(Interview 3/2018, oil on linen, 30 ins. x 40 ins.)
Christine lost her job as a dental office manager when the pandemic started. She qualified for Medial Assistance (Medicaid) health insurance coverage in Pennsylvania. Her coverage cannot be terminated until the pandemic disaster declaration ends.
Chris is employed now. "I have a great job in a dental office. I'm the insurance coordinator." But Chris still cannot afford the employee premium contribution she'd need to pay to get health insurance through her employer's group plan. She thinks she'll be able to swing it by March 2022.
Chris was uninsured for 7 years before she qualified for PA's Medical Assistance program. "I got a complete physical, bloodwork...all good. It took a pandemic for me to get insurance."
Chris reflects on the panic she felt when she thought she might have throat cancer.
“All I ever wanted was peace of mind. I couldn’t find out what was wrong with me. I panicked.” Who wouldn't? The two esophageal ulcers felt like "someone squeezing my neck." She lived with this medical scare for months until her daughter started a GoFundMe page to raise the money for the needed tests.
I rejected the first portrait I painted of Christine. I don't know why. The painting captures Christine's spirit. The exercise reminded me to practice restraint in judging my own work too quickly.
Artist Note (2018)
I asked Chris to share what her life was like. She said, “I don’t want to sound whiny or complain-y. I want to help rape victims. (See addendum)
I want to be there for my daughter. I don’t want to be dead.”
Christine is not a complainer. I probed, and she graciously shared her story in the hope that her voice will be added to the millions demanding a real health insurance and healthcare system that serve people.
Christine is a single mother of a college student. She is a manager for a dental practice. She makes $50,000/year. She is also uninsured.
Christine qualifies for a subsidy to help her purchase insurance on the Affordable Care Act’s online marketplace. But the only policy she can afford even with financial help is a high deductible health plan (HDHP). This means that Christine would have to pay thousands out of her own pocket–$5,000 for the policy she was considering – before her insurance coverage would pay her medical bills. The $5,000 does not include her monthly premium cost.
Christine does not earn enough to save for the deductible she would have to pay out of her own pocket before her insurance policy started paying her medical bills. Christine remains uninsured.
So, what is the point of a high deductible plan, if one is unable to save the thousands needed to pay the deductible?
High deductible health plans offer tax incentives for people who can afford to save for their out-of-pocket expenses. I have always said HDHPs should be sold by portfolio managers who can advise healthy and wealthy clients to leverage their good health for financial gain. Huhn? Yeah. If one has a high deductible plan, one can save money tax-free for medical expenses to cover the deductible. And if one is healthy, well...that money in savings goes unused, all the while earning interest and/or dividends.
HDHPs are a good example of our unworkable system. These policies are especially onerous for those who must find ways to pay steep out-of-pocket costs. The Bureau of Labor Statistics reported that the median income for a middle-aged person was around $50,000 in 2017, not enough to live on AND save for unanticipated medical bills in a health savings account.
Kaiser Family Foundation reported in 2017, “Three in ten (29 percent) Americans report problems paying medical bills, and these problems come with real consequences for some. For example, among those reporting problems paying medical bills, seven in ten (73 percent) report cutting back spending on food, clothing, or basic household items.”
High deductible health plans are a hardship on low to middle income American workers. And that’s most of us.
The more insurance and medical costs are shifted onto consumers, the more Christines we will see in the world – hard working people priced out of medical care and living in quiet desperation, afraid that a medical crisis might happen or panicked when one actually does.
The more I do this work, the more convinced I become that our health insurance / healthcare system is severely dysfunctional to the point of being non-functional for millions of Americans.
Lives are at stake. This must change. Christine says, “I want to tell my representatives that their families are good. Their medical is covered. I’m tired of it all.”
Here is Christine’s story.
(from 2018 interview)
Dental Practice Office Manager, Age 51, Uninsured
Christine first became aware of a problem with her throat when she was on a treadmill. “I was walking fast and feeling pressure on my throat. I stopped and drank some water.” The pressure did not go away. For almost 2 months she’d feel it. “At work the feeling would come out of nowhere. It felt like someone was squeezing my throat. I was scared.”
So scared in fact that Christine went to the emergency room. The doctor suspected a hole in her esophagus and severe acid reflex. She needed an endoscopy to confirm the diagnosis. She also needed a prescription. She had money for neither. She started to cry. “I don’t have insurance.” The doctor prescribed mega-doses of over-the-counter products. Christine sleeps with her head at an angle to keep the acid from backing up into her throat.
“I’m afraid I have throat cancer. I have gotten relief with OTC meds.” Christine uses the internet to look up esophageal issues. She has been taking over-the-counter medicines. Her throat swells daily. “I feel the pressure. I’m afraid of what is going to come of this. I’m afraid that not taking care of the hole in my throat will turn into cancer. When I finally save enough money for the endoscopy, and they tell me I have cancer, I will be on social media begging for my life. I have a kid. I don’t want to die at my age.” Christine is 51.
Christine’s employment does not include health insurance benefits. She works 45 hours/week as a dental office manager.
Christine meets all the criteria for purchasing insurance on the Affordable Care Act’s health insurance exchanges, an online marketplace where individuals like Christine can buy insurance from private companies. She even qualifies for a premium tax credit, a subsidy – financial help to pay part of the premium.
The only premium Christine can afford, even with the subsidy, is a high deductible plan . Healthcare.gov describes a high deductible plan this way. “A plan with a higher deductible than a traditional insurance plan. The monthly premium is usually lower, but you pay more health care costs yourself before the insurance company starts to pay its share (your deductible). A high deductible plan (HDHP) can be combined with a health savings account (HSA), allowing you to pay for certain medical expenses with money free from federal taxes.”
Christine’s share of the healthcare costs with a high deductible plan would have been the $200-$300 premium/ month plus the $5,000/year out-of-pocket, an outrageous sum for a single parent making $50,000/year with a daughter in college.
“I don’t have the money so what’s the point?”
“I’m paying college loans. My daughter has loans. Every year at tax time, I use my refund to pay my daughter’s college housing deposit. If anything goes wrong with my car, I can’t come up with the money to fix it. It takes me a while to save $200 for something.” Christine and her daughter live with Christine’s mother to lower their bills. Christine pays half the mortgage. “None of us can afford to live on our own.”
Christine has been uninsured since January 2015.
Christine manages the pressure and pain in her throat by swearing off coffee and soda. “The doctor gave me a list of things to eliminate.” She takes mega-doses of over-the-counter antacids her doctor recommended. “The antacids are costing me $100/month. I search for coupons to save $3 - $4.”
Christine has been looking into sites where doctors “bid” on procedures. “MediBid offers cash-paying patients seeking care, the ability to find the medical practitioner who best fits that patient’s set of criteria." Christine wondered, “What if I take the cheapest? Would he or she be qualified?” She would still have to come up with cash to get the procedure.
Christine called a Catholic hospital hoping they could help. She was told they could not help her without insurance.
Christine’s daughter offered to get a job during the school year to help her mom pay for diagnostic tests and treatment. Her daughter earns money in the summer to support herself during the school year while she focuses on her studies. Christine said no.
Christine has reason to be fearful. She understands the value of having health insurance.
In previous jobs that provided health benefits, Christine had a detached retina. She had emergency surgery and healed without complications.
In 2012 Christine tripped over a stool at work. She shattered her upper arm and got a concussion. She developed speech and memory problems. She lives with limited arm movement. Her neurologist prescribed medicine that treats dementia. It helped. When her employer’s workman’s compensation insurance ended – something she was entitled to since she was injured at work -- Christine could not afford her medicine without insurance. She stopped taking her medicine. Her neurologist agreed to set up a payment plan for her doctor visits.
Christine has had her struggles with complications from her head injury. At a certain time of day, or if she is tired and has a very long week, “My speech just stops. I can’t talk. “My brain ‘locks’ for 5-30 seconds, and I can’t continue. It’s embarrassing. I’m intelligent, a writer, well-spoken, and now I can’t speak.” She remains untreated for this condition.
Christine was assaulted when she was 18. (See addendum) Her attacker loosened 4 teeth which she pushed back in place with her tongue. “But the teeth always clicked and moved.” She needed periodontal surgery, but the stress was too great. Leaning back in the dentist’s chair gave her panic attacks.
“It is sad and disgraceful that we live like this in this country. I have a friend, a US citizen, in Denmark. He says he cannot live in the US because he has a severe heart condition. He says they pay higher taxes, but there are no additional dollars spent for medical care. He knows he cannot return to the US."
“I can’t turn to family. They struggle financially. No rich uncle. There were times I worked 2-3 jobs. I didn’t fail. I never had the opportunity. I couldn’t afford to go to college. I’ve done all the right things. My daughter was going to college. I want better for my kid.
“It’s upsetting to tell my story. I relive it. But it is also liberating. I know that there are people who go through this and worse. I wish I could help them. The greatest country in the world should not allow all this suffering."
UPDATE from Christine: "My daughter started a GoFundMe® page and my coworkers did a fundraiser for me. I got the money for the endoscopy and laryngoscopy which was recommended as well. I had two esophageal ulcers. I’m managing my symptoms very well with over-the-counter and prescribed meds and following a strict diet because multiple foods, spices and drinks had to be eliminated. I feel so much better and am grateful I can manage this and am not facing cancer."
Christine was raped at 18. She talks informally to many rape survivors. In her own words:
The Rape. Nov. 16, 1985. I was 18. I lived in the Bronx. I was walking to meet a friend. It was raining. I saw a guy coming toward me. He said something foul like “I want to eat your pussy.” “Fuck you” I yelled. I felt a shadow. The guy was following me, I tried to stay out in the open. He grabbed me anyway and threw me behind a bush. I was screaming. He punched me twice in the face. He fractured my nose and knocked out 4 front teeth. I could feel the teeth dangling. I pushed them in place with my tongue. I stopped screaming. I was being raped. He was chocking me. All I could think to say was “Please don’t kill me. I’m pregnant.” He stopped. I wasn't pregnant. He left and took my umbrella. I walked to the ER. There was a hospital around the corner. My parents were called. They could not believe it when they saw me. I had a fractured nose. I didn’t go to the dentist. I couldn’t. I felt too vulnerable. I couldn’t lean back in the chair. I want to help rape victims. I don’t want to be dead, I have a lot to do.