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THE INSURANCE GAP -- FAMILIES WHO WORK BUT CAN'T BUY COVERAGE

The CAT scan or the house?
After 17-year-old Faith Gorsky suffered a half-hour spell of blindness earlier this month, her doctor said it was probably caused by stress and dieting.

Or, much less likely, a brain tumor, the doctor told Betsy Gorsky, the girl's mother.

A CAT scan could tell. But the Gorskys, despite both parents working, had no health insurance for themselves or two of their three children. If they paid the thousands of dollars it cost, it would wreck their paycheck-to-paycheck budget, probably forcing them to miss house payments.

"We have to decide what's more important," said Mrs. Gorsky. It made her feel cold and cruel, like Joan Crawford in "Mommy Dearest."

She wondered what it would feel like if her daughter was diagnosed with cancer in two years. She wondered how fast banks foreclose after borrowers miss a mortgage payment.

Lacking health insurance for their children "really puts us in a bad place," said Mrs. Gorsky.

The Gorskys, like thousands of other families in Western New York, found themselves trapped in one of the most galling gaps in the nation's health care system, where parents can strip their families of health insurance by trying to earn a living.

Here's the catch: Unemployed people can qualify for Medicare, the federal health care program. But people who want to work, and follow income reporting rules, often find themselves losing Medicaid coverage because they make too much. But they don't make enough to buy health insurance, or have a job offering coverage.

Mrs. Gorsky runs a licensed home day care center in West Seneca. Her husband, Don, has an appliance repair and sales business. While the family was covered by Medicaid, the parents struggled to build their businesses. Together, they made about $17,000 in 1995.

That was several hundred dollars above the Medicaid cutoff for a family of five, Mrs. Gorsky said, ending benefits to the parents and two of their
children. (An exception was made for their 6-year-old son, who would remain covered until an upcoming operation.)

Western New York's eight counties are home to 135,000 people without health insurance, including 30,000 to 40,000 children, studies suggest. Many, if not most, are children with parents who work.

The lack of coverage for the working poor was a main point in President Clinton's ill-fated attempt at health care reform. It remains a topic of outrage on Capitol Hill, though no action is on the horizon.

Albany has something to offer, however.

The Gorskys and families like them may find relief in a state health insurance program for children called Child Health Plus. The plan was updated and expanded in October. Locally run by Blue Cross and by Buffalo Community Health, it offers nearly comprehensive coverage for children up to age 19, including hospitalization, prescription drugs, tests and mental health treatment.

It is priced on a sliding scale, per child, by family size and income. For instance, a family of four making less than $25,000 a year can get coverage for $9 per child per month. To help cash-strapped parents, premiums can be paid by the month.

The insurers have been trying to get the word out about the program, which has 7,000 children enrolled. That could leave as many as 34,000 uncovered children eligible for low-cost or free health insurance, said Blue Cross chief operating officer John Anderson.

"There's a huge population out there that's not taking advantage of this program," said Anderson. "We have a huge problem with kids living in poverty or uninsured in this community, and we need to get it fixed."

After hearing about the program earlier this month,, Mrs. Gorsky called Blue Cross to check it out. She learned that her children would be covered for free, requiring only $3 co-payments for office visits.

"This is what you call a Christmas miracle," said Mrs. Gorsky, trying not to cry. "Thank God. Now I can sleep at night knowing that if the unthinkable happens, my babies are covered."

Mrs. Gorsky and her husband still don't have health insurance themselves. That means that most health problems, short of a finger mangled in a snowblower accident, are treated at home. But as long as the kids are covered, they could sleep at night.

It's a familiar story to Carrie Loucher, a Grand Island mom who cares for three boys, ages 2, 6 and 7.

"I don't have insurance," said Mrs. Loucher, "Neither does my husband John. But that doesn't bother me as much as not having the kids covered."

Mrs. Loucher, 29, said she has been working since she was 15, always without health insurance. "It's like health insurance is this exclusive club you can only get into when you're rich," she said. "You can visit, and make payments on it, but you never belong."

She has learned to make do when she is hurt. Recently, she hit her head and lost consciousness while carrying groceries, and decided it wasn't worth seeing a doctor.

"If I went for that, they'd be giving me all these silly CAT scans and stuff. I'd be paying for it till the day I die."

But the children are another story. The two older boys recently started being covered through their father, Mrs. Loucher's previous husband. That leaves the 2-year-old as the only child without health insurance. "I've been putting off his next appointment until after Christmas," she said.

Mrs. Loucher said that she would check out Child Care Plus to see if it could cover her boy. "That would take such a load off my mind," she said. "We've been lucky so far."

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