Forty-three-year-old Ruben Alvira's last day of work in PimaCounty's Development Services Department was Jan. 17.
Now the married father of two is without health insurance.
'I had heart bypass surgery in 2000, and I saw the bill - it costmore than $100,000,' Alvira said. 'I have no idea what I'd do ifsomething like that happened to me now. Heart bypass surgery is nota forever thing. It's scary.'
Alvira's situation is not unique. A national report releasedFriday says that more than half of unemployed workers in Arizonawith low or moderate incomes have no health insurance. The same istrue on a national level, says the report by Families USA, anational non-profit organization that advocates affordable healthcare.
The report came out the same day that the federal governmentreleased data showing the United States lost 3.6 million jobs since2007, with half of those losses occurring in the last three months.A total of 11.6 million Americans are unemployed, the governmentsays.
Many health-care advocates say that for every percentage-pointuptick in unemployment, another 1 million people will go withouthealth insurance.
Local hospitals and health-care clinics are bracing for anonslaught of 'bad debt and charity care' write-offs in the nextyear, when the full impact of the country's recession is expected tobe felt in the health-care industry.
Bret Hicks, finance director at Tucson Medical Center, wrote offmore than $24 million in bad debt and charity care last year - afigure that's expected to grow in 2009.
Hicks said: 'There's no question with the economic downturn andpeople being uninsured or having high-deductible plans, there'salways going to be a problem. Almost everyone has some kind of a co-payment or deductible. If it's a question of keeping the heat on orthe electricity on in the house,' a hospital bill is not one of thetop priorities for people to pay.
Many lower- and middle-income workers such as Alvira say theycan't afford to pay for health coverage through the ConsolidatedOmnibus Budget Reconciliation Act of 1985, better known as COBRA. Itextends health insurance coverage from former employers for 18months.
Alvira said that to cover himself and his two children, COBRAwould cost him nearly $700 per month. In most cases, COBRA costsjust as much as the company's subsidized insurance plan, except thatthe individual pays the entire premium without the company's help.
'The average COBRA premium consumes on average 84 percent ofunemployment benefits,' said Ron Pollack, executive director ofFamilies USA. 'It is really difficult for people to get any otherkind of coverage - so-called Medicaid programs are not generous,particularly with adults.'
Indeed, because Alvira's wife works for the Tucson Unified SchoolDistrict, Alvira said the family makes too much money to qualify forthe Arizona Health Care Cost Containment System, or AHCCCS. But hesaid her health insurance is so expensive that Alvira and the kidsare going without for now, while the family tries to stayfinancially afloat.
Other unemployed Arizonans don't qualify for AHCCCS because theyown too many assets, such as a house or car.
AHCCCS, which added more than 70,000 people to its rolls in 2008 -including nearly 10,000 in Pima County - is for extremely low-income individuals and families in Arizona. In general, it's forpeople living at or below the federal poverty level, an annualincome of less than $10,400 for an individual or less than $21,200for a family of four.
Alvira, who is diabetic, had a doctor's appointment on Wednesdaybut decided to skip it to avoid the expense.
Tucsonan Arnold Moreno, 48, also is opting to go without healthinsurance because the construction work he does has been sporadic,and his income has dropped.
'To pay for health insurance is expensive, but I'm overqualifiedfor AHCCCS,' he said. 'My wife has insurance for her, but not for meand my kids.'
Moreno is diabetic, and his medications cost $500 per month. Hehas been dividing them in half to save the money. But this week heapplied for prescription-drug assistance and hopes to be taking hisfull dosage soon.
'I'm getting some work, but it's slow,' he said. 'We just allhave to hang in.'
Pollack, of Families USA, said only one in five unemployedworkers with income of 200 percent of the federal poverty level orbelow has private insurance or military coverage. And only one infour receives health coverage through Medicaid or other publicprograms.
'It is clear this is a group of people that will have enormousdifficulty retaining private health coverage,' he said. 'Losing ajob often means losing health insurance and as a result, millions ofmiddle-class and lower-income people become uninsured.'
Arizona shed 12,400 jobs in December, and the unemployment raterose six-tenths of a percentage point from November to 6.9 percentin December. Researchers at the state Department of Commerce predictthe unemployment rate will top 7 percent and might even hit 8percent before the state economy turns around.
Some relief for laid-off workers may come from Congress, whichis considering passing legislation to offset the high costs ofCOBRA.
Contact reporter Stephanie Innes at 573-4134 or atsinnes@azstarnet.com.
WHAT TO DO
Some health-care options if you lose your job:
* Find out if you can get coverage through your spouse's ordomestic partner's employer.
* Find out if you can continue your coverage through COBRA, theConsolidated Omnibus Budget Reconciliation Act of 1985.
* Find out if you or your family members are eligible forMedicaid, the Children's Health Insurance Program or any other stateor local programs, or coverage through the Department of VeteransAffairs.
ARIZONA BY THE NUMBERS
* Number of unemployed workers with incomes below 200 percent ofthe federal poverty level ($44,100 for a family of four): 92,123
* Unemployed workers who are uninsured: 50,721
* Percent uninsured: 55 percent
Source: Families USA, based on December 2008 data
