Tri-County Project Care - Project Care Offers Hope

News & Events

Ranks of Uninsured Grow: 1 in 5 Lowcountry residents lacks health insurance part of year, study finds
Source: Post and Courier, February 19, 2004
Written by: Jonathan Maze

Richard Ruff gets migraines, brutal headaches that sometimes get so bad they leave him rolling on the floor and punching walls.

Just as painful, though, is that even though he and his wife both work, neither of their employers offer-health insurance benefits. The Ruffs make a little too much money to qualify for community health coverage programs, and buying insurance out of their own pockets is too expensive.

So is the only drug that will help ease Ruff's pain: Imitrex, which costs as much as $165 for a week's supply.

ALAN HAWES/POST & COURIER STAFF

Richard Ruff holds some of the medications he uses to treat migraines

"Back when I had health insurance, I didn't worry about it," Ruff said. "I didn't have to judge whether the pain warranted me having to use (the drug). If I felt pain, I'd take it. Now, sometimes I have to let it get to the stage where it's so painful that I just have to take it. We can't afford to pay for it."

According to a new study, the Ruffs, who live in Charleston, have plenty of company.

One out of every five Low-country residents goes without health insurance at some time during the year, according to a state Department of Insurance study on health coverage obtained by The Post and Courier.

Statewide, more than 19 percent of the state's 4.1 million people goes without coverage for at least part of the year.
At any point in time, 13 percent of state residents under 65 goes without health coverage.

The Insurance Department's figures are higher than recent U.S. Census Bureau estimates, which put the percentage of the state's uninsured at 12.4 percent. The Census figures look only at those who are uninsured for a full year.

The state study, funded through a federal grant, provides what experts say is a more complete look at the problem, because it also counts those who are uninsured part of the year.

Researchers interviewed more than 2,000 residents. They found that 60 percent of the uninsured have jobs. Their average age is in the early 30s. And the average income of the uninsured is between $30,000 and $40,000 a year, said Viki Fox, the study's program manager.

"It's not just the working poor," Fox said.

Still, nearly three-quarters of the uninsured listed affordability as the main problem keeping them from buying insurance.

The study makes three recommendations to expand health coverage. One would expand Medicaid to allow the state to provide a group coverage option for small businesses. The plan would subsidize the premium for workers in those businesses who make less than $13,965 a year, or 150 percent of the federal poverty level for individuals.

Such a plan has many hurdles to overcome, including federal approval, Fox said. Yet other states have also proposed the idea.

Small employers have a particular problem providing coverage. More than half of the employers in South Carolina with fewer than 10 workers provide health benefits. Richard Ruff, for example, works for his brother's diving company. He's its only employee, and though the company would like to get group coverage, the cost is too high.

The study found that areas with larger concentrations of small businesses have a bigger population of uninsured than elsewhere. In the Florence-Myrtle Beach area, for instance, more than a quarter of the population is uninsured at some point in the year. That's nearly 10 percentage points higher than in the Upstate, which is home to a lot of large manufacturing companies.

Coastal regions, where tourism is big, have more employers like restaurants and small hotels that are less likely to offer coverage. Construction firms, too, are more likely to skip that benefit.

Even small medical offices struggle: According to the study, 17 percent of small medical businesses don't offer coverage.

Dr. Casey Fitts, a Charleston surgeon who has been active in promoting ideas to make health care more affordable, doesn't offer his employees coverage, either. Instead, he pays his workers' share of the cost of coverage obtained through their spouses' employers. "We used to always offer insurance," Fitts said. "We don't anymore because it's just gotten too expensive."

Another of the study's recommendations would allow community-based programs like Fitt's own Project Care, which provides coverage to the working poor in the Charleston area, to start collecting nominal fees for their services.

Doing so could also help ensure the future of such programs, encourage their growth and help people secure inexpensive coverage. "It's an opportunity for us to be more creative and generate more funds," Fitts said.

The study's third recommendation would seek funds, through mechanisms like grants, to develop education programs to teach the uninsured how best to access the health care system -- perhaps steering them away from an over-reliance on emergency rooms, Fox said.

It would also target the most difficult group to cover: those who don't bother to buy insurance. Many of these people are young, Fox said, and don't feel insurance is necessary. Others don't trust the health care system, or complain that insurance doesn't cover the alternative treatments they prefer.

The Ruffs are not in that group. Both were covered by wife Sara's employer when they moved to Charleston from Illinois in July so Richard could work for his brother.
Sara worked from home as a linguist for the same company that employed her in Illinois. In October, the company shut down its overseas offices and she was left without a job, and the couple without coverage. She has since gotten a job as a waitress, but her employer doesn't provide insurance.

At a minimum they make $26,000 a year (their weekly income varies), making them just a bit too well-off for community programs. With Sara going to law school in the fall, they don't know when they'll be covered again.

"It's not looking like it's going to be a short-term problem for us," she said.

So they shop around for their health care. They found a doctor in North Charleston who charges $74 for an office visit. And then they call pharmacies for the best price on Richard's medication -- they found it for $20 less at Sam's Club.

The rest of the time, they worry that something even worse than Richard's migraines might come up.

"It's scary," Sara said. "And it's not even so much that we're scared. We feel foolish, silly, embarrassed. I hate going to a doctor's office and saying that we don't have insurance. Before, I would associate that with someone who doesn't have a job.

"We both have jobs."

Jonathan Maze covers health care and non-profits. Reach him at 937-5719.