Sunday, January 17, 1999

No insurance, tough medicine

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A family struggles to be well and make ends meet

BY MARK CURNUTTE
The Cincinnati Enquirer

Mike Sparkman and his family attend a revival at Victory Baptist Church. (Steven M. Herppich photo) | ZOOM |

        Labor Day 1998. Mike Sparkman sat on the couch in his family's Norwood apartment with a notebook and pencil. No matter how many times he added or subtracted, the result was the same: There was not enough money that month to buy prescription medicine for his two daughters and his diabetic wife.

        Because he has no health insurance, he had to choose. It's the kind of choice he faces nearly every day at home and in the grocery and the garage.

        “I try to do the best I can,” Mr. Sparkman, 40, said. “Either way it goes, somebody's going to get hurt.”

UNINSURED AMERICANS

• A decade-high 43.4 million U.S. residents (16.1 percent) do not have health insurance.That's 1 in 6 people, up from 1 in 7 in 1990. • After rising slightly more than 1 million a year since 1987, the ranks of the uninsured increased by 1.7 million in 1997, according to a Census Bureau report released in October. • The number of uninsured Americans increases 100,000 each month, according to a December 1998 issue of the American Journal of Public Health. • Uninsured and lower-income Americans are in generally poorer health than people with private coverage, according to a government report.

        Living without health insurance hurts. Most of the decade-high 43.4 million uninsured Americans are like Mr. Sparkman. They face a battle of hard choices and fading hope.

        Mr. Sparkman makes $9 an hour with a small waterproofing company in Norwood. The job does not offer health insurance benefits, and Mr. Sparkman can't afford to spend $5,000 a year on private insurance. He qualifies for Medicaid coverage for his two children. But he risks losing that coverage if he works overtime.

        “Without overtime, I ain't got money for nothing,” he said.

        Living without health insurance forces Mr. Sparkman to think about every dollar he pulls out of his worn, 8-year-old black leather wallet.

        His family has more than its share of health problems. His wife, Kathy, 29, has diabetes and needs $600 worth of medicine a month. His daughter Christy, 8, is asthmatic. His daughter Cassie, 7, has allergies.

        They all need prescription medicine. They all need to see doctors. And it all costs money he doesn't have.

        “I think about their health all the time,” Mr. Sparkman said. “It makes me nervous.”

        Every month, Mr. Sparkman scratches numbers on his pad, trying to figure out a way to buy medicine for his wife or pay hospital and doctor's bills and the bank loans he has taken out to meet his family's medical needs.

        This financial drain means Mr. Sparkman probably will never own a house, and he can't see his daughters going to college. And he is left to wonder whether his spirt will survive.

In poor health
        Mike Sparkman says his family's health would be better if he could find insurance for himself and his wife and daughters. Untreated and undertreated health problems only get worse.

        Kathy has had diabetes for 10 years. In 1988, while working at a restaurant, she developed a nose bleed that wouldn't stop. The emergency room diagnosis was diabetes and high blood pressure. Her doctor ordered several hundred dollars of medicine and supplies a month.

        Before his children were born, Mike could scrape together the money to pay for his wife's medicine. After his children were born, Mike has relied on doctors to supply his wife with free samples a month at a time. Last month, Kathy had surgery on her colon, a complication doctors blame — in part — on her irregular use of her diabetes medicine.

        She now qualifies for Medicare, which pays for 80 percent of her doctor's visits but none of her prescriptions. She also receives a $265 check every month from Social Security because she is unable to work.

        Mike and Kathy would trade Medicare coverage and the Social Security benefit for Medicaid that would cover all of her doctor's visits and prescription medicine.

        Friends tell Kathy she could get Medicaid if she told a Hamilton County Human Service caseworker that she and Mike were separated. She would become eligible for more benefits, an agency spokeswoman says, because her income would be lower. But trying to cheat the system would not be a good idea because Hamilton County is one of the most aggressive in the state at prosecuting welfare fraud.

        “I hear all I got to do is tell them he left me and the kids,” Kathy said. “If we got to lie, we don't need it.”

        For the time being, though, Kathy is covered. On Sept. 30, University Hospital approved Mike's wife for 100 percent coverage through Hamilton County's indigent care tax levy. Approval was based on Mike's salary without overtime.

        Kathy's coverage was approved from Oct. 1 through April 1, retroactive to Aug. 31, the day she applied.

        But right before Christmas, Mike received an $800 bill from the University Hospital pharmacy for diabetes medication Kathy received earlier in August, just days before she applied for levy coverage.

        Like his wife, Mike's daughters need medication each month.

        Christy needs a steroid inhaler and other drugs for her asthma. A year ago, she was rushed to an emergency room in Lexington after a severe attack. They were there visiting relatives for Thanksgiving. Mike still owes $120 on the $400 bill.

        Cassie needs prescription pills to treat several environmental allergies.

        Mike has no savings. He can't afford to have a checking account. He has to purchase an 80-cent money order to mail a medical bill. In August, Mike applied for Medicaid coverage for his daughters through the Children's Health Insurance Program (CHIP). The Ohio program, using a combination of state and federal money, provides full coverage for children up to 18 in families below 150 percent of the poverty level.

        Mike's first application was denied because he made $20 more a month than the rules allowed. So, this fall, Mike cut back on his overtime and reapplied. Since October, his daughters have been covered.

        CHIP has been a lifesaver. It pays for the children's checkups, eye tests, dental benefits and emergency care. Mike has been able to get medicine for both girls, and Kathy took Cassie and Christy to a dentist at Children's Hospital.

        Before CHIP, the Sparkmans depended on free drug samples from doctors to treat the girls' ailments.

        “They either got samples or they got nothing at all,” Kathy said. “There was no way we could buy it.”

        Mike is 6-feet, 200 pounds and in good health, except for his teeth. He hasn't seen a physician since 1990. He saw a dentist earlier this year for a check-up. Diagnosis: Twelve cavities and root damage. Estimate: More than $1,200.

        “I don't have the money for that and probably never will,” he said.

        Mike and Kathy recently shared a bad cold. She got a 10-day antibiotic prescription from the University Hospital pharmacy. He couldn't afford his own, so they shared hers.

        “I got five days,” Kathy said, “and he got five.”

        Mike got better. Kathy's head and chest congestion hung on for weeks.

        The Sparkmans case is an increasingly common one these days and one that more family advocacy and business groups want to see helped with expanded Medicaid coverage.

        For now, though, people like Mike and Kathy Sparkman are forced to hunt and peck for partial insurance coverage or they have none at all.

        “We hear from these kinds of families every day,” said Gloria Reed, training director with Hamilton County Human Services. “We've done a little bit with welfare reform, but we've done nothing with medical coverage.

        “They are caught in a system that's not designed to look at the working poor. The system is designed to help the destitute, people on long-term welfare.”

Ripple effect
        Lack of health insurance figures into every decision Mike and Kathy Sparkman make about money. It affects where and how they live.

        Mike's home is a pair of one-bedroom apartments in a four-unit building, which has a doctor's office in the front.

        For 11 years, Mike and his family lived in a one-bedroom apartment.

        Mike is building caretaker. He receives a $160 discount on his $300 monthly rent for cutting grass in the summer, clearing ice and snow in the winter, taking out garbage and cleaning the lobby year-round.

        In March, when the unit across the hall opened up, Mike rented it. He pays an extra $300 a month for the second apartment, but he and his wife now have a bedroom. His daughters have a playroom.

        At night, they lock up one apartment and walk across the hall to go to bed.

        “We was fighting all the time before we got the second apartment,” he said.

        Mike's take-home pay is about $300 a week, or $16,120 a year. The federal poverty level for a family of four is $16,450.

        Mike works 40 hours most weeks. When waterproofing jobs are scarce, he works as little as 30 hours. Then he'll take some overtime during another week to make up the difference.

        But if he makes too much overtime, Mike risks losing CHIP coverage for his daughters.

        A year ago, he looked into buying a health insurance policy. The cost to cover his family: $5,000 annually.

        Mike's car, a used 1985 Cadillac he bought a couple of years ago, has 184,000 miles on it. In December, he unexpectedly had to buy a belt tensioner for $117. The purchase sent shock waves through his finances.

        “I took it away from the rent,” he said.

        The rent money came from a $200 check Kathy received from their pastor for cleaning his house every week for two months. That money was supposed to go toward Christmas presents for the girls.

        Mike's father-in-law, Wallace Combs, gave them $400 to use for Christmas. But most of that money went to replace a water pump in Mike's car. Mr. Combs, who lives around the corner in Norwood, loaned Mike and Kathy another $250 to buy presents for the girls.

        The Sparkman's social life consists of visits with family members. They never go out to eat.

        Mike and Kathy take the girls grocery shopping on Friday night at the Norwood Kroger. Kathy keeps a running tally on a calculator. They try to stay under $100 a week for food.

        Wednesday and Sunday are their nights out. They attend services at Victory Baptist Church in Norwood. Mike and Kathy joined a bluegrass gospel choir this fall.

        Every week, Mike wears the same dress shirt and pants that a church member gave him. His wife and daughters also wear second-hand clothing Kathy buys at thrift stores.

        Every two years, Mike takes out a personal loan to buy the girls a couple of new outfits and pay outstanding medical bills. Mike pays $113 a month on the bank loan. He's paying back his fourth, two-year loan.

        “I got to borrow money to make ends meet,” he said. “I ain't got no choice.”

        Mike admits to one non-essential expense. He spends $40 a month on cable television. He doesn't drink or smoke.

        “Cable's the only luxury I get out of my money,” he said. “You got to have something.”

        Friday, if he has the money, Mike leaves Kathy $2.40. After school, Kathy walks Christy and Cassie to a Laundromat down the street. Mike's daughters buy a can of soda pop and a bag of chips as rewards for working hard all week in school.

        “I ain't ever going to be able to save nothing. I've come to grips with it,” Mike said. “It's hard, but, hey, a lot of people got it worse. Them people in Africa is poor. In the United States, we're poor. But we got it good compared to a lot of people.”

Constant worry
        Living without insurance takes an emotional toll on the Sparkmans. The uncertainty of cut-off dates and paperwork related to public health programs is a constant worry. The requirements are confusing. A benefit from one program leaves them ineligible for another. And Mike has to be careful not to make too much money.

        After Christmas, a computer glitch at Hamilton County Human Services produced a letter that told the Sparkmans their daughters were being dropped from CHIP. Agency officials later called to clear up the situation.

        Mike holds on to diminishing hope that his situation will improve. His biggest worry is the cost of treating Kathy's diabetes.

        At times, he tells himself he has lifted himself and his wife from the harsh poverty they knew as children in Perry County, Ky. He had to quit school to go to work but later earned a GED in Kentucky.

        A coal miner until the mines shut down, Mike came to the Tristate looking for work. His life in Norwood is better than the one he knew growing up in a house with no heat or indoor plumbing and snakes roosting in the crawl space.

        “We ain't homeless. We ain't hungry,” he said. “I don't think I done a bad job for the last 12 years.”

        At other times, Mike feels he has come up short. He would rather not receive any form of welfare benefits.

        Getting welfare opens him up for this: In December, he received a letter from the Hamilton County Department of Human Services telling him he owed more than $900 because he was overpaid food stamp benefits from April through July 1995.

        “We wasn't on food stamps at that time,” Mike said. His family did receive food stamps later in December 1995 and January 1996 — when he was laid off during a slow period, he said.

        Human services has an aggressive overpayment recovery unit, an agency spokeswoman said, and it is not uncommon for it to be three or four years behind on collections. A check of human services records shows the Sparkmans received food stamps during spring and summer 1995.

        “If we owe it, we'll try and pay it,” Kathy said.

        Mike is proud, but not proud to a fault, like many working poor who experts say refuse to enroll in public assistance programs for which they're eligible.

        “I believe you should work for your money,” Mike said. “I would be much happier if it was $15-$20 coming out of my check and nothing to do with the government.

        “But I deserve what I'm getting. I'm paying taxes. If I wasn't paying taxes and was sitting on my butt and not doing nothing, I'd say, "Hey, right, I don't deserve nothing.' But I'm out there everyday, so if the government wants to give me a little help, that's fine by me.”

        He has no safety net except for a patchwork of public health programs. There are many holes in the quilt.

        Mike wonders what would happen to his family if he were injured and couldn't work.

        His employer, Collins Water Proofing of Norwood, does not offer paid sick days. The owner, the Rev. Chester Collins, said he can't afford it. The Rev. Mr. Collins considered insurance a few years ago, but his other employers — primarily single men — weren't interested.

        For Mike, there's also no paid vacation. No retirement plan. No worker's compensation. His blue-and-gray work uniform is the only benefit he gets.

        Mike's wife wants him to look for a job with health insurance. He has asked around about benefits at other Tristate waterproofing companies. Some have benefits. Others don't. But all of the other companies would start him at minimum wage, about half of what he earns as a supervisor at Collins.

        He also stays on the job because Kathy's dad, who's 50 and had heart surgery, works with him. Mike worries about his father-in-law's job security and health.

        Besides, Mike said, he enjoys what he does and he's good at it. Friends have mentioned labor shortages in factories and construction.

        “I don't want to work in a factory, and there's no guarantee of construction work in winter,” he said. “And ain't nobody going to offer me insurance I can afford because Kathy has diabetes.”

        Mike has the choice to look for other work, but it is really no choice at all.

        “I'm afraid of losing what little I got,” Mike said.

        If he had a choice of one benefit, Mike would choose health insurance.

        “If I had insurance, it would be a lot of burden taken off of me,” he said. “That way, I could say I was taking care of my family without having no stress and nervousness on me.”

        Meantime, his faith sustains him.

        “Without the Lord, I couldn't make it,” he said. “I know God's going to take care of me and my family, 'cause he will help those who help themselves. And, buddy, I sure help myself.”

The hardest choice
        Mike Sparkman is frustrated because he can't escape the hard choices he faces being uninsured.

        The choice is not where to go for a family vacation or which computer or shoes to buy.

        The choice is who will get medicine this month.

        Mike had to make that decision in September and could be forced to make it again at any time.

        “I thought if I don't get Christy's or Cassie's medicine, Christy could take an asthma attack and die, which she almost has done before,” he said. “Kathy's got a whole lot more problems than Christy has, but I love 'em both the same. I shouldn't have to choose like that.”

        Mike bought medicine for his daughters.

        Then he bought as much as he could afford for his wife. It was about half of what she needed.

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