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The Honolulu Advertiser
May 1, 2005
By Susan Au Doyle and Laurel Johnston

Hawai'i's uninsured suffer health gaps
An uninsured mother with three children says, "When the kids get sick, like with a sore throat, I think it's just a sore throat. Unless it doesn't go away, I'm not going to take them to see a doctor. Yet I always worry that it might be something more serious like strep."

For parents on limited incomes with no health insurance for themselves or their children, waiting to seek treatment is not unusual. They are forced to make tough choices between the necessities of life. Should they pay for insurance for their children, pay the rent or pay for food?

An estimated 112,565 Hawai'i residents — about 10 percent of the population — do not have health insurance. Of those uninsured, 75 percent are adults, of which 58 percent are working, many at full-time jobs. Sadly, 23 percent are children.

An uninsured woman working three part-time jobs says, "I've never been able to afford health insurance because of my age and having diabetes. It's hard to get insurance when you're already sick. ... It's out of my range."

It is no surprise then, that those who do not have health insurance often don't receive the medical care they need. Consider these facts:

• Common illnesses in children who are uninsured often go untreated and can impair a child's normal development. Without health insurance, children miss out on routine preventive care, which can identify a child's health needs before it becomes a major problem.

• Uninsured adults are less likely to get the medical care they need compared to those with health insurance. They also are less likely to have a primary-care physician or healthcare provider, and are more likely to suffer from poor health. Many die prematurely.

• Individuals without health insurance are less likely to receive preventive services such as pap smears and mammograms for women and prostate cancer screenings for men.

• Many uninsured families rely on over-the-counter medications to treat their illness rather than seeing a physician. These families also are more likely to go to an emergency room for conditions that can be treated in a doctor's office.

As a result, healthcare costs for the uninsured are often considerably higher because they don't seek early treatment. And when they finally do receive treatment, their conditions are more serious and sometimes require hospitalization. Over the past several years, Hawai'i's hospitals have reported financial losses because of bad debts and charity care. These losses strain hospital budgets and are passed on to those who are insured, increasing healthcare costs for everyone. This cycle must be broken.

Yet for many, being uninsured is not a matter of choice — they simply can't afford it. Many don't have health insurance coverage because they were laid off from work; others are too ill to hold a steady job; or the sole breadwinner's employer pays only for the employee and not dependents.

Today marks the start of "Cover the Uninsured Week," a national initiative funded by the Robert Wood Johnson Foundation to raise awareness about and seek community support for efforts to ensure that all Americans have access to healthcare coverage. The Hawai'i Uninsured Project is joining community organizations across the country in a unified effort to highlight the human and economic consequences of being uninsured. With a deeper understanding and political will, we can help bridge the gap between those with insurance and those without so that fewer people will be forced to make the painful choice between healthcare and life's other necessities.

Susan Au Doyle is president and chief professional officer of Aloha United Way and chairwoman of the Leadership Group for the Hawai'i Uninsured Project. Laurel Johnston is executive director of the Hawai'i Uninsured Project, an initiative of the Hawaii Institute for Public Affairs funded by grants from the state Department of Health. For more information about the project, see www.healthcover agehawaii.org or call 585-7931.