Remember health care reform? For those without insurance, nothing has improved since Congress killed efforts to offer health services to more Americans.
Lee Douglass has cataracts -- an abnormal and sometimes progressive clouding of the lenses in his eyes.
He is 62, retired from his own handyman business in Eudora and says his eyes aren't too bad -- yet. He can read well, but his long-distance vision isn't what it used to be. His wife did the night driving during their trip to a son's wedding last year in Ohio.
After the trip, Douglass spent $100 on a pair of glasses. He'll wait three years before he does anything else about his eyes -- such as surgery to remove the cataracts and restore his vision. By then he'll be 65 and eligible for Medicare, the federal government's health benefit program for the elderly.
His wife, Shirley, also 62 and retired from her small house-cleaning business, took a free test last year for another eye disorder, glaucoma. The test suggested she was in the early stages of the degenerative condition, caused by excess fluid pressure within the eye.
When treated early, loss of vision can be prevented. But when left untreated, glaucoma can lead to blindness.
But Shirley has yet to go to an eye doctor. Nor has she visited a dentist to replace a crown that fell off one of her back teeth.
"It doesn't show, so it's not a cosmetic thing," she said. "There's no way I can afford to go and get that crown replaced, so we've let it go."
The Douglasses, who own their house in Eudora and get by on about $580 a month in Social Security benefits, do not have health insurance.
Caught in the middle
A year ago President Clinton was pushing hard for a plan to expand the availability of health care to most of the 38 million Americans without health insurance.
But now, six months after congressional leaders declared health reform dead, the uninsured are still caught in a peculiar health care system that favors the poorest, the wealthiest and those with employer-subsidized insurance.
Millions of Americans, and thousands in Douglas County like the Douglasses, are caught in the middle without any form of insurance. They are retirees, the unemployed, the self-employed, and low-wage workers whose employers do not pay for insurance.
Their inability to get routine, preventive health checkups is not addressed by the Republicans' "Contract With America," a 10-point plan that includes $66.4 billion in cuts in federal welfare spending over five years.
And the uninsured won't benefit from any of several state initiatives proposed to change the Medicaid program in Kansas.
"Those without are still without, and that list is growing," said Graham Bailey, a spokesman for Blue Cross-Blue Shield of Kansas, the state's largest private insurer. "It's a growing problem, not a shrinking problem."
Medicaid, with 60 percent of the costs paid by the federal government and the rest covered by the state, helps only the poorest and neediest.
It is primarily for the elderly, children, pregnant women, the disabled and families that qualify for cash assistance from the government because they earn no more than, in the case of a family of four, about $6,000 a year.
Statewide, 250,875 people received medical assistance through the Medicaid program in 1994. About 6,000 of them lived in Douglas County.
The program cost $715.7 million in Kansas that year, with $20.8 million in Medicaid services provided in Douglas County.
Douglas County residents who don't qualify for Medicaid can get routine, preventive health services at Health Care Access, a clinic at 1920 Moodie that is funded by contributions from Lawrence Memorial Hospital, pharmaceutical companies and area physicians.
In 1994, Health Care Access logged 4,225 appointments, and nurses and physicians there treated 1,599 people, up about 14 percent from 1993.
"The real problem is we still need more reform," said Judy Eyerly, the clinic's director. "For people who are already living on the financial edge, any kind of health problem can push them over. A single hospitalization can ruin someone."
Eyerly estimates at least 11 percent of the population of Douglas County -- about 9,000 people -- doesn't have access to any other form of health care. But only a fraction of them go to Health Care Access.
"There isn't enough access for people without resources," she said. "There's still a lot of people in this community who are not getting health care."
Ad hoc reform
Some have suggested that the Clinton health reform effort, though a legislative failure, still managed to spur changes in the health care industry.
The rate of inflation for health care costs has slowed, to about 5 percent a year from 14 percent or more a few years ago. And hospitals nationwide are busy forming partnerships or merging to cut costs.
Three hospital groups, including the for-profit Columbia/HCA Healthcare Corp., have proposed partnerships with Lawrence Memorial Hospital, which is not-for-profit and owned by the city.
The groups all hope to be able to bid on contracts to provide services to state employees and, by mid-1997, Medicaid patients.
Under managed care, hospitals and doctors bid on contracts to provide services to large groups of patients based on lump-sum annual payments for each patient.
But for those who earn too much to qualify for Medicaid and too little to be covered by private insurance, the industry changes will make little difference.
"Managed-care contracts are for people who already have insurance," said Kay Kent, director of the Lawrence-Douglas County Health Department, which provides some preventive services on a sliding-fee scale. "It still doesn't address the issue of people who do not have insurance contracts."
Even those with Medicaid are not guaranteed access to health services. For years, while Medicaid expenses have swelled -- nearly doubling between 1990 and 1995, the state has had difficulty finding physicians willing to provide reduced-cost services to Medicaid patients.
That has been true in Douglas County, designated in February by the federal government as a health professional shortage area.
A poorer America
With no insurance, Lee and Shirley Douglass do without routine checkups and non-emergency health care.
"We very much look to God to take care of us," Lee said. "Things are taken care of."
"I can't even think of when I've been to the doctor," Shirley said. "We just don't go unless it's a matter of life and death."
They thought they had reached such a moment in the spring of 1988, when a daughter complained of stomach pains. They took her to the Lawrence Memorial Hospital emergency room, where doctors began a series of tests that found she had a colon disorder related to stress.
The $1,400 bill wiped out Lee and Shirley's savings.
"We talk about the wonders of modern science," Lee said. "One of the wonders is what it costs."
Retired less than five months, the Douglasses are now thinking about finding part-time work to bring in some more money. But they're thinking about making ends meet, not about buying health insurance.
"Times are changing," Lee said. "We don't want to say it, but America is getting a little poorer."
Said Shirley: "I just personally am concerned, not just for myself but for other people. Medical costs are so high. I just feel that in this country the costs are so prohibitive that the people who need it the most don't get it."