Pain for uninsured Americans

By Kevin Anderson
BBC News Online in Washington

One wrong step and Valerie Bonds now faces up to $15,000 in medical bills and financial uncertainty for years to come.

Accident victim Valerie Bonds tells how she will struggle without health insurance

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She had just moved into a new apartment outside Washington and was rushing to catch a taxi to work.

"Instead of stepping on the steps, I stepped into the air. I took a dive off my porch," she explained dryly as she waited for a doctor to put her leg in a cast.

She fell more than a metre from the steps outside her apartment. She broke her ankle and damaged ligaments in her lower leg.

Valerie now faces surgery and quickly mounting medical bills because she is one of the more than 43 million Americans without health insurance.

The working poor

Her problems began last August when she lost her job in her home state of Michigan.

"The economy at home was so bad, I wasn't finding steady employment," she said, so she followed her daughter who recently graduated from university and moved to Washington.

UNINSURED IN AMERICA The rate of uninsured Hispanics was 32.4% in 2002, higher than any other racial or ethnic group. Young adults, aged 18 to 24, were less likely than other age groups to have health insurance coverage. The proportion of people who did not have health insurance ranged from about 8.0% in Minnesota, Rhode Island, Wisconsin and Iowa to 24.1% in Texas Source: US Census

Like most of the uninsured, she was working when her accident happened.

The most recent US Census data showed that about 80% of Americans without health insurance were either working or lived with someone who worked.

Valerie found work through a temp agency. Temporary workers, workers at small businesses and service industry workers are the most likely to be uninsured.

Crisis care

Without health insurance, Valerie had to go to the emergency room at Providence Hospital in north-east Washington.

The swelling and pain of her broken ankle had become unbearable.

Many of the uninsured do not seek help until they are gravely ill

Emergency departments cannot turn away patients in the US, so when the uninsured become sick or injured, they often see their only option as the emergency department.

At Providence Hospital, volume at the emergency department is up by 10,000 patients in the last year, said Karol Duffy, nurse manager of the department.

The crush of more patients is the same across the United States, she said, adding: "I'm sure it has to do with the present economy and lack of insurance."

Without being able to afford a doctor on a regular basis, the uninsured put off seeking medical attention until they must.

"Generally, when they arrive to the emergency room, it is when they are really sick because they don't have the time or the money to go when they aren't feeling well at the beginning of an illness," Ms Duffy said.

And treatable illnesses become debilitating or even life-threatening crises. High blood pressure leads to strokes and heart attacks, and diabetes leads to blindness and amputations.

Financial pain

The uninsured rely on luck and good health, but if one of those runs out, they often face financial ruin.

"The uninsured pay on average about 40% of their healthcare expenses out of pocket. About half of all personal bankruptcies involve healthcare costs," said Linda Bilheimer, a health insurance policy expert.

For Valerie Bonds, the surgery alone could cost up to $12,000, and she will have to pay for her two visits to the emergency room.

She had to return to her home state of Michigan where her parents live. They will help her pay the cost of the surgery and give her a place to live while her ankle heals.

She is angry at the cost of healthcare and the lack of affordable insurance.

"It's a tremendous problem. We're supposed to be one of the richest, most powerful countries in the world, and our people are uninsured," she said.

Insurance and healthcare should be readily available to all Americans, she added.

Her leg will heal in the coming months, but it will take her longer to recover financially.

She was just getting back on her feet when the accident happened, but now, she says: "I'm looking at another two to three years just to recoup from this."