Without a safety net

Diane was in the grocery store when it happened.

"I had heaviness in my chest. I started sweating profusely, and I was sick to my stomach. I got home and was feeling a little better, but then it happened again, and I knew I was in trouble," said the Fox Valley resident, now 56, who didn't want her real name published.

She called 911 and was taken to Provena Mercy Medical Center in Aurora. Two days later, she was airlifted to Northwestern Memorial Hospital in Chicago. It was May 2007. Diane was 53. Her heart had failed.

Now on disability but lacking insurance coverage to address her lingering health issues, Diane is far from alone.

There were 46.3 million Americans without health coverage last year — 15.4 percent of the population, according to the U.S. Census Bureau. Among white Americans, about one in 10 had no insurance, while in the black population, it was about one in five. And in the Hispanic community, a staggering 30 percent — nearly one in three — lacked coverage.

The lion's share of insurance comes through employers, but unemployment is rising. Many lose their ability to see a doctor when they lose their jobs.

Between 2007 and 2008, the number of people who got insurance through an employer dropped by 900,000, going down to 176.3 million. During that same year, more than 1.8 million people joined the ranks of the unemployed, according to the Bureau of Labor Statistics.

A growing need

Kara Murphy sees the local fallout of the jobless trend firsthand, every day.

The executive director of Access DuPage said she sees "many, many Naperville residents" who have no insurance to cover the costs of health care. Established in 2001, the agency partners with the county Board of Health to connect uninsured and economically disadvantaged residents with services donated by physicians and hospitals throughout the county. One recent headcount of health care providers showed 550 participating physicians. The organization, which runs on an annual budget of about $4 million, also has a list of 450 specialists to whom they refer patients for care, Murphy said.

There's more than one factor operating in the relief entity's caseload, which last year topped 11,500 residents.

"I think it's probably the coming together of a lot of pieces, but most obviously the financial crisis has had the most impact on our enrollment," Murphy said.

The fastest-growing sector is those who have recently become unemployed and those who work, but don't make enough to cover their medical expenses.

One reader who responded anonymously to The Sun's health care survey said Access DuPage is her vital connection to medical services. Although she would be willing to accept higher taxes to pay for universal health care, insurance is beyond her budget.

"I can barely afford food and a place to live on my income," she wrote.

While the agency still has many clients among the working poor — those whose employers don't provide benefits — increasing numbers are people unaccustomed to using social services to meet basic needs.

"It's a period of uncertainty for us, because we aren't certain what the future's going to bring," Murphy said. "But in the last 12 to 15 months we've have rapid growth and an influx in new requests for assistance that make it difficult for us to manage."

Management assistance

Edward Hospital in Naperville is increasingly accustomed to having uninsured patients run into trouble when the bills come.

"We have a very generous financial assistance policy," said hospital Vice President Brian Davis. He described how the billing department works directly with patients who need to spread out their payments because they have no cushion provided by an insurance policy.

There are also interest-free payoff options, Davis said. The hospital employs financial counselors whose job it is to help patients understand their bill, sometimes directing people to sources for assistance at the county and state level.

In the fiscal year that ended June 30, the hospital had nearly 1,300 patients qualify for financial assistance.

"We've seen an uptick obviously in people taking longer to pay off their bills," Davis said. "Often their deductibles and co-pays are higher."

And often they lack insurance entirely.

Low on options

After her cardiac crisis 2 1/2 years ago, Diane remained at Northwestern for almost two weeks, spending several days with her name on the heart donor list.

"They wanted me to have cardiac rehab, and the insurance company — this is when I had insurance — wouldn't pay for that," she said.

Although her husband was laid off in 2007, his former employer had kept Diane's insurance going. But the employer's generosity couldn't last.

It was a small company — 15 people — and when two current employees had medical problems (cancer and a car crash, respectively), the company couldn't afford to keep the insurance going for past employees.

Diane's husband is eligible to receive care at VA hospitals, but she has to go through her recovery completely uninsured.

"My heart doctor, he wanted me to have all these tests done, and I said, 'I'm sorry. I just can't afford this,'" Diane said.

She takes six different prescription medications daily, all drugs she was prescribed two years ago. She can't afford the needed tests to determine if the drugs are still helping or are now making things worse. She pays out-of-pocket, but has a "kind doctor" who only charges a sliver of the routine visit cost.

Diane is tired all the time and can't lift anything heavier than 15 pounds. Stairs are difficult. Sometimes she wakes up with her heart pounding. It won't stop.

But the worst part is the mystery.

"I just don't know the status of my heart right now," she said.

Often reluctant to accept new customers with pre-existing conditions, insurance companies are not jumping at the chance to take on a 56-year-old woman with a bad heart.

"I am like the Typhoid Mary. No one will touch me because of the heart condition," Diane said.