Middle class rapidly joining ranks of uninsured

Factors include job losses, rising costs and state cuts

November 16, 2003|By NEW YORK TIMES NEWS SERVICE

DALLAS - The last time Kevin Thornton had health insurance was three years ago. The lack of it was not much of a problem until he began having trouble swallowing.

"I broke down earlier this year and went in and talked to a doctor about it," said Thornton, who lives in Sherman, north of Dallas.

A barium X-ray cost him $130, and the radiologist charged $70, expenses he charged to his credit cards. The doctor ordered other tests that Thornton could not afford.

"I was supposed to go back after the X-ray results came, but I decided just to live with it for a while," he said. "I may just be a walking time bomb."

Thornton, 41, left a stable job with good health coverage in 1998 for a dot-com company that went bust a few months later. Since then, he has worked on contract for companies, including one that provided insurance until the project ended in 2000. "I failed to keep up the payments that would have been required to maintain my coverage," he said. "It was just too much money."

Thornton is one of more than 43 million people in the United States who lack health insurance, and their numbers are rapidly increasing because of soaring costs and job losses. Many states, including Texas, are also cutting subsidies for health care, further increasing the number of uninsured.

The majority of the uninsured are neither poor by official standards nor unemployed. They are accountants such as Thornton, employees of small businesses, civil servants, single mothers, and those working part time or on contract.

"Now it's hitting people who look like you and me, dress like you and me, drive nice cars and live in nice houses but can't afford $1,000 a month for health insurance for their families," said R. King Hillier, director of legislative relations for Harris County, which includes Houston.

Paying for health insurance is becoming a middle-class problem, and not just in Texas.

"After paying for health insurance, you take home less than minimum wage," says a poster in New York City subways sponsored by Working Today, a nonprofit agency that offers health insurance to free-lancers, cabdrivers and other types of independent contractors in New York. "Welcome to middle class poverty."

In California, 70,000 supermarket workers have been on strike for five weeks over plans to cut their health benefits.

But the insurance crisis is especially visible in Texas, which has the highest proportion of uninsured in the country - almost one in every four residents. It has a large population of immigrants; its labor market is dominated by low-wage service sector jobs; and it has a higher than average number of small businesses, which are less likely to provide health benefits because they pay higher insurance costs than large companies.

State cuts to subsidies for health insurance to help close a $10 billion budget gap will cost the state $500 million in federal matching money and are expected to further spur the rise in uninsured. In September, for example, more than half a million children enrolled in a state- and federal-subsidized insurance program lost dental, vision and most mental care coverage, and some 169,000 children will lose all insurance by 2005.

"These were tough economic times that the Legislature was dealing with, and the governor believed in setting the tone for the legislative session that the government must operate the way Texas families do and Texas businesses do and live within its means," said Kathy Walt, spokeswoman for Gov. Rick Perry.

She pointed out that the Legislature raised spending on health and human services by $1 billion this year and that lawmakers passed two bills intended to make it easier for small businesses to provide health insurance for their employees.

Those measures, however, will not help Theresa Pardo or other Texas residents like her who have to make tough choices about medical care they need but cannot afford.

Pardo, a 29-year-old from Houston, said that having no insurance meant choosing between buying an inhaler for her 9-year-old asthmatic daughter or buying her a birthday present. The girl, Morgan, lost her state-subsidized insurance last month, and her mother must pay $80 instead of $5 for the inhaler. Rent, car payments, insurance, day care and utilities cost Pardo more than $1,200 a month, leaving less than $200 for food, gas and other expenses.

So even though her employer, the Harris County government, provides her with low-cost insurance, she cannot afford the additional $275 a month she would have to pay to add her daughter to her plan.

Carol Johnston cannot afford doctor visits. A single mother in Houston, she lost her job in health care administration in May, and she said she was still unemployed despite filling out 500 to 600 applications and attending countless job fairs.

COBRA insurance would have cost $214 a month, or more than one-fifth of the $1,028 in unemployment she gets a month. As it is, her monthly bills for rent, car, utilities and a telephone line exceed her income.

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