It's barely 9 a.m. at the Marin Community Clinic in Greenbrae, Calif., and already the waiting room is packed, humid and buzzing. Those waiting -- mostly young women -- step up one by one to the receptionist's window and hear the same dispiriting questions: Do you have insurance? Do your children? How much do you make a year? Do you have pay stubs with you today?
Within half an hour of opening its doors, the clinic is full. A voice from behind the appointment desk cries out, in a mock groan, to no one in particular: "This day is going to be not fun."
Marin County, just north of San Francisco, is among the wealthiest communities in America, but that doesn't mean the clinic's patients have health insurance. In fact, many of them are here on this early spring morning precisely because they don't.
A cramped prefab building resembling five or six trailers welded together, the clinic is one of the few facilities in the county that will treat the uninsured at low cost. Last year its staff saw more than 9,000 patients, and were still so overbooked, they turned away as many as 100 people a week.
The clinic's visitors probably aren't who you would expect. Eighty-five percent come from working families, and surprising numbers are middle-class. More than half are women. In the 1990s, the number of uninsured American women increased by roughly 20 percent, according to U.S. Census Bureau statistics; one in five non-elderly women nationwide now lack insurance. That translates to a remarkable 12.9 million uninsured women between ages 19 and 54.
Going without insurance for as little as one month can be harmful to your health, according to a recent report by the Institute of Medicine in Washington, D.C. Without coverage, the institute found, you're less likely to detect cancers early, head off a heart attack or heal after a car crash -- all raising your risk for premature death. When uninsured women get breast cancer, the report said, they're up to 50 percent more likely to die from the disease than women with private insurance.
Politicians often talk about America's health system train wreck. In three days at the Marin Community Clinic, SELF heard from the people who understand it best -- uninsured women themselves.
Fact: A single woman is up to two times more likely to be uninsured than a married woman.
Gayle Conway, 30, massage therapist said, "today was the first doctor's appointment I've made for myself in more than a year. Even if nothing were wrong, it costs me $25 for the initial appointment and I'm thinking, 'Where am I going to get that from?' As it turns out, the doctor suggested I have a needle aspiration to remove cysts in my breasts. Since the condition isn't life-threatening, I'm not going to deal with it now: can't afford it, don't have time."
"I work at a fitness center here in Marin, but they don't subsidize the health plan. Right now I'm raising two kids by myself and bringing in $2,400 a month. Once you start adding things up -- $1,350 for rent, plus groceries, utilities, gas for the car -- paying $300 a month for health insurance is insane. It's insane! If I break my arm, I figure that only costs about $800, so in the end it's cheaper for me to go without. You do hear about people who get really hurt and go bankrupt, but I have to take the risk."
"My kids and I are happy but struggling right now. Weirdly, we've become close through the financial strain. The truth is I would rather have Little League for the kids than have health insurance for myself. You have to do that kind of thing when you're a parent."
Fact: Nearly one in four women in the United States delayed or went without health care in 2001 because they couldn't afford it.
Maureen Hayes, 56, home health worker said, "I have recurring bladder infections, and for the past few months I've also had heart palpitations and light-headedness. I knew I should go to a doctor, but I didn't have the money: I lost my insurance last fall when I was laid off from a receptionist job after 11 years. One day I was having chest pains and thought about going to the hospital -- I was so scared, weak and worried about my heart. But then I remembered how expensive visits to the emergency room can be, so I didn't go. It took weeks before I made this appointment at the clinic. I'm already spending more than $200 a month on two medications and doctor visits, and I'd also like to get a stress test. Ironically, paying for it has become one more thing adding to my stress."
Fact: Latinas are more than three times as likely to lack health insurance as non-Hispanic white women.
Juana Lopez, 21, a stay-at-home mother said, "I'm the only one in my family without insurance. Even if my boyfriend and I got married, we still couldn't afford the extra $100 a month that it would cost to add me to his health plan. I used a clinic during my pregnancy with my daughter, Jennifer, but otherwise when I go to the doctor I have to pay. So I haven't gone in more than a year. For now, I focus on getting Jennifer taken care of. She's 18 months old and was recently hospitalized for dehydration. My boyfriend goes to school to get a teaching degree, and we hope that when he's done, he can get a better job and help us all get covered. Of course we worry, but I'm young and healthy now."
Fact: 2.4 million American women with college degrees have no health insurance.
Samareh Eskandaripour, 37, a teacher and graduate student said, "I lost my coverage 16 months ago when I moved from New York City to take care of my mother. My husband is working freelance now and doesn't get health insurance at his job; I'm in a master's program at San Francisco State University and teach full time at a Montessori school for $10 an hour."
"We were in New York on September 11, and it just wore on me. I've been severely depressed, and it's so frustrating to have nowhere to turn for help. It's been hell. I was prescribed antidepressants, but it's been a struggle to pay for them. Meanwhile, I never go to a gynecologist. And my teeth are literally falling out of my head."
"I think we need universal health care in this country. We need to get our priorities straight. I'm a humanist: I believe in taking care of people. There's a misperception that people in the clinics are uneducated, that they don't have a say. It's like we're a lower caste or something. It takes away your humanity and your energy. Actually, I just feel incredibly pissed off."
Fact: Nearly 300,000 high-income Americans lost their insurance in 2001.
Ain Ashby, 28, real estate agent and waitress "I was doing really well working for a mortgage company until 15 months ago, but then the bank closed and I lost my job. I have a real estate license, and I've gone back to school full time to study economics. But I cannot get a job to save my life. I've started working nights at a restaurant for minimum wage: $6.75 plus tips."
"I came here today to find out if I qualify for Medi-Cal [the California state version of Medicaid] and because I sprained my ankle. The Marin clinic doesn't have an X-ray machine, so they sent me to the emergency room. If I don't qualify for Medi-Cal today, I'm guessing I'll have to pay about $900. That's not all: I have to pay out of pocket now for birth control pills, treatment for my eye problems, my annual physical... My short-term goal is to get on Medi-Cal. My long-term goal is to get a job with benefits."
Fact: Two thirds of uninsured women work at least part time.
Agustina Gomez, 23, a bank teller said "My husband works as a freelance construction worker, and in a good year the two of us make $40,000, too much to make public insurance programs an option. But we can't afford the premium for the health plan at the bank where I work, either. The last time I saw a doctor was three years ago, when I was pregnant with my son, Allejandro. Right after his birth, I went to the emergency room with stomach ulcers. I was in a lot of pain, and it was getting worse and worse. The doctors saw me, did an X-ray and told me to go home, that I was fine. Then I got a bill for $2,000. We're trying to pay it off, but now it's gone to a collection agency. I don't know what we'll do."
Solving the Problem
The number of uninsured is skyrocketing at unprecedented rates, says Ron Pollack, executive director of Families USA, a Washington, D.C., health care watchdog. Naturally, policy makers want to confront the problem -- Though it's unlikely these plans will become reality soon, you'll hear more about them as the 2004 presidential campaign gears up.
There Ought To Be a Law
Just as driving without car insurance makes you a menace, going without health coverage raises the cost of care for everyone else. So why not mandate health insurance as we do for cars? That's the plan favored by Senator John Breaux (D-La.), who supports tax credits to help individuals afford it.
You Deserve a Break
Low- and middle-income Americans who lack health insurance should get a tax credit to help them buy it elsewhere, proposes President Bush. The administration has also increased federal funding for community clinics (the Marin clinic gets $450,000 a year) and high-risk health insurance pools run by the states.
Coverage for All
One of the most ambitious proposals comes from Representative Richard A. Gephardt (D-Mo.), a candidate for president. He says Congress should repeal tax cuts passed since 2001 and use the windfall -- at least $210 billion a year -- to guarantee coverage for every uninsured American. Employers would have to offer insurance, but the feds would pay for 60 percent of the cost.
Uninsured? Read this now
Don't take risks with your health. Consider some of these stopgap ways to get covered:
Comparison shop for the cheapest health plans at Insure.com. If you're in good health, think about catastrophic coverage. With lower premiums and high deductibles, these plans won't cover basic care but help pay for big-ticket problems.
Another option: Find a group plan through your college alumni association or trade organization.
Thirty-one states have high-risk health insurance pools for people who've been denied coverage; to learn more, visit NASCHIP.org.
Finally, consider joining the health-care savings program Pinnacle Choice. Though it doesn't replace insurance, a yearly fee of $360 gets you big discounts on doctor visits, hospital stays and medicine. For more information, go to Pinnaclechoice.com.