'Broke ain't no joke' for the uninsured

ELKHART -- Every Wednesday, Rowena Gutierrez sets up a large plywood sign and opens her garage door, inviting people to browse through her possessions -- lamps, a dining table, small angel statues, clothes. If they find something, both people benefit. The buyer takes home the trinket, and Gutierrez puts that money toward the estimated $11,000 she owes in medical bills.

Several times this summer, Gutierrez's three-month long "Broke Ain't No Joke" sale helped her get her gas and electric utilities back on. She continues to sell off her possessions in hopes of paying down medical debt.

"The only thing I can think of is just continue to sell everything from the floor up, and go live with a relative," she said sitting on her exercise bench, the only furniture she hasn't sold from her otherwise empty living room.

"We're down to just the beds we sleep in, you know," she said of her and her 14-year-old daughter. "And my exercise bench."

Stress of unemployment takes a toll

Most of the medical debt she faces stems from a heart attack she suffered last June. Before that, she had no prior heart problems. She attributes the heart attack to unemployment and financial stress. The uninsured, unemployed nurse hasn't had consistent work since 2007, she said. She gets $98 a week in child support for her daughter, and recently was approved for $148 a week in unemployment benefits. She's behind on her mortgage. Her house is for sale.

"When I'd get some money or sell something, I'd go to the doctor," she said. "I'm still supposed to go see one more doctor, a heart specialist, but you know, just to go see my doctor is $75."

When she does need a medication refill, she sees if her doctor can call in a prescription instead of visiting him or racking up higher bills with an emergency room visit. To make it affordable, she buys a higher dose than she needs and splits the pills in half in order to make them last her a month.

"Where do I have money for medical care?" she said. "And a specialist is not going to let you come see them unless you have insurance."

Rowena Gutierrez's garage is where she holds her weekly "Broke Ain't No Joke Sale" where she has been selling all her possessions in order to pay her home and medical bills.

Tara Morris, executive director of the Elkhart County Minority Health Coalition, sees people with stories similar to that of Gutierrez walk through her door each day. Increasing economic stress and double-digit unemployment percentage impacts the health of her clients, she said. About 65 percent of her clients are African-American. She sees people with diabetes and high blood pressure. She sees people under stress, suffering from depression.

"You've got the economic stresses around us, unemployment being one," Morris said. "I have to put health at the top of the list, because it's stress. That can cause a lot of conditions unknowingly. If you already have high blood pressure, you can't find a job or you just lost a job, you're threatening to stroke."

Her clients might have trouble finding doctors who accept Medicaid. They may be jobless but they must support a family. They don't know where to turn to find decent health care.

"Just in Elkhart County alone, the stress adds up and that's what we're hearing from a lot of people."

Blacks face greater health risks

Nationally, health disparities abound between whites and blacks. African-Americans are twice as likely as whites to be diagnosed with diabetes, are 1.5 times as likely as whites to have high blood pressure, and made up 49 percent of HIV/AIDS cases in the United States in 2007, according to the U.S. Department of Health and Human Services Office of Minority Health. Compared with whites, blacks have higher rates of being overweight or obese, according to the Interagency Council on Black and Minority Health's 2007 annual report.

About 7,400 Elkhart residents, or 14.3 percent of the city's population, are black, according to the U.S. Census Bureau's American Community Survey.

Nationally, blacks have suffered disproportionately since the recession hit, said Dr. Beau White, a researcher who worked for the National Institutes of Health for 40 years.

"As we say, when America sneezes, black America gets pneumonia," he said. "Black America has always been in a recession."

White founded www.blackhealthcare.com, a Web site monitors research of the African-American population. In general, the black population, especially in the southern states, is still stuck on old ethnic health habits, White said.

"There are a number of things such as education, poor lifestyle regarding preventative health and overall irresponsible behaviors" that contribute to health disparities, he said.
Historically, blacks have received inadequate medical and dental care.

"That's well established and that's been the case before the recession," said Dr. Booker T. Morris, an obstetrician and gynecologist who runs a practice inside Elkhart General Hospital.

"Historically many times the black poor would not have jobs where they would get health care benefits," Morris said. "Going back many years a lot of black women were hired as domestics. There certainly were no health benefits for that."

Add to that the notion that some African-American patients do not seek out health care.
"It's a matter of education for a lot of Americans, not just black Americans," he said. "It's our own lifestyles - smoking, drug use, et cetera - not necessarily the black population."
Morris said he hasn't seen the frequency of his patients' visits at his OB/GYN clinic, dubbed For Women Only, change since Elkhart County's economy spiraled downward. His patient population varies from those who carry private insurance, those on Medicaid and indigent patients.

He pays attention to his young black patients who become pregnant for signs of hypertension, of which African-Americans typically have greater risk. He watches them for the risk of pre-term births and lower birth weights.

The doctor is one health care professional who says that hard times in Elkhart don't seem to be affecting his clients' health, one way or the other.

"I haven't noticed that they are presenting more or less problems with health care because of the economy," he said.

Twenty-five-year-old Preston Morris and 43-year-old Pamela Price, both unemployed Elkhart residents who face health issues, might argue that.

Doing what it takes for health care

Morris, son of the minority coalition's director who is of no relation to the doctor, has cardiomyopathy -- a weak heart -- and had a defibrillator put in his chest in 2006. He's had trouble with the Medicaid system and hasn't had consistent health care coverage since March. He finds himself competing against skilled workers for the few jobs available in the county, and can't afford the $430 a month for his meds.

"I feel it in my body but I don't try to share it with nobody or tell anybody," he said. " But I can tell my heart is getting worse. What people don't understand about a person's heart - you look at me, I'm looking real fine on the outside. But on the inside, you deal with pain constantly."

Price has hypertension, diabetes, heart disease and no job.

"Some doctors, if you've gone to them before and you've accumulated bills, they won't see you because you have a bill," Price said. "It's like an ongoing affair. Can't see the doctor, can't pay the bill. They won't see you, you get sicker, you can't pay for meds. So how do you get better? It's ongoing."

The two were surrounded by pamphlets describing services available to minority groups, on display in the minority coalition's office at the Washington Gardens housing project. Morris and Price said they believe the Medicaid system is broken, and the people who need the coverage aren't getting it. Morris told a story of his friend who was having chest pain and eventually went to the doctor at Morris' urging, to discover his heart was infected.

"As a black man, they don't go to the hospital because they don't have Medicaid. Nobody can pay these bills."

Aside from her garage sale, Gutierrez seeks other ways to pay her bills. She's taken out ads as a housekeeper. Her smooth alto voice helps; she takes unpaid singing gigs on the weekends -- singing as Reyna Rojas -- in hopes someone will spot her and want to hire her.

"Singing is what I do to calm myself," she said. "Music is what calms me. It helps, you know, get me grounded and things like that."

She hopes she'll be able to croon her way out of debt.

"I'm willing to sing for my supper," she said. "I'm willing to do anything."

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