This is Covering the Uninsured Week, a national initiative to call attention to the 45 million Americans who do not have health insurance. In part 1 of this series, The Roanoke Times explores how the issue is playing out in our region.

Here, we examine the issue from a business perspective and look at what kinds of programs are in place to help people without insurance.

The last time Ginny Hale had health insurance was about eight years ago.

As a stay-at-home mother, she let her insurance plan run out. Her main concern at the time was that her son, Damian, was covered.

Now divorced, Hale works as a hairstylist at Paula's Salon on Brambleton Avenue. Like many stylists at small salons in Virginia, she is essentially an independent contractor who rents space from the salon's owner.

Hale, who is 35 and lives in Floyd County, is one of the estimated 20.4 percent of people in Southwest Virginia who lack health insurance. That means as many as 267,140 people in Southwest Virginia did not have health insurance in 2001, according to a study from the Virginia Health Care Foundation.

Health coverage is a coveted benefit.

"Everybody who comes in to ask for a job, they ask you that first - 'Do you have health insurance?'" said Zena Azar, owner of Azario Salon & Day Spa on Starkey Road. She looked into getting insurance for her full-time employees, but found it was too expensive. Peggy Nance, who owns Brambleton Styling Salon, said an insurance agent told her that hairdressers were considered a "high-risk" group.

Hale has gone to the health department in Floyd County for annual checkups, which she paid for based on a sliding scale because of her income. As for going to the doctor any other time, "I only go if I'm too sick to work," and she pays for it out of pocket, she said.

Last spring, Hale found out that she had some cancerous skin cells. It cost about $500 to have the cells removed. She worked out an arrangement to make monthly payments to Carilion to cover the bill. She paid it off in November.

After that incident, Hale looked into buying health insurance and was quoted a rate of about $300 a month.

"It's a pretty large chunk of change," Hale said. "Being a single mom, it's very hard to try and put that aside." (Her son, who is 10, is covered through his father). Even some friends who work at large companies that offer health insurance tell her they still can't afford to pay for their portion of it.

There's no question that lack of health care insurance is complex and solutions aren't easy.

The Kaiser Family Foundation has found that in 2004, the average annual premium for group coverage in the United States was $3,695 for a single employee and $9,950 for a family.

"It's a huge issue," said Ward Stevens, chief executive officer of Montgomery Regional Hospital in Blacksburg.

About 20 percent to 25 percent of the people who seek emergency room care at the hospital lack health insurance, he said. The hospital does try to collect for services, and Stevens said he thinks most people who are uninsured do want to pay their bills.

Like other hospitals in the area, Montgomery Regional has a charity care program. The hospital provided $5.5 million in charity care and $4.5 million in bad debt in 2004, he said.

Stevens said he thinks a lot of the emergency room visits could be avoided if people had access to good primary care.

At the same time, he and other regional hospital administrators said they do not want to discourage anyone - uninsured or not - from seeking necessary medical care.

Stevens recalled that when he worked at Alleghany Regional Hospital in Low Moor, a woman came into the emergency room with a tumor the size of a cantaloupe on her stomach. She looked scared and said she thought she might need surgery.

"There are people who avoid care until it gets to a point when it really is an emergency," he said.

And the lack of health care coverage doesn't only affect the people without insurance.

"The cost of services to those who are uninsured is a health care cost that is borne out by other consumers," said Don Halliwill, director of finance for the Carilion New River Valley Medical Center.

Hospitals in the Carilion network and the HCA Southwest system provide millions of dollars in charity care each year, according to their spokespeople.

Those hospitals also work closely with and contribute to free clinics and other organizations that provide services to people without insurance. (Anthem Blue Cross and Blue Shield has also contributed to these efforts, according to Jane Pratt, a company spokeswoman.) If people without insurance have a place to go to get primary medical care, they might not make an unnecessary and expensive visit to the emergency room because they don't know where else to go for care.

Amy Forsyth-Stephens, executive director of the Mental Health Association of the New River Valley and the Pro Bono Counseling Clinic in Blacksburg, describes clients with mental health problems as running toward the edge of a cliff.

"When they fall off that cliff, lives are shattered," she said. "That's when it gets very expensive for society."

She said she sees the clinic as a fence that can prevent people from falling off the cliff.

Directors of the free clinics and other groups that provide services for the uninsured and underinsured work together and with organizations such as the Virginia Health Care Foundation to get services and inexpensive or free medication for their patients.

But as yet, there's not necessarily a central resource for the care of those without insurance.

"It's more of a collection of programs and care access points than it is an overall coordinated effort between all these different folks," said Matt Perry, president of the Carilion New River Valley Medical Center. But G.C. Duck, who works in the center's social work department, maintains that resources are many times available; it's just a matter of working through the system.

Still, organizations that provide services for people who are uninsured depend largely on the volunteerism of doctors, nurses, pharmacists and other personnel; are subject to state cutbacks; and serve a lot of clients without many resources. Many only see patients a few days a week.

"They're trying to keep their ship floating," Perry said.

Don Craighead, executive director of the Bedford Christian Free Clinic, will tell you the clinic needs help in its pharmacy. And Karon Jones, director of the Free Clinic of Franklin County, says finding funding for ongoing programs is always a challenge.

Another issue is that free clinics don't necessarily have the resources to take on patients indefinitely. The Bedford Christian Free Clinic tells clients they can only treat them for two years.

Indeed, the goal of free clinics and organizations such as Project Access in Roanoke, which provides specialist care to patients, is to care for people when they don't have insurance, with the hope that they will get better, find full-time work with benefits, and leave the program.

Interviews with people who are uninsured show that those jobs may not be out there.

Craighead said the Bedford Christian Free Clinic allows some patients to stay on because they have nowhere else to go to get care.

Other clinics don't have defined treatment parameters.

"We kind of take them on and know we're going to be seeing them for a while," said Forsyth-Stephens, of the Mental Health Association.

Despite the challenges of the uninsured in Southwest Virginia, Deborah Oswalt of the Virginia Health Care Foundation said she sees a robust kind of spirit in the valleys to help people.

The Roanoke and New River valleys "seem to have a wonderful spirit of volunteerism that you don't see in other localities," said Oswalt, executive director of the foundation that helps get medication to the uninsured through assorted programs across the commonwealth.

Dr. Jody Hershey, medical director of the New River Health District, also said that people here have a sense of responsibility to their own.

Given the importance of religious faith in the region, he said, people who want to make things better for those without health insurance have to reach out to religious communities in the area.

And Ginny Hale's opinion on health insurance?

"It's something we all should have."

***

Anthem Blue Cross and Blue Shield has created a plan targeted to the uninsured called Individual Essential KeyCare. For more information, go to www.anthem.com and go to the section for Virginia.For more information on potential coverage options for the uninsured in Virginia, go to http://covertheuninsuredweek.org/stateguides/english/VA.pdf


Organizations that provide health care for people without insurance or help people register to sign up for services

Many of the entities have eligibility requirements for residence and/or income level. Others provide only specific services, such as mental health care.

Bedford Christian Free Clinic, Bedford, 586-3711.

Blue Ridge Behavioral Healthcare, Roanoke, 345-9841.

Blue Ridge Independent Living Center, Roanoke, (assists people with disabilities), 342-1231.

Bradley Free Clinic, Roanoke, 344-5156.

CHIP (Child Health Investment Partnership), Roanoke, (helps parents register children for health insurance), 857-6993.

Health Department, New River Valley District. Offices in Montgomery County, 381-7100; Floyd County, 745-2141; Giles County, 921-2891; Pulaski County, 994-5030; Radford, 831-5774.

Health Department, Roanoke and Alleghany Districts. Offices in Roanoke, 857-7600; Botetourt County, 473-8240; Salem, 387-5530; Vinton, 857-7800; Clifton Forge, 862-4131; Covington, 962-2173; Craig County, 864-5136.

Kuumba Community Health and Wellness Center, Roanoke, 362-0360.

Project Access (specialists providing care), Roanoke, 344-4200.Free Clinic of Franklin County, Rocky Mount, 489-7500.

Free Clinic of the New River Valley, Christiansburg, 381-0820.

Free Clinic of Pulaski County, Pulaski, 980-2931.

Pro Bono Counseling Program, Blacksburg, 951-4990.

Rescue Mission Health Care Center, Roanoke, (health care for people who are homeless), 777-7669.

Roanoke Valley Mental Health Collaborative, Roanoke, 344-0931.

CHIP of the New River Valley (children's insurance), 633-2518.

Med-Ride, 888-633-7433.

New River Community Action, 633-5133.

Radford University Clinics, 831-7660.

Radford University FAMIS Outreach Project (health insurance for children), 831-7693.