Kidney stones will hurt, and cost, regardless of Clinton health plan Uninsured jobless in difficult position

November 02, 1993|By Ed Brandt | Ed Brandt,Staff Writer

When President Clinton and Congress finish pushing that health-care rock down the road a year or so from now, Frances Mackall, 32, will probably be at the end of the line awaiting treatment for a painful kidney stone.

She is one of an estimated 37 million Americans without medical coverage.

Removing the kidney stone would require an operation that costs $5,000, nearly half of what her family receives annually in Social Security and other benefits. Her remaining options seem to be these:

* Acquire a life-threatening condition that qualifies her for free emergency room treatment.

* Come up with more than $2,800 and have the system pick up the rest of the cost.

* Work out a plan with a hospital to pay off the $2,800.

* Endure the pain.

Her case offers a look into the problems that low-income families face in dealing with a medical care system in which insurance is a key factor. In fact, the Mackalls exemplify a whole range of

social issues, including public subsidy, health care, education, poverty and employment.

When it comes to medical insurance, there is no guarantee the Clinton proposal will solve Mrs. Mackall's problem. The current plan would create an employer-based system in which the employer's insurance pays 80 percent -- in most cases -- of the cost of medical coverage, and the employee pays 20 percent.

But Mrs. Mackall is unemployed. This puts her into a "gray area," according to Nancy Fiedler, spokeswoman for the Maryland Hospital Association. Ms. Fiedler said the government would pay 80 percent of Mrs. Mackall's cost under the Clinton proposal, but she wasn't certain how the remaining 20 percent would be paid.

"It might be subsidized in some way," she said, "but it's unlikely the entire amount would be paid" by the government.

Family gets $915 a month

Mrs. Mackall can't get state medical coverage now because the $915 her family receives each month is more than twice the allowable limit of $425. Her husband, Villareal, 47, and daughter, Maria, 4, are insured.

Mr. Mackall, who injured his back while working at the Bethlehem Steel shipyard at Sparrows Point, has been on Social Security disability since 1987. He gets $610.10 a month, less $36.60 for Medicare insurance, provided as part of his disability coverage.

Maria gets $305 a month as a dependent child of a recipient of Social Security disability. Her medical coverage comes through the federally funded Medical Assistance to Pregnant Women program, which is administered by the state. The family pays $187 a month for a subsidized apartment in the Village of Tall Trees in Essex. As of last week, they were $275 behind in their rent.

Mr. Mackall was born in Calvert County and came to Baltimore when he was 6. He failed the fifth grade, and eventually took special-education courses before dropping out of school at 17. He said he reads "fair" but admits to being a little slow.

After leaving school, he washed dishes and worked in the Job Corps and at the Chevrolet plant on Holabird Avenue before getting a job as a laborer at Bethlehem Steel. He held the job 10 years, then injured his back when he fell against a steel table in 1976. He left Sparrows Point, was on and off welfare, and worked as a cabdriver, janitor and maintenance man before going on disability in 1987.

He was judged unemployable by the Social Security Administration because of his deteriorating back condition, arthritis, high blood pressure, and lack of education. He is now overweight and walks with a cane.

Frances Mackall left Kenwood High School in the ninth grade and worked occasionally as a waitress before she had Maria.

Last summer, she started feeling pains in her side.

"It was like someone sticking me with needles," she said.

On July 11, 1992, her husband took her to the Francis Scott Key Medical Center, part of the Johns Hopkins Hospital system. She was prescribed antibiotics for a urinary tract infection on two visits. X-rays showed a large kidney stone. She also received a diet tailored for kidney stone patients.

'Operation will cost $5,000!'

Written in longhand on an FSK consultation request was the notation: "Kidney stone. Will need ESWL at Kidney Stone Center soon as possible. No insurance or medical assistance. Her operation will cost $5,000!" ESWL is shorthand for a machine that uses ultra-sound to break up kidney stones. The alternative is surgery. The choice depends on the stone's size and location, according to a doctor who treated Mrs. Mackall at FSK.

"Some people walk around for years with a kidney stone and don't even know it," the doctor said. "But it can also cause infection or block the kidney. It's been my experience that if a patient is in imminent need of treatment and can't afford it, the hospital will work with the patient. But the patient has to also work with the system. I don't know what happened in her case."

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