Living with no medical support

Where only first names appear, names have been changed to protect the identities of the sources.

When a softball smashed into her left knee during a neighborhood pick-up game in sixth grade, Maria, a junior, heard the bone break, but she never went to see a doctor. As usual, she dealt with the emergency herself, putting ice on her knee to suppress the swelling.

All her life, Maria has lived without health insurance. Her version of health care usually consists of a struggle to ignore the pain and –– if the pain becomes unbearable –– a reluctant visit to the emergency room.

Maria is one of the nearly 46 million Americans without health insurance, according to the U.S. Census Bureau. Recently, several health care initiatives have garnered national attention. On April 12, Massachusetts adopted a new healthcare law requiring that everyone in the state have health insurance, according to National Public Radio.

Montgomery County wants to help its nearly 100,000 uninsured residents, says Steve Galen, the executive director of the Primary Care Coalition, a non-profit organization working to increase access to health care for low-income residents.

On the national level, the Robert Wood Johnson Foundation (RWJF) sponsored "Cover the Uninsured Week" from May 1 to 7 as a nonpartisan effort to urge lawmakers to make health coverage for all Americans a top priority.

Silent sufferers

The coalition has two initiatives for healthcare coverage: Montgomery Cares for adults and Care for Kids, says Sharon Zalewski, the Vice President and Director of the Center for Health Care Access. Currently, Montgomery Cares provides primary healthcare through a network of eight nonprofit clinics located throughout the county and serves approximately 13,000 patients, according to Zalewski. Care for Kids has enrolled 3,000 children who would not otherwise have health insurance.

Local initiatives like these could help Karen, a senior, who has been uninsured since seventh grade. As a single parent, Karen's mother must choose between health insurance and more pressing necessities like rent and food.

Maria's family does not have health insurance because her parents make less than $30,000 per year, she says, and until recently, Maria's mother has never tried to obtain healthcare.

According to Wilbur Malloy, the director of one of the Primary Care Coalition's eight clinics, the tendency of the uninsured forgo healthcare threatens a build-up of more severe medical problems. Maria felt this first-hand when she developed kidney stones last December. She began to feel so ill that, in a moment of desperation, she even thought of suicide as an option to end her pain.

The pain continued for the next day, so Maria's father drove her to a doctor, who prescribed her medication. During the four hours before the pills put her to sleep, Maria says, "I was a soldier. I was taking the pain."

The next morning, Maria began vomiting and was unable to urinate. Maria's parents rushed her to the emergency room at Washington Adventist Hospital, where technicians placed her on a stretcher and took her to receive a CAT scan. After learning that Maria had a kidney stone, the doctors gave her an insulin injection, free of charge. Washington Adventist is one of the four community hospitals that work with the Primary Care Coalition, says Galen.

Like Maria, Karen chose to suffer rather than seek medical attention when she needed a root canal for her wisdom tooth in February. After three days, the entire left side of Karen's mouth was swollen and pain shot up to her ear.

When she finally visited the dentist, Karen avoided the medical costs through insurance fraud. Her cousin has two dental plans, one through her mother's job and another through a different company. Because her cousin never used the insurance through her mother's job, Karen told the dentist she was her cousin. The $300 root canal was cheaper in comparison to the approximately $800 it would have cost out-of-pocket.

David, a senior, also delayed seeking medical attention for a broken bone. He has been uninsured for at least six years. Due to family problems, he has lived on his own since age 15. His income from his part-time job at a construction company does not even cover phone bills, much less medical insurance.

Last November, hospital visits for a broken bone in his right hand cost him $1,000 out-of-pocket, $600 of which he still owes today.

This debt is exactly what David wanted to avoid when he initially refused to see the doctor even though his fracture prevented him from writing, making schoolwork almost impossible. It was only after five days, when his condition had become debilitating, that David decide to go the emergency room.

The refusal of the uninsured to seek medical help is one of the many problems hindering the Primary Care Coalition from reaching the county's uninsured population. The coalition also struggles to communicate with the multicultural and multilingual population. Because many patients feel more comfortable with people who relate to them culturally, Malloy's clinic tries to employ a diverse staff, he says. He believes that after consolidating the healthcare system, the clinics will be able to move faster towards their goal of effective healthcare for uninsured residents.

Unlike David, Karen did heal from her root canal. However, the days of school she missed hurt her academically and accumulated huge amounts of make-up work.

Maria has lived the struggle of balancing school and work from a young age. To help alleviate her family's financial troubles, Maria found her first job at the age of 12. Currently, her income from the CVS Pharmacy in Langley Park combined with her mother's income as a housemaid pays the $220 for pills she needs every six weeks for her anemia.

Despite her health problems, she works from 3 p.m. to 8 p.m. four days a week. She is just thankful for every day she has without any major medical complications.

New hope

While Maria's family never tried to find health insurance in the past, Nelly, a senior who emigrated two years ago from the Central Republic of Africa, did. She says that her lack of health care knowledge prevents her from finding insurance. To educate others like Nelly, during "Cover the Uninsured Week," Langley Park hosted enrollment fairs at medical centers and shopping areas for affordable healthcare plans or public coverage programs.

The Primary Care Coalition plans to further its basic outreach system, but first the clinics have to expand in order to serve more people, Galen says. In its five-year evaluation plan, it intends to create 12 more clinics in Montgomery County by 2010.

Maria and her family are slowly progressing towards securing their medical future. Her uncle recently got insurance, and now, after so many years of medical emergencies, her mother has finally decided to pursue insurance for Maria and herself. Maria knows that this can never compensate for the past medical neglect, but at least she can cling to the promise of overcoming the uncertainty and lack of care suffered by the other 46 million uninsured Americans.