Parents roll dice on insurance

By Christi Parsons

Tribune staff reporter

Published December 5, 2005





The Evans family avoids the doctor except in emergencies, like when its youngest member has an acute asthma attack, and then its concerns are compounded by worries of how to pay for his costly care.



The Evanses are among thousands of families in the state who have no health insurance for their chronically ill children, in part because they make too much money to qualify for Medicaid.



Gov. Rod Blagojevich featured the Evans family in his campaign for All Kids, his signature program to offer health insurance to all Illinois children beginning next summer.



They and others were cited to demonstrate the perils of raising a family without medical coverage and the difficulty of paying high private insurance premiums on even a middle-income salary.



Their stories are filled with calamity and frustration--sometimes the result of overwhelming odds and sometimes the product of their own difficult choices.



For Michael and Tracie Evans, every family choice is weighed on a careful scale. That includes their decisions to have Tracie home-school their children and to pay for extracurricular activities instead of putting the money toward sky-high health care premiums that seem impossible to pay anyway.



Those private choices fuel part of the debate on the larger social policy at play: Should taxpayers take on the responsibility of expanded government health programs?



But as the public discussion about reforming the system wears on, the families of 253,000 uninsured Illinois children grapple with its difficulties on a daily basis.



"You ask yourself if you could have done this differently or that differently," said Michael Evans, a minister and a community organizer in the Roseland neighborhood on Chicago's Far South Side. "You worry that you're not giving your children the best."



His is a prime example of a family that makes too much money to qualify for Medicaid, the government program for poor families but is stymied by the cost of private insurance.



For years, the family had health insurance through his job as a community organizer with the Developing Communities Project, which covered two emergency room trips for the acute asthma attacks of his son, Aaron.



When the organization stopped paying the children's premiums, the family enrolled in KidCare, the state's insurance program for low-income children, which paid most of the cost for portable inhalers and an electric nebulizer to treat Aaron's asthma.



But when Evans got a raise two years ago, the family made too much money to qualify for that program. With Michael earning $53,000 a year, they say, they just couldn't pay the $800 to $1,000 in monthly premiums to cover the children.



"It's incredible," he said. "We couldn't have afforded that."



So the four children, ranging in age from 11 to 15, have gone without insurance since 2003. Aaron, the youngest, ran out of hand-held inhalers, so he uses the electric nebulizer at home instead. Because the family only uses the nebulizer when Aaron's asthma flares up, the Evanses haven't yet run out of the medication that goes into the machine.



In the constant effort to be frugal, said Evans, his family makes decisions to seek health care on a "need-to-go" basis.



"You do less preventive care because of the prices," he said. "There are things that suffer. You catch them late. You can't be as on top of things because you just can't afford it."



Michael and Tracie Evans considered turning down his raise to keep the KidCare coverage. But they decided the money would be important to help pay for the children's educational supplies and activities. This year, the family estimates it paid about $1,000 for music lessons and basketball fees.



The Evanses look for low-cost programs for the children to join at local museums. The raise helps cover the mortgage on their single-family home.



"I believe having a home is important, especially as they're growing up," said Michael Evans. "They need some space."



Tracie Evans, who has a business degree from the University of Illinois, has thought about going back to work. But she has been committed to home-schooling for eight years now.



The Evanses budget to afford extracurricular activities. Their life is a careful balancing act, she said.



"We're OK," she said. "They're healthy children."



The Evans children are a primary target of the governor's All Kids program, which will offer coverage to the estimated 125,000 uninsured children who don't qualify for KidCare. The rest of the state's uninsured children qualify but aren't enrolled.



Blagojevich plans to pay for the expansion by putting most people who are in government-funded health insurance plans into a form of managed care, which will promote preventive medicine and discourage emergency room trips and other high-cost treatment.



Some question whether taxpayers should assume more responsibility for health care coverage. Government health care programs rely partly on taxes and drive up the cost of private insurance by reducing the pool of participants, critics argue, and they may discourage people from being self-sufficient.



"Another dimension of this issue is moral hazard," said Michael Cannon, director of health policy studies at the Cato Institute, a libertarian think tank based in Washington, D.C. "If you promise that you will cover people after they make bad decisions, you will get more people making bad decisions."



But other policy analysts say expanding government health insurance is wise. Regardless of whether parents cannot afford private insurance or simply take unwise risks, they say, children shouldn't bear the burden.



"It is a question of whether children should have to pay the price for their parents' choices," said Diane Rowland, executive director of the Kaiser Commission on Medicaid and the Uninsured. "Children are an investment in our future, and you want to invest in their health and well-being."



Besides, the rest of society ultimately ends up paying for care of uninsured people through higher health care costs, Rowland said.



"Wouldn't it be more prudent to pay up front for them to have early care," she said, "than to pay for that much more expensive care later on?"



Like the Evanses, Bianca Sanchez makes tough choices. A single mother, Sanchez also was an early advocate for All Kids and appeared at events with the governor to press for it.



Her 7-year-old daughter, Soledad, also has asthma, but her case is more severe and requires almost $700 a month in medications, she said.



"I try to stretch it," Sanchez said. "Instead of giving her two doses in a day, I'll give her one."



Skipping doses isn't good for her daughter, she knows. When things get bad, they go to the emergency room.



Sanchez said she didn't realize she'd lose KidCare coverage when she took a promotion at the Little Village health center where she works. She realizes now how difficult it is to get by without that subsidy, she said, but the receptionist job she had previously is no longer available.



She fears she couldn't get a decent job somewhere else because she doesn't have a high school diploma.



"Without education, it's hard," she said. "The company promoted me because I help out a lot of people."



Another family that appeared at All Kids events were Annette and Dan Akey of west suburban Carol Stream, self-employed real estate brokers who are uninsured.



"Owning our own business, we have a lot of decisions to make about where to allocate money," Annette Akey said. "It really became a question of, do we keep our business running and not have health care, or do we have health care and not have money to put back into the business? The cost of insurance was so staggeringly high, we could not afford both."



That proved disastrous in 1999, when the couple had to pay almost $30,000 to cover the Caesarean-section birth of their daughter. Then they discovered that Katana had a mild form of autism, heart murmurs and a kidney condition.



No insurance company will cover her now.



"I get as far as, `She is autistic, she has heart murmurs,' and they say, `I'm sorry, we cannot insure her,'" said Annette Akey.



The Akeys set aside money to pay for medical costs, but they worry what may be down the road.



"I don't know that we could have done anything differently," she said. "It always became a choice between the business and having money to live on, and having health care and not having the business."