DETROIT - It’s like a fish out of water, flopping around, gasping to inhale a breath that’s never going to come.
That’s how 45-year-old Detroit native Paula Dubose describes the feeling of an asthma attack. She’s lived with the condition for over a decade, and says it’s brought her near death more times than she can count.
“This one time I just knew I was gonna die. Three, four, five times,” she says.
Paula knows there is a possibility that any day, she may suffer an asthma attack that would leave her unable to catch that next breath.
But what she is most fearful of is the absolute certainty that she will be left without any breathing room in her budget if she has to be hospitalized due to her existing condition or any other illness.
She is still recovering financially from the last severe asthma attack that landed her in the hospital two years ago.
“I got behind in my lights and my gas. My lights got cut off,” she says. “I lost my house because of my illness.”
Paula, a home health aide who takes care of the elderly, has been living without health insurance for almost 20 years. She is one of an estimated 200,000 people in Detroit – and 46 million people nationwide – in the precarious position of being uninsured.
Paula falls into a gap alongside millions of others who make too much money to qualify for government-assisted healthcare programs like Medicaid, but don’t make enough to pay for their own private insurance.
“My check when I get it, I got to pay the light bill, the gas bill, buy food, pay the car note, pay rent, and after that, that’s it,” she says. “So how I’m going to afford insurance?”
It’s a question to which Paula may find the answers in the recently enacted healthcare reform bill, which among other things, would expand the poverty-level qualifications for Medicaid, and offer federal subsidies to purchase affordable insurance through state-run insurance exchanges.
But although Paula says she followed the debate and news coverage leading up to the passage of the bill, she wasn’t aware that there was anything in the legislation that could ease her situation, or how she could go about signing up.
And she’s not alone. A recent Kaiser Health Tracking poll found that although 8 in 10 Americans know that President Obama signed the bill into law, more than half are confused about the law, and haven’t received enough information to understand how it will affect them personally.
It’s a knowledge gap that means there’s still more work to be done, says Bishop Edgar L. Vann, pastor of Detroit’s Second Ebenezer Church.
“Just because a bill is signed doesn’t mean that people sign up. Doesn’t mean that people know how to sign up. Doesn’t mean that people know that they are qualified to sign up. Doesn’t mean that people understand all the standards of assessment that may come out of this bureaucratic, regulatory process,” he says.
Bishop Vann says he had the opportunity to look at the legislation before it passed during a visit to a congressional office in Washington.
“When I saw the bill I knew that this was not something that the average person could fathom or understand,” he says.
He returned to Detroit with a conviction to take the lead in making sense of the law for his congregants, and opened the doors of Second Ebenezer for a forum called “Health Reform REAL TALK – What is it? What does it mean to me?”.
“I saw the devastating effects of people without health insurance especially here in the city of Detroit,” he says. “I saw the unfortunate decisions people have to make as to whether they get their medicine or their healthcare or they eat.”
The forum gave members of the congregation and the community outside the church an opportunity to get clear answers about healthcare reform from a panel of medical experts. It’s information, says Vann, that has the potential to change lives.
“There are actually deaths. I must actually preside over funerals of people who die of preventable causes. And I don’t think there’s any of a more [sic] stark realization than that,” he says.
The need to make sure that those most in need of healthcare coverage are educated about the new reform is urgent in a city like Detroit, where the economic downturn fell especially hard on this city that was already staggering under the failure of its auto industry.
Unemployment here is almost 30 percent, a figure that is three times the national average. Locals say that doesn’t include those who’ve given up hope, and have stopped looking for work, and that the population of unemployed in Detroit is really closer to 50 percent.
As the numbers of the jobless climb in Detroit, so too do those of people living without a safety net in the event of medical emergency.
Dr. Herbert Smitherman sees patients without insurance at the federally-funded health clinics he runs in Detroit. He says that for those without health insurance or the money to pay for care by a private physician, emergency rooms become the first and last stop for care.
“In our city we have a 69% higher preventable ER use and preventable hospitalization use as compared to the rest of the state,” says Smitherman. “That has to do with climbing numbers of uninsured and a deterioration in the amount of primary care physician capacity.”
Smitherman, who wrote the book on health care reform, literally, is one of the authors of “Taking Care of the Uninsured: A Path to Reform”. When he first arrived in Detroit 25 years ago, the cost of caring for people who couldn’t afford to pay for their care was $150 million. That number today is closer to $600 million, and he says, all of us are footing the bill.
“Those who are insured are paying for 42 million who are uninsured,” says Smitherman. “People keep talking about I don’t want to pay for a new set of people. You’re already paying for them.”
The free and discounted medical services Dr. Smitherman provides in his clinics is a beacon of light for the many in this city who would otherwise have few alternatives for care.
Earl Williams, a patient at one of the clinics, has suffered since the age of 16 from a severe neurological condition called myasthenia gravis, which can cause muscle weakness, an inability to swallow, droopy eyelids, and double vision. He also has high blood pressure, and lost his health insurance when he lost his job over a year ago.
“My physician has been very supportive in sending me places where the medication has been purchased inexpensively,” he says of his care under Dr. Smitherman.
“It still causes some depression and some concerns about what’s gonna happen in the near and distant future.”
Like Paula Dubose, Earl may be eligible under the health care reform legislation for medical coverage that may ease his stress, and help him manage his illness. But also like Paula, he’s not sure what’s in it for him.
“It hasn’t been articulated at all. Not in a clear sense. When politicians start using political jargon I don’t understand what they’re talking about. I’m not really sure what’s to be given, what’s not to be given. What’s going to start immediately, what’s going to start down the road. I don’t know anything about the near or distant future with this healthcare bill.”