Judy Dillow looked down the hallway that serves as
the waiting room for the free clinic she runs at First Baptist Church in North
Charleston on Tuesday. It was packed, with nearly every folding chair occupied
by an uninsured patient.
"I don't think it's that busy today," Dillow said matter-of-factly.
The clinic nevertheless is seeing more than its share of patients these days,
thanks to a steady increase in the number of people without health care
coverage.
About 609,000 South Carolinians had no health insurance last year, an
increase of nearly 53,000 over the previous year and about 100,000 since 2002,
according to U.S. Census Bureau figures released Tuesday.
The uninsured rate of 14.5 percent last year was well below the national
average of 15.7 percent, which was up slightly from last year, but advocates are
hardly singing the state's praises.
That's because South Carolina is one of only eight states in which the
uninsured population is growing, and because Medicaid, the state/federal
insurance program for the poor, covers a much bigger population here: 19 percent
versus 12.9 percent nationally.
Experts say the state's figures hardly come as a shock, and they blame a high
unemployment rate and rising health-care costs for forcing more South
Carolinians to go it alone when it comes to paying their health care bills.
"People can't afford health insurance," said Sue Berkowitz, director of the
South Carolina Appleseed Legal Justice Center and one of the state's foremost
advocates for the poor. "They're dropping it because no one has the ability to
absorb the cost."
Not only are more South Carolinians uninsured, 19,000 more were living in
poverty last year than in 2003. According to Census figures, 579,000 South
Carolinians, 13.8 percent of the state's population, live in poverty.
That's higher than the average of 12.7 percent for the nation as a whole,
where despite signs of an improving economy, an additional 1.1 million people
are now officially poor.
Nationally, the number of people without health coverage grew by more than
800,000 to 45.8 million.
The increase means that free clinics such as the one in North Charleston are
busier. The once-a-week clinic is screening its patients more carefully now to
keep it from being overrun and to make sure that it's treating those who truly
need the care.
Columbia-based nonprofit Commun-i-care, which provides free medications and
primary care visits to the uninsured working poor, has also seen a recent spike
in the number of people signing up for its services.
"The cost of living is going up, people are being displaced from their jobs
because of layoffs," said Ken Trogdon, the agency's executive director. "People
find themselves without insurance. They're looking for options to provide that
safety net."
Health care costs get much of the blame. Medical costs for a family of four
have risen by 10 percent a year, and 50 percent overall, since 2001, according
to an index produced earlier this year by Seattle-based consulting firm Milliman
Inc.
A typical health plan for a family of four in the Charleston area now costs
nearly $11,000 a year, according to United Benefits Advisors, a national group
of benefits consultants.
These costs are pricing more small businesses out of the health care market.
Nationwide, the percentage of Americans covered through employer-based insurance
fell below 60 percent last year.
"It used to be that the traditional way people got insurance was through
their employer, and businesses paid a fringe cost for it," Berkowitz said. "It's
not a fringe cost anymore. It's a substantial part of doing business."
In response to the rising costs, many employers are increasing employees'
contributions, deductibles and co-pays, which may lead many workers to opt out
of health insurance.
For that average family coverage that costs $11,000 a year total, the
employee's contribution is $4,536 a year, or $378 a month.
"People lose their health insurance because they can't afford it," said Lynn
Bailey, a health care economist in Columbia.
Not all those who get priced out of the market are poor: 15.8 million of the
uninsured have incomes over $50,000 a year. Many of these people could afford
insurance but simply decide that the cost isn't worth it, said Dr. Robert Sade,
a surgeon and a medical ethicist at the Medical University of South Carolina.
Also, nearly 19 million of the uninsured are between 18 and 34 years old.
"They're young and (think they're) immortal, and relatively healthy," Sade said.
"They don't feel they need to spend money on health insurance."
Another 15 million people around the country, Sade said, could qualify for
coverage through a government program like Medicare or Medicaid, but don't.
That includes people like Calvin Patterson, a 48-year-old Charleston resident
who went to the North Charleston free clinic for one of his twice-monthly visits
Tuesday.
Health problems have kept Patterson out of work for five years, and his
doctor is helping him apply for disability payments that would qualify him
automatically for government health insurance.
For now, he relies on the free clinic for four of the eight medications he
needs for an enlarged heart and liver troubles. The rest he does without.
"They're too expensive," Patterson said.
13.4% -- S.C. residents with no health insurance in 2002-03
14.5% -- State residents with no health insurance in 2003-04
13.5% -- S.C. residents living in poverty in 2002-03
13.8% -- Resident of state living in poverty in 2003-04
-1.2% -- Change in S.C. median household income from 2002-03 to 2003-04
SOURCE: U.S. Census Bureau; all figures based on two-year averages
