it one day and the husband takes it the next, all to try to stretch the medication out."
Hospitals in Maine have been seeing the recession's effects in decreased patient volume and increasing bad debt and charity care. At Maine Medical Center, charity care is up by 15 percent. At Goodall Hospital in Sanford, it's up 8 percent.
About half the hospitals participating in a December survey by the Maine Hospital Association reported decreases in patient volume, with between a third and a half seeing decreases of more than 10 percent.
In the primary care offices of Mercy Health System of Maine, the phones were ringing less often last fall, and more patients were canceling appointments or failing to show up, said Dr. Jeffrey Heckert, medical director of the primary care network.
"They didn't even want to drive the five or 10 miles to the office, spend the money on the gas and the $5, $10 co-pay," he said, noting that the situation has since gotten better.
The patients who did come in admitted to skipping medications and failing to fill prescriptions, Heckert said.
BOSSES STRETCH TO OFFER BENEFIT
The federal stimulus package recently passed by Congress includes provisions to make COBRA more affordable. A tax credit for eligible individuals would allow them to have COBRA for nine months at 35 percent of the premium cost instead of the usual 102 percent, but health advocates say that even with that subsidy, it will be out of reach for some Mainers. And it will cover only those who lost their jobs between Sept. 1, 2008, and Dec. 31, 2009.
It's not clear how many people are using COBRA now, because the government does not collect that information and relies instead on survey data, which is not sufficiently up to date to capture the effects of the recession.
MaineCare, the state's Medicaid program, has not yet seen a bump in enrollment. That typically occurs further into an economic downturn because people will generally use their savings or COBRA before enrolling, said Health and Human Services Commissioner Brenda Harvey.
In January, the department saw a spike in food stamp applications, Harvey said, which typically comes before increased demand for MaineCare.
It's not just job loss that's causing financial pain. As the recession deepens, employers are finding it increasingly difficult to offer affordable coverage to their workers.
"Some employers are either dropping insurance or raising the deductibles and co-pays to the point where employees can't afford it," said the Brunswick clinic's McGuire. "So (patients) may be keeping their job, but they're dropping their insurance."
Brian Ketchen, whose family has owned Dave's Appliance in Winthrop since 1977, has always paid the full cost of his 18 employees' medical coverage. He sees it as an investment that pays off in performance, good attendance and low turnover.
But last year, for the first time, Ketchen had to cut 2 positions because of the slowdown in the housing market and competition from larger retailers.
He's still paying his employees' health benefits – his next 12-month renewal will set him back around $45,000 for a plan that has a $5,000 deductible – but he's not sure how much longer he can do it without asking workers to share the cost.
"Two topics of conversation always come up every year: Do we keep the benefit, and do we deduct from the employees?" Ketchen said.
TAKING PREVENTIVE MEASURES
Young, the registered nurse living in Gray, worked as an outpost nurse on American Indian reservations and as a school nurse until a couple of years ago, when she decided to try her hand at teaching.
Last year, she got a temporary job in health education at a Portland vocational school, and was optimistic that the funding for her post would be renewed and the job extended. But by then, the country was deep in a recession, and her employment ended. So did her insurance.
"I was prepared for it as much as I could be in that last summer while I had insurance," she said. "I made sure I got a physical exam and mammogram. All the things that you should have done annually, or every other year, I got up to date. I refilled my medications."
Young says it would have cost her $6,000 a year to extend the coverage she was getting through her employer, on top of a $4,000 Medicare coverage gap for her husband.
A knee injury recently sent Young to the Portland Community Free Clinic, where the staff helped her apply for prescription assistance so she won't have to cut her pills in half anymore. But she still worries about the future, as she has yet to find another job.
Her predicament has taught her how to spend her money more wisely. She buys medications for controlling her cholesterol, diabetes and thyroid at Wal-Mart. She thinks about prevention by adding aspirin, Vitamin E and fish oil to her regimen. She does yoga and exercises regularly, and visits a chiropractor once a month.
Young also applied for and received a grant that helps pay for her husband's medication, which runs $1,900 a month.
When she has to, she visits the free clinic. It's a bit uncomfortable, but she believes the experience will make her a better nurse. She is determined to one day repay those who have helped her in her time of need.
"When things are more prosperous for me, I'll give back," Young said. "Now I realize, by needing them, how important they are."
Staff Writer Meredith Goad can be contacted at 791-6332 or at:
mgoad@pressherald.com
Staff Writer Ann Kim can be contacted at 791-6383 or at:
akim@pressherald.com
Copyright © 2009 MaineToday Media, Inc.