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2009 Investigative Report

August 10, 2009 

By Jay Kim with reporting by Reem Abdou, Leslie Gallardo, Sandy Jean-Louis, Melissa Sanchez, Asmaa Rimawi and the staff of The Princeton Summer Journal. 

PrincetonGenaro Mendez, in his White-collared shirt and black apron, is an assistant cook at Chuck’s Spring Street Café in Princeton. He works hard each day in the restaurant’s small kitchen to earn enough money to make ends meet. If Mendez gets sick, he might find himself in need of medical care. But paying for that care would be difficult if not impossible for Mendez, who has worked for nine years without health insurance.

When he went to work at Chuck’s, a diner that specializes in chicken wings, Mendez, 43, of Princeton, did not ask the store’s owner about health insurance. Confident in his good health based on one visit to a doctor two years ago, Mendez said he “pays no attention to health insurance.”

Mendez’s lack of health insurance may be at least partially attributable to poor communication between employer and employee. Mendez is an immigrant from Mexico and does not speak English fluently. Indeed, Chul

Choe, 32, the owner of Chuck’s, said he believed that Mendez had health insurance from another source. Choe does not pay for health care for his three full-time employees. However, he said he would consider providing coverage if the government paid for at least some of the plan.

“Cost is probably one of the most important things [to consider],” Choe said.

Uninsured individuals often use hospital emergency rooms as their primary care providers when they become sick, frequently leaving the hospitals with large unpaid bills that are subsequently passed on indirectly to paying patients and taxpayers. The plight of uninsured Americans is at the forefront of the ongoing national debate regarding the health care overhaul spurred by President Obama.

As the father of a seven- year - old boy, Mendez remains focused on supporting his own young family. For him, health insurance is not a priority right now.

Mendez’s attitude regarding health insurance is not unusual among many other uninsured workers in Princeton. Interviews with owners and workers at several area small businesses, as well as at University Medical Center at Princeton (UMCP), revealed that many lower-income employees and residents work and live without health care.

However, some local business owners are making their own attempts to rectify the health care situation.

Matthew Errico and Gabrielle Carbone, co-owners of a local ice cream store, The Bent Spoon, offer to pay 50 percent of the cost of health coverage for their full-time employees, though they are under no legal obligation to do so. Nevertheless, they have found that some employees decline.

“About two or three years ago [our employees], who were straight out of college, declined [health care] because they didn’t visit the doctor as much and felt that it wasn’t necessary since they were healthy,” Errico said.

“I think that they’re very grateful that we pay 50 percent because most small businesses don’t,” Errico said. “We believe that on one hand it’s a necessity and on the other hand it’s a retention tool because we want to keep good people around.”

The recent economic crisis has forced some businesses to cut back on health insurance. Teresa’s Café Italiano, a restaurant in Palmer Square, used to offer an incremental health insurance plan for its full-time employees, but is no longer able to do so because of the economic downturn.

Until about six months ago, the café offered to pay for an increasing portion of health coverage after one, three and five years. After five years, fulltime employees’ health care was fully covered. Now non-managers must pay for all of their coverage. Managers are exempt from this new policy and still receive coverage from the café’s owner, Terra Momo Restaurant Group, according to Rich Phillips, general manager of Teresa’s Café.

“I believe that sometime in the future the [corporate office] will begin to provide health coverage again,” Phillips said. But Phillips said he did not know when the restaurant would resume providing insurance to workers.

Local residents and small businesses are not the only ones struggling with questions of whether and how to provide health care; hospitals are also affected.

Any uninsured patient seeking care at UMCP must first visit the emergency room for assessment and emergency treatment if necessary, according to Donna Daniels, the manager of the hospital’s outpatient clinic. The patient would then be referred to the clinic.

There, hospital employees provide treatment and also help with applications for Charity Care, a state-sponsored health program.

Charity Care, also known as the New Jersey Hospital Care Payment Assistance Program, covers part or all of care provided to lower-income patients who receive inpatient and outpatient treatment at hospitals in New Jersey. The treatment must be necessary hospital care to qualify for coverage, according to the New Jersey State Department of Health and Senior Services website.

The program has developed eligibility requirements based on income and need. Patients must have no current health insurance provider, be ineligible for any government or private health coverage, and meet certain income and asset requirements.

Jane De La Cruz, 54, an uninsured employee at the Witherspoon Bread Company, said she and her family have come to rely on UMCP as their sole health care provider because enrolling in the insurance plan offered by her employer would consume a substantial part of her take-home wages. De La Cruz, who said she has numerous other more pressing expenses each month such as providing food and housing for her family, must prioritize when deciding how to spend her paycheck. She said that she does not want to pay for health insurance when she has no immediate need for medical care.

“If you don’t get sick, [the money you pay for health care] isn’t refundable,” she said.

De La Cruz’s son used to work at the Witherspoon Bread Company and was also uninsured. He was injured, received care and was not required to pay anything because of the Charity Care program, De La Cruz said.

Edith Gonzalez, 24, found herself in a similar situation. A worker at a café called Dispensa located in the Princeton Public Library, Gonzalez had an allergic reaction two months ago resulting in $1,000 in hospital fees at UMCP, she said. After she qualified for Charity Care, the program covered her entire bill.

In part because of programs such as Charity Care, UMCP has “yet to fully feel the effect of the economic situation,” Daniels said.

UMCP, a relatively small private hospital, receives about 400 patients per week—a relatively small number when compared to those of larger public hospitals. UMCP also provides help for those who are not eligible for Charity Care. If patients are rejected from Charity Care and are uninsured, UMCP will write off a hospital bill if the patient cannot afford it or reduce the bill. Many patients who are uninsured, who cannot afford paying hospital bills and who are not eligible for Charity Care rely on this system.

But not all low-income and   uninsured patients have access to smaller, private hospitals or programs such as Charity Care.

Elmhurst Hospital in Queens, New York, treats about 130,000 patients per year, according to Dario Centrocelli, an Elmhurst Hospital public relations representative. He said that Medicaid and Medicare usually cover patients without insurance, but some people still fall through the cracks.

Elmhurst Hospital is like many other hospitals in the nation that are struggling with the question of how to provide health care for uninsured patients. That question has prompted clamorous debate in Washington, most recently in connection with Obama’s proposed revamping of the nation’s health care system.

Uwe Reinhardt, a University professor of economics and health care expert, said that the American health care system is in desperate need of reform.

“Americans, when they feel they are sick and need to see a physician, have financial barriers between them and the doctors because they are poor and uninsured,” Reinhardt said. “This is not only inhumane, but it is also inefficient. Uninsured poor children are hospitalized at three times the rate of [insured] poor children.”

Reinhardt said even insured citizens can have trouble affording quality health care. “They can no longer make their utility payments,” he said. “The [fact that a] family has to yank a kid out of college because a member of the family has cancer is unacceptable .”