When friends find out that Alice Manning and her children don't have health insurance, they are surprised.
After all, she is an actress who has entertained troops in Germany with the USO, toured the country in one-woman shows and appeared in television commercials. Her husband, Patrick Hubbard, is a high-tech entrepreneur turned solar energy system salesman.
"People say, 'How can you not have health insurance?' " he said. "I say . . . 'It's food or health insurance.' "
The family has little voice in the debate over healthcare reform, but they have a lot at stake.
They are among the more than 46 million people who lack health insurance in the U.S., including 20% of Californians under age 65. That number soared over the last decade as the price of insurance rose, employers dropped health benefits and insurers shunned people with preexisting conditions.
Reducing the ranks of the uninsured is a central goal of healthcare reform. The Senate is expected to vote early today on a landmark bill to extend coverage to more than 30 million of the uninsured, including families like the Manning-Hubbard household.
The bill would do this by requiring insurers to sell to everyone regardless of preexisting conditions and require all individuals to have medical coverage of some kind.
The legislation would expand coverage by opening Medicaid, the government's healthcare program for the poor and disabled, to people with higher incomes. For people who earn too much for Medicaid but cannot afford private insurance premiums, the government would subsidize their coverage.
If passed by the Senate as expected, the bill would go to a conference committee to work out differences between the Senate and House versions. A final vote would come next year.
Healthcare reform is more than a topic of dinner-table conversation at the Manning-Hubbard household. The family lost its private health coverage when a son's medical crisis plunged them into poverty seven years ago, and they have struggled ever since.
One night, for instance, Manning, 49, awoke bleeding from what she believed was a recurrent bladder infection that she had been hospitalized for this year.
She called a urologist who told her to go to the emergency room if it didn't stop. The bleeding got so bad that she put pillows in the bathtub and slept there. Still, she had no intention of going to the emergency room because, without insurance, she knew the visit would only add to her family's debt.
Manning's crisis passed. The urologist, over the phone and at no charge, prescribed an antibiotic that seemed to clear up the infection. But the chronic problem of living without health insurance remained.
The day-in, day-out difficulties of coping with a son's nagging cough, a daughter's broken arm, a mother's middle-of-the-night hemorrhage are reminders for the family that the status quo isn't working.
More than half of the uninsured lack a regular source of medical care, and, because of fears of the cost, they are more than twice as likely as people with insurance to avoid getting needed treatment, surveys show.
With President Obama imploring Congress to pass a historic healthcare overhaul, the Santa Monica family's story is an example of what the political struggle is all about. Their story shows how easy it is to lose health insurance and, with it, access to comprehensive medical care and peace of mind. It also illustrates how one serious medical episode can destroy a family's financial security almost overnight.
"If there had been healthcare reform already, they wouldn't be in this horrible jam," said Elizabeth Benson Forer, chief executive of the Venice Family Clinic, where Manning sought help for her bladder infection this month. The nonprofit clinic, which provides medical care to people in need, has seen demand rise as the recession expanded the ranks of the uninsured.
That's why healthcare reform is so urgent, Hubbard said. "Doing nothing will only make things worse."
The family had health insurance for years through Manning's membership in the Screen Actors Guild. Daughters Natalie, 12, and Caroline, 9, each were born on Manning's guild policy. Hubbard, 44, who worked for himself as a high-tech employment recruiter, also was covered through the guild policy.
But the family lost its grip on health insurance in 2002. That's the year that Manning, still insured, gave birth to twins Tristan and Aidan. The boys were premature but healthy and were expected to go home as soon as they gained a little weight.
Then Aidan contracted an infection in the hospital, which led to a stroke that left him partially paralyzed, cognitively impaired and prone to seizures. Aidan had three brain surgeries while he was in the hospital. After he went home, he developed fluid on the brain and had to be rushed back to have a shunt implanted.
"It was just awful," Manning said. "It was just one emergency after another."
Their lives haven't been the same since. Aidan's needs were immediate, all-consuming and unrelenting.
"We had no nursing care, no baby sitter, no help whatsoever," Manning said. "So our entire lives and careers were put on total hold. His life was literally in the balance for a long time, and we have three other kids. He was 24-7. So everything just stopped."
Hubbard's business had been suffering since the dot-com crash, and the family's medical crisis dealt the final blow.
"We were literally at rock bottom," Manning said. "We had no food to feed our family. We had all these creditors calling us."
Aidan qualified for Medi-Cal, the state health program for the poor and disabled. But they could no longer afford the $390-a-month cost of the guild policy for the rest of the family.
They kept food on the table, lights on and a roof over their heads by running up their credit cards -- until the debt reached more than $30,000.
"We were going to file for bankruptcy," Manning recalled. "But we couldn't afford to pay the $200 fee."
Nationwide, medical problems contribute to more than half of all bankruptcy filings, according to a recent Harvard University study.
The family qualified for food stamps, and, at one point a group of parents from their children's school threw a fundraiser to help them get by.
"We've lived extremely frugally," Manning said. "We just don't buy anything. That's how we've been living for seven years."
Hubbard found work as a handyman and mural artist, allowing him the flexibility to help with the children and Aidan's special needs.
Things are looking up. Hubbard got a job last year as a solar energy designer and salesman. He recently sold his first big system, but the money isn't rolling in yet. He will get a commission when the project is installed, which could take a year.
Until then, the family survives on the $2,200 base pay he brings home each month after taxes. Rent is $673 a month, a 50% discount Hubbard earns by managing apartment buildings.
But routine problems are huge setbacks. Both cars recently broke down on the same day, and the repair bill was more than $1,000.
So, when Hubbard got health insurance as a benefit of his new job, it was a big help. But, at $800 a month, he can't afford the premium for adding the rest of the family.
It is not unusual for people with jobs to go without insurance, often because they can't pay for it. In fact, 66% of uninsured households include at least one full-time worker.
Manning brings in extra money by baking fluffy scones and crunchy pecan brittle that she sells to friends in gift packages. One regular customer bought $242 worth of goodies to give as holiday gifts.
With a sigh of relief, Manning said, "That's my [money for] Christmas presents."