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 Some Orange County, Calif., Residents Don't Fit Stereotypes 
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Geregistreerd: 12 okt 2018, 12:32
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Bericht Some Orange County, Calif., Residents Don't Fit Stereotypes
Apr. 9--People who have no health insurance: the unemployed, immigrants with a poor command of English, families living below the poverty line.


Not necessarily.

Meet Brett Clifford, the youth pastor at Cavalry Chapel in San Juan Capistrano. He lives with his wife Joanne and two children in their small home at the end of a cul-de-sac on a quiet street two miles from the church.

Clifford, 36, could be the poster boy for a substantial and possibly growing segment of the county's uninsured population: full-time employees, native English speakers, homeowners and car owners, making just enough to squeak by. But not enough to afford medical coverage -- at least not without some onerous trade-offs.

The couple started watching their pennies after Clifford sold his successful window-washing business seven years ago to pursue what he felt was his true calling as a youth minister. Joanne stays home with the kids. Brett's job provides their sole income -- with no health benefits. They are young, money is scarce, and medical insurance does not top their priority list.

"If the car breaks down or something like that, it puts me in sweat mode," Clifford says. "We gave up going to the movies a long time ago."

When a pain in Clifford's back became unbearable recently, he visited the Camino Health Center, a community clinic in town that provides medical services on a sliding scale to people of limited means. Clifford made four visits for $30 each. Now he feels like the million bucks that he and his family will probably never have.

The Clifford family is among the nearly 600,000 non-elderly people in Orange County and about 42 million in the United States who lack health insurance.


Politicians this year are pushing a range of proposals they hope will shrink those numbers, as the plight of the uninsured beeps across radar screens in Sacramento and Washington. In Orange County, as statewide, the lack of health insurance is a bigger problem than it is nationally. Twenty-three percent of county residents have no insurance, according to a recent study by the Center for Health Policy Research, at the University of California, Los Angeles. That's about the same as statewide, but well above the U.S. average of 17 percent.

The widespread lack of insurance weighs on the health-care system. Orange County's 30 hospitals lost more than $200 million last year providing care to the uninsured, says John Gilwee, vice president of the Health Care Association of Southern California. Doctors also lost money. In recent years, hospitals and doctors have begun to push more of their rising costs onto insurance companies, which have passed them along to employers and individuals through sharply higher premiums.

Despite the many cases like Brett Clifford's, being uninsured is still disproportionately the lot of immigrants, minorities and the poor. Orange County's Latino and Vietnamese residents are more than twice as likely to be uninsured than non-Hispanic whites. County residents who make less than $20,000 a year are three times as likely to be without insurance than those with incomes between $50,000 and $75,000, according to the Orange County Health Needs Assessment survey.

True, some of the uninsured are well off -- about one in six Californians without insurance has annual income greater than $71,000. They either choose not to buy insurance or are excluded due to a pre-existing medical condition.

But the vast majority of California's 7 million uninsured residents are people with low to moderate incomes. More than half of them are in families with at least one member working full-time. Many of these people make too much money to qualify for public health programs like Medi-Cal, yet not enough to buy their own insurance. Ironically, they'd be better off -- in terms of health care -- living under the poverty line.

"You end up wishing you were just a little bit poorer," says Terry Schafer, who runs a small janitorial supply company with her husband, Bob, out of their Buena Park home.

The Schafers, who moonlight as part-time janitors, manage to scrape together a living. But they don't take vacations, they don't eat out, and they've gone years without insurance.

When Bob needed a hernia operation two years ago, they were told it would cost $9,000. So they drove to Tijuana and found a doctor who did it for $1,300.

Others have had insurance for years, and suddenly find themselves without it.

Ulises Rodas, medical director at the Camino Health Center, says that in the past year, he's seen many people who have lost their health insurance because of a job change. "It's kind of sad," Rodas says. "They walk in the room and they're self-conscious about it, because they always paid their own way."

At the Maternal Outreach Management System in Santa Ana, which serves uninsured pregnant women, executive director Pamela Pimentel says she has seen a big increase in the number of native English-speaking U.S. citizens who walk through her doors.

"What has been thought of in the past as a problem of low-income, under-educated, undocumented people isn't true anymore for the uninsured," Pimentel says.

A survey by the California HealthCare Foundation found 2.5 million Californians it called the "non-poor uninsured." Within this group, accounting for more than one-third of the state's uninsured population, 62 percent were white, 90 percent were U.S. citizens, 40 percent were homeowners, and 56 percent owned a personal computer. Yet 60 percent had household income under $40,000 a year. Seventy-five percent said they couldn't afford insurance.

Full family coverage, with a reasonable range of medical services, costs about $6,000 a year, and families making $30,000 to $40,000 a year can ill afford to pay that, says Larry Levitt, vice president of the Kaiser Family Foundation.

Much cheaper policies are available, but they typically cover only catastrophic medical cases with strict limits on doctor visits and other more mundane medical services. They also usually have high deductibles. If your family makes only $30,000 a year, by the time you pay the deductible "it's going to be a catastrophic event for you anyway," says Levitt.

Silvia Ozuna and her family, of Laguna Beach, have a limited policy like that. She and her husband pay cash when they see the doctor. But they take their 4-year-old daughter, Amanda, to the Camino Health Center, where the fee is lower.


"I'm happy they have this kind of clinic," Ozuna says. "It's very important."

What may sound like a livable, if modest, wage doesn't go very far in Orange County. The Orange County Health Needs Assessment Project found that a family of four making $37,013 a year -- about 2.25 times the poverty level -- would have no discretionary income after paying for food, transportation, housing, utilities and child care.

"So if you have to choose between shoes and insurance, and your kid's not sick today, what do you choose?" says Pamela Austin, the project's director. "You choose shoes."

For some people, the choices may not be quite that stark -- but they can be highly personal and difficult ones. Terry Schafer says she and her husband have considered getting full-time jobs with health benefits, but that could mean shutting down their own business. "Is it right to be self-employed and not have insurance?" Schafer wonders.

For Brett Clifford, doing without insurance is a trade-off he accepts as the price for having his wife stay home to raise the kids. "We've made that sacrifice because it's a priority," he says.

Clifford knows that not having insurance is a gamble. "Right now the gamble is paying off," he says. "That's why having insurance has been a low priority. But I know that as you get older you have to get something established."

12 okt 2018, 12:35
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