Summit Examines The 'Gray Areas' Of Health Care

January 13, 1992|By JoAnna Daemmrich | JoAnna Daemmrich,Staff writer

When their tiny daughter developed a rare form of cancer last March,Ken and Cheryl Linton had to put aside their pride and beg for help to save her life.

The Glen Burnie couple had no medical insurance to cover the cost of treatment for their 2-year-old daughter, Carol, who was diagnosed with a full-blown case of neuroblastoma, a tumor ofthe nerve cells.

By the time Carol began chemotherapy at Johns Hopkins University Hospital in Baltimore, the cancer had spread from her abdomen to her right eye. Most of her bone marrow was filled with cancerous cells. Within weeks, her hair was just a soft down. Her pale skin looked as delicate as tissue paper.

Now, Carol is 3 years old and healthy again. After a year of chemotherapy, blood infusions and a bone marrow transplant, she is cancer-free. Her thick brown hair is growing back. Her cheeks are pink.

"It's fantastic," Cheryl Linton said. "We're having the best new year ever. We're just so thankful we got our little girl."

But even in their happiness, the Lintons still are worried about paying off all the hospital bills.

Without the support ofthe community and fellow firefighters at the Ferndale Volunteer FireDepartment, Cheryl Linton said, the family would have been overwhelmed. "If it hadn't been for the fund, I don't know how we would have made it, I really don't," she said.

Their struggle is becoming increasingly common as more and more county families join the ranks of the estimated 50 million Americans without health insurance. At least 570,000 people in Maryland have no medical insurance. Many more are underinsured -- relying on health-care plans that provide only minimal coverage.

Growing numbers of patients walking into hospital emergency rooms and doctor's offices have inadequate health insurance. Somelost their medical coverage when they were laid off. Others can't afford a co-payment plan, or only qualify for emergency care.

Often called "gray-area clients," they're not poor enough to receive federal or state medical assistance. But they can't afford to pay the monthly premiums of private insurance plans. A long-term illness or accident forces them to spend all their savings on medical bills.

The critical problems faced by the growing numbers of "gray-area" people was the topic of a two-day state summit in Annapolis which ended Saturday and will be discussed at town meetings in Anne Arundel County thisweek.

Only the poorest people qualify for Medicaid or Medicare, the federal government's insurance plans for the indigent and old, said Fran Phillips, chief of program planning and development at the county Health Department. The cutoff line for a family of three is an income of $5,868 a year.

Maryland also provides medical assistance for pregnant women and young children in income brackets up to 185 percent of the poverty line. The program's main purpose is preventive care, to help pregnant women develop healthy habits and to get infants immunized and under a physician's care.

Families who don't fall into those categories, but can't afford to buy private insurance or receive limited coverage, are "at the biggest risk when something serious happens," Phillips said.

"They spend down," she said. "That's the dismal situation. They're forced to spend what they have to pay thebills."

Low-cost family planning, maternity and child health services are available at the county's 10 public health clinics. Fees arebased on a sliding scale, and families that fall within the federal poverty level don't have to pay for care. But the health department doesn't offer care for the injured or sick.

"We often get calls from young people looking for care," said Alice Murray, director of clinical services. "Or they're looking for the treatment of some condition, or they just have bronchitis and don't have money to go to a doctor."

County health clinics refer those patients to outpatient treatment at Harbor Hospital in Baltimore or to the Owensville Medical Center in South County. In emergencies, they suggest going to the nearest hospital, but warn that the cost can be high.

Hospitals usually try to set up payment plans with uninsuredpeople, but sometimes they're forced to simply eat the cost, said Kevin Murnane, spokesman for North Arundel Hospital in Glen Burnie.

The number of NAH patients who have no insurance has increased substantially in the last year, hesaid. In fiscal 1990, an average 12.38 percent of 63,000 patients were uninsured. By last November, the latest date for which statistics are available, the number of uninsured patients had increased to 16 percent.

Anne Arundel Medical Center loses about 7 percent of its revenues on uninsured patients, said Carolyn Tonty, spokeswoman for the Annapolis-based hospital.

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