Without Health Insurance in NYC

by Joshua Brustein

December 5, 2005



A woman from Pastor Ebenezer Martinez?s congregation was recently bit by a dog, and ended up spending a week in the hospital. Neither the woman nor her husband had health insurance, and they were worried about the thousands of dollars of medical bills. Martinez is not sure how to help her, or the many others among his South Bronx congregation he knows don?t have insurance. But he does know what they?re going through: He is not covered, either.



Martinez, 54, gave up what he refers to as his ?secular job? as a counselor at the Upper Manhattan Mental Health Center two years ago, when he left to become the pastor at the First Pentecostal Church of Jerome Avenue as its only full-time employee. Knowing that the church was not in great financial shape, he hid his medical condition ?- he has high blood pressure -? from the board of trustees, so it wouldn?t strain to pay for health insurance. Martinez gave up his prescription drugs, instead taking aspirin when he felt pain in his chest or arms.



?Using aspirin is not the same, but you know, aspirin helps a little,? he said. The prescription "was very expensive.?



Aspirin was not helping enough, however, and Martinez ended up in the emergency room for nosebleeds he couldn?t control. The trip cost him $700, and he still left without a prescription.



Stories like Martinez's are common in New York, where almost a quarter of the population lacks health insurance. True, the percentage of New Yorkers without insurance has been dropping in recent years, largely due to a unique statewide program that allows community groups to sign New York residents up for Medicaid. But health care advocates fear that within a few months this program will end, and the gains that have been made will be reversed.



Public officials are aware of the growing anxiety among New Yorkers. Mayor Michael Bloomberg made a campaign promise that within the next four years virtually every child in the city would have health coverage. The mayor and the city council are also pushing separate efforts to encourage ? or force ? private employers to give their workers health insurance.



But as it stands today, huge problems remain. People of color are much more likely to be uninsured than whites, aggravating racial disparities in health care. And experts and officials worry that having a large uninsured population is undermining the financial stability of the health care system as a whole.



?From a health care system?s point of view, the uninsured are the single largest structural flaw in the system,? said James Tallon of the United Hospital Fund.



On an individual level, the lack of having individual health insurance is often devastating financially. Other times it is far worse. Manny Lanza learned that he had a serious brain condition, AVM, after he had a seizure in 2004, and was referred to St Luke?s-Roosevelt Hospital for treatment. But for months, the Manhattan hospital reportedly refused to provide care for him until he had insurance. His family labored to get him enrolled in Medicaid, but the delay, they charge, was deadly: Lanza died in his bedroom earlier this year. He was 24 years old. After his death, according to the Post, debt collectors for St. Luke's-Roosevelt called the family demanding payment of $42,000.



THE COSTS OF BEING UNINSURED

About half of New York City residents get health insurance through their work, either receiving it as a benefit free of charge or splitting the cost with their employer. Another quarter of the population receives health insurance through a public health plan like Medicaid or Medicare. Funded by various levels of government, these programs are available to the elderly, the poor, and other disadvantaged populations.



But 1.7 million New Yorkers have no insurance at all. Most, like Martinez, are adults working for small employers, the majority at secular jobs like restaurants or hardware stores. Eighty percent of city residents without insurance are either employed or are the dependents of someone who works.



?There are programs for the very poor,? said Martinez. ?But people like me are in between.?



People without insurance are less likely to get preventive care. They often wait until their health problems are too serious to tolerate or ignore, and then arrive at hospital emergency rooms. By this time, health problems that could have been easily addressed earlier have become difficult or impossible to treat.



While it is less effective, the health care received by the uninsured is actually more expensive, both for the patient receiving it and the health care system providing it. Because uninsured patients do not have access to the group discounts that insurance companies negotiate for their clients, they pay higher rates, a burden that has become ever less bearable as health care costs skyrocket. Unpaid medical bills are now the country?s most common cause of personal bankruptcy.



Treating uninsured patients also takes its toll on the hospitals that do so. Dealing with a problem once it has progressed to the point that it warrants an emergency room visit is much more expensive than preventive care; and if a patient cannot pay for this visit the hospital is left to pick up the bill. This burden falls particularly hard on the city?s public hospitals, and is regularly cited as a reason for their financial difficulties.



No one has calculated how much it costs to service the uninsured in New York in particular, but a recent nationwide study showed that the country?s health care system would save between $65 billion and $135 billion if all of the patients it served were insured.