O.C.’s Uninsured Can’t Afford a False Step : Health: Thousands of workers lack coverage. They may be a doctor’s bill away from insolvency.

Cross-country truckers Robert and Roberta Barrett always assumed that when they were through hauling rigs together from Southern California to the East Coast, they would retire in comfort to a nice mobile home near the Pacific Ocean.

But reality set in about the same time Robert Barrett’s diabetes and related heart troubles did.

Instead of enjoying the long-awaited fruits of their labor, the Barretts are facing a rather bitter existence, working part time, struggling with mobile home payments and running up expensive medical bills.

The Barretts are among hundreds of thousands of workers in Orange County who have no health insurance to cover their maladies and who sometimes find themselves one step from insolvency. Unlike many others--rich and poor--they have little or no access to health care through employers’ health insurance, Medicare, Medi-Cal, veterans’ hospitals or other programs.

As a result, they are at the center of the national debate over health care reform and how to pay for it. By September, President Clinton wants his advisers, led by his wife, Hillary Rodham Clinton, to come up with a plan that would ensure basic medical care for everyone.

“I can imagine why Hillary has not been able to come up with solutions,” said Chuck Holt, district manager for the National Assn. for the Self-Employed. “It’s a tricky problem that can’t be solved easily.”

In Orange County, officials estimate that about one in five workers are uninsured. While politicians and insurance and medical experts grapple for answers, uninsured workers continue to struggle. Their stories have a common denominator: Stay healthy or else face a system that many say punishes those whose employers do not offer benefits.

Robert Barrett was diagnosed with diabetes about three years ago. Under federal Department of Transportation guidelines, he was unable to continue driving trucks across state lines and was let go. Along with the loss of his steady paycheck, he says he was unable to pay for the same level of medical care he once enjoyed.

“Basically, I lost my job when my health went bad,” said Barrett, a 60-year-old part-time driver training instructor for convicted drunk motorists.

To add to his woes, Barrett recently underwent heart bypass surgery. Although the county is footing much of the hospital bill, he still faces a tab of as much as $10,000. He said he is also being dunned by a collection agency for $500 in unpaid medical bills relating to a visit to the doctor’s office for his diabetes.

“I worked for all those years and now I don’t have anything,” he said. “I just think this is so unfair.”

His wife, Roberta, who now works as a part-time secretary for an office of Alcoholics Anonymous in Costa Mesa, agreed: “You never know from one day to another what’s going to happen.”

Of the estimated 36 million uninsured in America, there are more than 3 million in California and approximately 252,000 in Orange County, according to estimates provided to The Times by the UCLA School of Public Health.

Of those without insurance, about 42% have full-time jobs, while the rest are employed part time. Further, 64% of uninsured workers have incomes that place them above the poverty line, a fact that seems to run counter to the belief that most uninsured workers are minimum-wage earners.

For many uninsured workers, the emergency room has replaced the family doctor as the entry point into the medical system, which experts say drives up the cost of care for everybody. But some people maintain that they have no choice.

Gina Catalano, a single mother of two toddlers, lost her medical coverage when, as a teen-ager suffering from diabetes, her father’s new insurance company would not cover her for that pre-existing condition.

Now a 23-year-old, part-time physical therapist for a Newport Beach chiropractor, Catalano said she has used UCI Medical Center in Orange for her primary, gynecological and obstetric care. Since she only works one or two shifts a week and qualifies as a low-income resident, the cost is usually covered under the Medi-Cal system.

It was there that the Newport Beach resident had her two daughters, 2-year-old Hanna and 2-month-old Nina. It was either go to the UCI Medical Center emergency room for her deliveries or pay about $30,000 for each birth because of complications relating to her diabetes.

“It’s really difficult,” Catalano said. “But when you feel stuck, you have to do something.”

Such use of emergency rooms for basic, primary care--which would be covered, and paid for, under a national universal health plan--has led to billions of dollars in uncollected charges for hospitals in the state.

Edward Foley, regional vice president for the Hospital Council of Southern California, said that emergency room use in California has more than tripled in a 25-year period, from 30 million visits in 1965 to 92 million visits in 1990. For comparison, the state’s population increased 50% during the same period.

The jump in emergency room use by the uninsured resulted in a $2.6-billion loss for California hospitals in 1991, the last year the council compiled such data, Foley said.

And although not all of those who visited emergency rooms have jobs, Foley said uninsured workers make up a sizable portion of emergency room users.

“We continue to be inundated with uninsured patients,” he said.

Nearly nonexistent preventive care makes it worse. Treatment costs for the uninsured are compounded when they put off seeing doctors for the unusual lump in the breast, rash on the arm or morning sniffle, Foley said. All too often, a doctor isn’t consulted until the lump develops into breast cancer, the rash becomes extreme eczema or the sniffles develop into pneumonia.

“All that really adds to the cost of medical care,” Foley said.

Matthew Midenmann, 24, of Lake Forest said he has learned to “let nature take its course” in regard to health. He has also learned how to be extra careful.

The Saddleback College sophomore aspires to be a psychologist. He now has a 24-hour-a-week job at the Four Seasons Hotel in Newport Beach while he pursues his studies. That means that Midenmann, a room coordinator for the hotel, is on his own when it comes to medical coverage.

“I could work more hours and get insurance,” Midenmann said, “but it would take away from my schoolwork.”

It was an especially difficult decision to make, considering that he has been nursing an ulcer for the past several years. Rather than getting regular treatment for the ailment, he has learned to change his lifestyle and eating habits while living through the occasional bouts of pain.

But the ulcer is not his only health problem. Several weeks ago, Midenmann paid $60 cash for an eye wash at a clinic. He also recently paid more than $100 to stitch up a cut in his foot from a surfing accident. Those costs ate into his book fund for the summer session.

All that is a far cry from when he grew up, living under his parents’ health coverage. “I really took it all for granted,” Midenmann said, who lost his parents’ coverage when he turned 18. “You think nothing will happen to you.”

Health care experts agree that uninsured workers add a tremendous burden to the health care system, but they disagree on a solution to the problem.

Ted Rosenbaum, a resident of Leisure World in Laguna Hills and vice president in the National Health Program, said he has spoken to dozens of groups with the hope that one day no one in America will have to make the type of health decisions that Midenmann does.

The National Health Program is a nationwide organization that advocates creating a universal, single-payer health plan for all U.S. residents, much like Canada’s nationalized health plan. Under such a plan, every resident would be offered total access to medical care, but at a cost of about $78 billion a year.

Nevertheless, Rosenbaum said, the investment is necessary because universal health care is the only way to ease the financial and emotional strain of those not covered by medical insurance.

“What they face is a horror,” Rosenbaum said. “Here are working people who can’t earn enough money to pay for insurance. It is so inequitable.”

Maryann O’Sullivan, director of the San Francisco-based consumer advocate group, Health Access, agreed. She added that the current system is so fragmented and diverse that an overhaul of how medical care is paid for is needed before the uninsured can receive any real help.

“I don’t think any piecemeal approach will work,” she said. “It’s really impossible to bring in the uninsured without doing something drastic to the whole system.”

Ed Haizelmeyer, a spokesman for the Heritage Foundation in Washington, proposes a different approach that “takes the health care decision-making process out of the employers’ hands. Why are employers in the middle of all this in the first place?”

The Heritage Foundation recommends tax credits of up to 30% for employee health care payments. Its plan would eliminate employer payments for group health insurance but require insurers to price individual policies at the former group rate, giving those who cannot afford the premiums a better opportunity to be brought into the system.

Such a system would also address the problem of so-called “portability,” or the ability for workers to take their benefits and their physicians with them if they change jobs.

“It would be like earned income tax credits,” Haizelmeyer said. “Or it could even be like food stamps. It’s a novel idea, but I think it could work.”

Until such proposals are adopted, the choices for uninsured workers in Orange County and elsewhere will continue to be limited to what they can afford, health experts said.

A new state law to help small businesses join a cooperative to obtain affordable health insurance went into effect July 1, but some critics point out that it won’t help those working part time or the self-employed.

Alan Yeon, 27, a self-employed real estate appraiser from Laguna Hills, experiences the conundrum of earning a good income but not enough to pay for coverage.

Even though he earns up to $3,000 a month in his job, he said he can’t seem to afford health insurance. Instead, he usually shops around for medical care--going from clinic to clinic to get the best deal he can.

Take last month, for instance. Yeon received a deep bite on his thumb after being mistaken for someone else in an altercation at a local bar. The next day, Yeon sought medical attention at Saddleback Memorial Medical Center in Laguna Hills. The high price of emergency room treatment there drove him to a small clinic that was “more reasonable,” he said.

The clinic charged him $215 for a doctor to wash the wound and bandage it tightly. The visit also included a three-hour wait in a crowded waiting room. “It was degrading,” Yeon said. “But I had to put up with it because it was the cheapest rate in town.”

Insurance broker Danna Alvey of Orange said health insurance can be affordable and people like Yeon do have options. Health plans can range from $100 a month for a single person to $600 for an older couple in their late 50s, she noted. Younger workers with few dependents could have medical coverage for about the cost of auto insurance.

“Some people just choose not to have health insurance,” she said. “They just want to spend their money somewhere else.”

For some cash-strapped workers, the only way to get health benefits can be frustratingly simple: lose your job, which may qualify you for Medi-Cal or other government-sponsored programs.

“Unemployed people get better care than a lot of others,” said Wayne Dieter, an Irvine insurance broker. “It is the uninsured worker who loses out.”

In the end, some workers simply prefer the security of an employer with health insurance, even if it means changing jobs. That happened to Linda Krall, 33, of Irvine, who has worked most of her adult life as a free-lance graphics designer and artist with no medical benefits. She landed a job in November with the Roman Catholic Diocese of Orange and is now covered by a local health maintenance organization.

“It feels so good, you know,” she said. “I got tired of neglecting my physical well-being. Now I am taking care of myself and seeing the doctor regularly.”

Sunday Briefing / Orange County and Health Care

Is it shockingly expensive? Yes. Is it maddeningly bureaucratic? Oh, yes. Without question, America’s health care system needs a doctor. As President Clinton prepares his plan to reform health care, people in Orange County and throughout the nation wait to learn whether they will pay more and what kind of service they’ll receive. For an overview of health, life and death in Orange County, please see The Times’ Sunday Briefing Page, B3.

Covering Yourself

Uninsured individuals can invest in health care coverage if they are willing to pay the price and can meet qualifications for pre-existing conditions. Some premiums are comparable to auto insurance. Asterisks (*) indicate that the plans have an additional $500 deductible and 20% co-payment. The monthly rates from some major health care providers:

Couple in Individual early 40s younger with two Type than 30 preteens HMO California HMO $105 $513 FHP Inc. HMO 106 400 Kaiser Permanente HMO 137 386 Blue Cross of Southern Calif. PPO* 88 361 Blue Shield PPO* 94 381 Principal Mutual Indemnity* 196 953

Couple in late 50s HMO California $557 FHP Inc. 450 Kaiser Permanente 273 Blue Cross of Southern Calif. 394 Blue Shield 426 Principal Mutual 1,071

Glossary

Indemnity: Subscriber chooses own physician or clinic. Insurance plan generally reimburses 80% of billed charges.

Health Maintenance Organization (HMO): Subscribers must stay within a network of physicians and hospitals. No benefits payable outside the network. Most plans call for employees to share costs in the form of deductibles and co-payments.

Preferred Provider Organization (PPO): Similar to an HMO, except subscribers can go outside the network and pay higher prices. Subscribers are free to choose specialists within the network without authorization from a primary care physician.

Sources: Individual companies

Researched by JAMES M. GOMEZ / Los Angeles Times