Without a safety net

Lives are on the line for residents who can't afford insurance or have to push past Medicare's red tape

Health insurance has never been an option for David Stukel.

The 26-year-old Channahon man was born with a congenital heart defect -- his left ventricle doesn't pump blood out of the heart properly. Stukel was only 2 years old when he had his first pacemaker implanted. He was also diagnosed with a condition that produces multiple spleens. And neither of his kidneys work properly.

David's pacemaker had to be replaced every six to eight years as he was growing up, and he has had to rely on drugs to prevent renal failure. But problems really escalated for the young man in January when doctors in Morris discovered his heart was beating 150 times per minute. A healthy heart beats about 72 times per minute.

He was taken by ambulance to Loyola University Medical Center in Maywood where it was determined he needed a heart transplant. But as an adult, David was no longer was covered by his parent's health insurance.

"As part of the paperwork, we had to sign David up for Social Security disability and Medicaid," said his father, Jim Stukel. "He was granted a temporary Medicaid card in June, but by mid-June was denied by the federal government. They did not think he could possibly be disabled because of his age."

Though Social Security and Medicaid are separate entities, Jim Stukel said they seem to come to the same conclusions.

"I was told 99 percent of the time all applications are denied," the father said. "I had to hire a lawyer and start the appeal process."

While waiting for the appeal to begin, the bills began piling up. David's two days at Morris cost more than $25,000; his 23 days at Loyola, $260,000.

"He also was prescribed Coumadin and required regular checkups," Jim Stukel said. "They were not covered. I don't think anybody bothered to look at his medical records. I had to hire an attorney to file an appeal."

Eventually, the Stukel family won that appeal -- and the entire ordeal was blamed on "an internal error."

"I worry about all the people that are too sick to fight these decisions who have no one out there to fight for them," Jim Stukel said. "I am blessed that I am able to retire from my job and have a wife who works to support our family. I am convinced my son would have died if left to fight the system on his own."

In some ways, the Stukels are among the lucky ones. 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. That same year, more than 1.8 million people joined the ranks of the unemployed, according to the Bureau of Labor Statistics.

"People who receive a pink slip experience a double whammy," said Ron Pollack, executive director of Families USA, a health care consumer watchdog group. "That's why health care reform is so important. It will protect America's families when they lose or switch jobs."

In addition to those who are unemployed and uninsured, there are many who simply can't afford insurance through their employers.

Among those is Melissa, a 32-year-old Crest Hill woman who asked that her real name not be used in the story. She was paying $500 a month for health care coverage for a year, until August, when pay cuts forced her into making a decision. She could buy health insurance or pay her mortgage.

"My income has been cut more than half and I only make $10 an hour," Melissa said. "With my mortgage, it is just not affordable."

She said she recently experienced severe pain and sickness but skipped going to an emergency room.

"I knew I would have an enormous bill and the anxiety of the financial burden outweighed the pain I was in," said Melissa. "I am having the same problem with my fiance. He is running out of his diabetic supplies and insulin, but we simply can't afford the costs right now and we don't know what to do."

There is no chance, she added, that her employer will provide her with health coverage.

"Plus, to add insult to injury, I have to hear every day from my boss about his opinion on the health care plan that the president is trying to pass," Melissa said. "To say the least, he doesn't agree. But then again, he has health insurance. And so does his wife and daughter."

Melissa insists she would be willing to pay more taxes to ensure better health care for all Americans.

"I am not asking for free, but something affordable. If I am willing to pay more taxes and I only make $10 per hour than more Americans should be able to."

So would Sandy Gregorash, who works part time and has no health coverage.

"I would like to stop the fraud to the Medicare system and get rid of Medicaid," said the 55-year-old Joliet woman. "I think people should work for free entitlement and to get healthy."

David Stukel is trying to get to that healthy part as he awaits a new heart.

Today, the young man, who endures frequent chest pains, has had a defibrillator installed and has a device that sends a signal to Loyola when there are problems.

"I think all the time that there should be some sort of a handbook out there to help guide people through the process," Jim Stukel said. "They need to look at the medical records of the applications and not deny coverage until after the appeals process ..."