Faces of the uninsured: Individuals behind the statistics

More than 46 million people in the United States are uninsured.

Their stories are as diverse as the country. Many are young, working in low-wage jobs. Many others are self-employed or are recently out of work. And many have medical histories that health plans deem too risky for insurance. While lawmakers spar over health system reform details, uninsured people in the U.S. live in the health system's coverage gaps.

American Medical News spoke with four people who, for various reasons, are uninsured. Their stories highlight some of the reasons why people fall through the cracks -- and why the solution has proven so elusive.

These individuals aren't all seeking the same solutions. But a common thread is affordability and access.

Like many others, they are waiting to see how Congress will act.

The self-employed painter

Once the recession hit California, health insurance became a luxury for Daniel Luna. Last year he went nearly five months without work as a painting contractor.

He's been living on more than $20,000 in savings and from pawning more than $10,000 worth of coins for a fraction of their value. "Anything that I had saved up, I used it to make ends meet," said Luna, 55. But business has picked up a bit recently in Manteca, about 80 miles east of San Francisco.

Luna, a painter since 1981, has been trying to manage his diabetes since he was diagnosed several years ago. "I'm kind of in denial about it."

Luna had an individual, high-deductible health insurance plan that cost about $200 a month in 2000. But after he reunited with his ex-wife, Vicki, that year, the premiums started increasing, finally reaching $795 a month in 2008. They couldn't afford it, so he's been uninsured for more than a year. Sometimes he skips the medication he needs to control his diabetes because it costs $200 a month.

But Daniel is more worried about the health of Vicki, whom he remarried in 2006. She received a kidney transplant a year later and qualified for Medicare. But Luna is afraid that coverage will end next year and they won't be able to afford the $1,800 per month in immunosuppressives.

Luna has limited his visits to physicians for years. "I just don't want to create another bill."

About three years ago he sliced his finger with a razor blade while cutting a tube of caulk. He put some caulk in the cut and went to the emergency department. While he waited for the doctor, Luna cleaned the wound himself. A physician advised him to use a medical adhesive, then the hospital and doctor each sent an $800 bill.

But Luna speaks more positively about one physician. In 2002, he painted a house for Eric Ramos, MD, medical director of the Del Puerto Health Center in Patterson, Calif. Dr. Ramos took a personal interest in Vicki and Daniel, making sure she was seen by specialists and he monitored his diabetes.

Luna is waiting to see what Congress can do about the health system, but he's not expecting a breakthrough. Although he served in the Marine Corps, he doesn't have enough service time to qualify for care at Dept. of Veterans Affairs hospitals. "They need to take care of some of us," he said.

The physician without a practice

Pierrette Mimi Poinsett, MD, 51, has treated thousands of children in her 16-year career as a pediatrician. But she's spent most of the last few years caring for only one -- her 12-year-old son, Josh.

Although she described Josh as an intelligent boy who has excelled in school at times, she said he also has bipolar disorder, severe emotional problems and Tourette's syndrome. Josh's father has not been actively involved in his life, she said.

Josh has been uninsured for a year, and Dr. Poinsett for more than two. She ran her own practice in Modesto, Calif., from 2000 to 2006 but was unable to keep it afloat. Seventy-five percent of her patients were enrolled in the state's low-paying Medicaid program or in its Children's Health Insurance Program. The Kaiser Permanente health network also began operating in Modesto, increasing competition.

Dr. Poinsett moved to Petaluma, Calif., in February 2006 to work for another clinic. But Josh had an emotional breakdown and was hospitalized two weeks after they arrived, she said.

Dr. Poinsett found it impossible to balance her son's needs with her job, so she resigned.

Since then, Dr. Poinsett has been a medical consultant, has taught in a medical school and has even worked in a coffee shop, among other jobs. She hasn't practiced medicine for more than a year and has not been a full-time pediatrician for more than three years. "I'm not able to work the full 40 hours a week plus calls," she said. None of her jobs have offered health insurance, and having asthma makes getting an individual policy difficult. She took a $100,000 loss when she sold her home in Modesto and has spent thousands on her son's health care.

Dr. Poinsett is exploring Josh's eligibility for CHIP. California reopened the program to new enrollees in early September after a budget crisis led to an enrollment freeze over the summer. Josh used to be eligible for Medicaid, but child support payments pushed their income over the program's limit, she said.

"My heart says I would love to practice medicine," Dr. Poinsett said. But pediatric jobs are scarce in the area, and she doesn't want to leave Sonoma County after spending years navigating the county public health system and finding the right school for Josh. She also has family nearby. Lately, she's been writing more about health policy and serving as an advocate for families of children with special needs. She's also considering starting a fair-trade spice company.

Dr. Poinsett's experience makes her think that the only way she and her son will be insured steadily is if Congress adopts a single-payer system or at least a national public insurance plan. Something is wrong, she said, when a health plan CEO makes millions while his or her company denies care to patients.

The young adult willing to go without

If Keith Cross represents the general attitude of young adults -- the most likely age group to be uninsured -- many believe health insurance is just for the sick and people with families. Cross, 30, could have bought insurance when he was a server at a few restaurants in Covington, Ky., in the early 2000s. He remembers being offered one policy that cost $75 a month. But he declined.

"From a restaurant employee's point of view, it's not worth it to have health insurance unless you have a family," he said. "A single person -- it's not even worth it."

He has been ill at times. One day Cross woke up with his throat swollen, apparently from an infection. But the boss at the restaurant told him to come in anyway to cover a double shift. "I wasn't dying or nothing. My throat was sore," said Cross, who had to communicate in writing with that night's customers.

After his shift ended at 10 p.m., he went to a hospital emergency department in Cincinnati, just across the Ohio River. A doctor ordered a shot of antibiotics. It cleared up Cross' infection, but even now he still cringes at the $175 bill.

Cross self-treats most minor illnesses with over-the-counter medication. He said he would see a doctor if he were to develop something serious. Mostly he received updates on his health through physical exams required by some of his jobs.

That approach worked for awhile. Then in 2002, after moving to be near family in Houston and getting a job as a cable TV contractor, Cross put his foot through a customer's ceiling. The injury required two surgeries, costing $15,000, plus six weeks of rehabilitation and six months on crutches. Although he was still uninsured, workers' compensation covered the cost.

Afterward, he held two steady jobs in Texas for about two years, but neither offered health insurance -- and he couldn't have afforded it anyway, since his fixed wage never exceeded $10 an hour.

Another severe injury from a high-pressure hose at a water well drilling company put him in the hospital in October 2006 -- less than two months before he would have qualified for health insurance at that job. Cross is seeking workers' compensation coverage for that incident, too.

Cross doesn't have a grand plan for health system reform. But he would like workers who rely on tips to get a free doctor visit now and then for preventive care.

Cross said he would have taken up that offer. "In my 20s I would have went. Even now."

The uninsurable retiree

Paul Gerhold can afford health insurance, and he'd like to have a full policy to cover him until he qualifies for Medicare.

Gerhold, 62, who lives with his wife near a retirement community south of Ocala, Fla., spoke with several major health insurance firms in the early 1990s. "It was universal. Nobody would insure me for what I needed insurance for."

Gerhold was diagnosed with ulcerative colitis more than 20 years ago. He has traveled to India for three separate colon surgeries, most recently last fall.

Gerhold paid $30,000 for the surgeries, relying on previous income as a manager for General Foods, income from stocks and income from the decorative, metallic-glazed pottery he makes with his wife, Claudette, 70.

They used to be insured, though he doesn't recall needing the coverage much. Gerhold had employee coverage through General Foods until he took a company buyout in 1985. COBRA covered him for a couple of years, then he bought an individual plan. When premiums increased 30% in one year, he let it lapse.

Now his ulcerative colitis diagnosis makes insurance companies shy away. "I wouldn't really insure myself either."

But he has a gripe with hospitals. He wanted to have colon surgery in the U.S., but he couldn't find a hospital that would bill him at the same rates they would an insurance company. His third surgery in India cost $6,000, including travel and a recovery stay in a guest house. The same operation would have cost $26,000 in the U.S. if he paid cash up front, more if he waited for a bill. Insurers would have paid $11,000 to $13,000, an amount Gerhold said he would have paid.

Gerhold said if Congress accomplishes one thing, it should be to allow the uninsured to receive care at the same cost insurers pay. In the meantime, he has decided against buying health insurance that covers everything but his colitis.

"You can see the bus coming. You're not worried about the cars behind you."