For some who've lost their jobs, the lack of health insurance could cost them their lives.
In January, Mike Harris was laid off. ¶ In March, he found out he has cancer. ¶ In the difficult weeks since then, he has started chemotherapy while scrambling to make mortgage payments and cover his medical bills with a patchwork of private insurance, public coverage and the generosity of friends. ¶ He's making it for now, but the ordeal has taught him firsthand a peculiarity of the U.S. health care system: Lose your job and -- even if it's when you need it most -- you typically lose your health insurance benefits.
For many, that means suddenly picking up the full cost of insurance previously subsidized by their employer, or searching for alternatives.
As the recession drags into its second year, thousands of other Americans are sharing Harris' experience. With unemployment at a 26-year high, economists estimate that more than 5 million people have lost their health insurance since the recession began.
Many will just tighten their belts and postpone the next doctor's appointment. For those with life-threatening illnesses, however, that's not an option.
"I worked hard all my life," said Harris, a 52-year-old husband and father from Minneapolis. "When does it pay off for being a good citizen?"
Harris, who also goes by his given name Clayton, has short gray hair and a perpetually furrowed brow, which can signal that he's in pain, or about to crack a joke, or both.
Two years ago, he began feeling a pain in his chest. He thought it was indigestion or heartburn. His doctor did a stress test and pronounced his heart "healthy as a horse's."
Last winter, he felt more tired than usual. He blamed the 10- to 15-hour workdays. "I figured I was just getting old."
Sometime in March, Harris woke up drenched in sweat, freezing, body aching. He landed in an emergency room. By the end of the week, he was diagnosed with advanced gastrointestinal cancer. It had spread to his stomach, liver and lungs.
The day before the diagnosis, his wife, Linda, sprang into action. She applied for health insurance through COBRA, the federal program that enables people to extend their employer-based coverage for a limited time if they lose their jobs involuntarily.
The cost can be daunting -- $400 a month for Harris -- because the ex-employee has to pay the full premium. But people who are sick have little choice, because private insurance companies will almost certainly deny individual coverage to applicants with serious pre-existing conditions.
This month, the Harrises found out that Mike qualifies for Medical Assistance, Minnesota's version of Medicaid, although how much it will cover remains unclear.
Never saw it coming
Mike and Linda Harris met in 1985 at a bar called the Leaning Post in St. Louis Park, where he worked as a bouncer. It was Valentine's Day.
They danced that night. He told her: "Don't be doing that."
"Doing what?" she asked.
"Don't be leading."
More than 20 years later, she's still doing it. Every morning, Linda Harris checks her to-do list in a small notebook. She calls the hospital to schedule Mike's appointments. She calls Medical Assistance to check on Mike's benefits. She calls the mortgage company to see if their request to temporarily reduce monthly payments -- and hold off foreclosure -- has gone through.
Like most people, the Harrises didn't see the recession coming. Three years ago, they bought the small, neat duplex they'd been renting for years and rented out the other half. Their daughter, Emily, 22, is a college student and lives with them.
Last week, the mortgage company agreed to halve their $2,645 monthly mortgage payment. But the reprieve is only for four months. "Meanwhile, I'm getting all these bills," said Linda.
This year's federal economic stimulus law will help because it covers 65 percent of COBRA premiums. That cut Mike Harris' premium from $400 a month to $138.
Not that it has turned Harris into a supporter of President Obama. He watches Bill O'Reilly, the conservative cable network host. He's disillusioned with politicians, Republicans and Democrats. Only once in his life has he voted, and it was for Ross Perot.
Harris says he wants to know why it's so tough for him, someone who has been paying taxes all his life, when illegal immigrants can walk into an emergency room and get free care. "The more I put into the system, the less I get. The less I put into the system, the more I get," he said. "How does that even make sense?"
But the ordeal has made him think about health care in the United States; he says a national health system isn't such a bad idea, because "at least you know you're getting something for your taxes."
On bad days, he tells Linda: "You might as well divorce me and kick me out the door."
Cancer patients struggle
Harris is not alone in the struggle to pay for cancer treatment.
The Twin Cities' biggest independent cancer practice, Minnesota Oncology, where bad debt was "significant but manageable" two years ago, expects bad debt to triple between 2007 and 2009.
Unemployed patients sometimes take drastic steps. In March, Stanley Trisko of St. Paul called Minnesota Oncology to try to cancel his last chemo session for colon cancer. He'd been laid off from his job as a transportation auditor after 23 years.
A financial counselor there plugged Trisko's details into Needymeds.com, a nonprofit website, and found that a drug company would cover the cost of the one drug for the final session -- $11,000.
There are other sources of help for people with cancer, but it's hit and miss. The Leukemia and Lymphoma Society will help pay for certain treatments. Angel Foundation will help with rent and groceries (Harris applied twice but was rejected because even his diminished income is too high). Those who need help paying for radiation are out of luck, said Sally Shoemaker, until recently a financial counselor at Minnesota Oncology.
Shoemaker used to see perhaps one patient a month with no insurance because of a job loss. Recently, it was three or four patients a week.
Which helps explain why the pressure is building in Washington for health care reform.
Stay in the game
One day in mid-June, Harris was at the hospital for chemotherapy, which he gets every three weeks.
"What's been going on with you?" asked Dr. Dean Gesme.
"Besides a few throw-up incidents, not too much," Harris replied.
He confessed he'd been to a movie with Linda and indulged in buttered popcorn and a meal from Taco Bell. The night that followed was not a good one.
Linda asked: "How do you think he's doing?"
Gesme was matter of fact: "We're not going to win the World Series, but if we can just stay in the game, that's as good as it gets."
"I don't want you to deprive yourself," he added. "So go ahead and have that buttered popcorn."
Help and advice
By now, the Harrises are used to getting advice from everybody. The woman at the beauty salon recommended aloe vera juice. A fellow in the doctor's waiting room swore by Vitamin C and distilled water. The Chinese couple who run the neighborhood grocery offered this: "Laugh, cancer go away; be sad, cancer stay."
They've been touched by the kindness of friends and family. Linda's sister visited from Iowa and washed the walls of Mike's den. His brother from Shoreview moved in for a while to help out. There's a July 31 benefit at the Knights of Columbus Ballroom in Bloomington, to be thrown by friends of Linda's.
In May, Linda was laid off from her job as a manager at a paint manufacturing company. The parting was amicable, and she hopes to get rehired when business improves. But at this point, staying home is not entirely unwelcome for Linda.
It allows her to take care of Mike and drive him to chemotherapy, as well as keep up with the paperwork that has engulfed their lives.
She's not sure how they'll pay the bills, but she's sure of one thing.
"He's going to get better," she said. "I'm not going to have it any other way."
Chen May Yee • 612-673-7434