SUNBURY — In the midst of the intense political debate in the Valley over what to do about people who lack health insurance and those who are under-insured, one important consideration often is overlooked.

The human face. The faces of the uninsured or those with insurance that does not adequately pay for care when it’s needed.

Look around. According to state data, you should not have to look far to find someone who could really benefit from health care reform.

A 2008 survey conducted for the Pennsylvania Insurance Department estimated that 23 percent of all adults in Union County, or 6,601 people, are uninsured; in Montour County, it’s 1,106 people; in Northumberland County, it’s 5,542; and in Snyder County, it’s 2,181.

There are no statistics available that estimate how many people in the Valley are under-insured.

The stories told by the uninsured or under-insured illustrate the costs and consequences of living without coverage — offering windows into the lives of young and middle-aged people, white and African American, middle-class and working-class families.

Here is how they live, and in one case, died:



Self-employed, no insurance

Tom Casimir, of Lewisburg, can’t speak for himself.

Uninsured, he died at age 47 of pancreatic cancer in 2008. By the time Tom Casimir, 47, learned he had cancer, the disease had spread throughout his body and there was little that could be done to prolong his life, said his brother, Lewisburg Borough Councilman Trey Casimir.

Tom was a designer-builder and very much into self-dietary techniques, Casimir said. His brother also had a lifelong arthritic condition.

“He was used to being sore,” he added.

Casimir said he was often worried about his brother, who would ignore the aches and pains. “There were times, he told me, that he didn’t go to a doctor or held off on going because he was uninsured. He would outlast the pain.”

When Tom finally learned he had pancreatic cancer, he was admitted to Geisinger Medical Center, Danville.

“Nobody has ever said that he could have been cured had they found out earlier,” Casimir said. “Pancreatic cancer is very fast moving. But the last two weeks of his life were spent filling out paperwork so that he could pay for medical services, which totaled more than $100,000.”

Casimir said Geisinger was very helpful in trying to find revenue sources to help defray costs for his brother.

“It was just a terrible, miserable time for the family, and of course, for Tom,” Casimir said.



Insured, unemployed

Tammy and Brad Brought, of Middleburg, thought they had adequate insurance coverage.

Until serious health issues arose.

Tammy Brought, 37, was a licensed practical nurse for 15 years with a local hospital. Everything was fine until 2001, when her husband Brad became ill with an auto-immune disorder. “We weathered through that storm and came out stronger than ever, even though it eventually caused his job loss and lots of medical bills,” she said.

Then, 28 months ago, Tammy Brought experienced severe pain and numbness in her arm, which eventually required four cervical neck surgeries in 28 months for different herniated discs in her neck.

“I will require complete cervical neck reconstruction in the future,” she said.

Brought is out of work, having had her fourth surgery just six weeks ago.

Taking all that time off has resulted in unwanted consequences.

“(Her former employer) was wonderful to me. But I lost my position there since my Family Medical Leave Act time expired,” Tammy Brought said. The hospital was nice enough to continue her health insurance for one year for the family.

The Broughts thought they were covered by their insurers.

“I’m intelligent. I know all about insurance. I thought we were OK. I have both a short-term disability policy and a long-term disability policy.

“I wasn’t 100 percent, but I went back to work,” she said. “Then I had another herniated disc. It was totally unrelated to my other issues.”

Brought’s short-term benefits ended Sept. 29. Brought said the insurance company considered her latest surgery a continuation of her January surgery, even though both her neurosurgeon and family doctor wrote letters stating that it was a completely different medical problem.

On the other hand, her long-term disability insurance provider said the condition was a new problem, and it would not pay benefits until a six-month waiting period was over. That won’t kick in until January.

“Now that I’ve lost the short-term insurance,” she said, “I have to hope that I’m well for the next four months before the long-term insurance kicks in.”

Brought finds it extremely upsetting that a professional person can have everything in place in case of such a time like this, and it still isn’t enough.

“I have a short-term policy, a long-term policy, a 401K , I had a savings account. My husband and I own our home, but it has a mortgage, and the mortgage company will hopefully work with us. We could lose our home because I’m unemployed.”

Sighing, Tammy said, “Through it all, the way things are, I’m just grateful that when I put my child to bed, she’s not hungry.”



Recently unemployed, no health insurance

Robert Lee Dodson, of Sunbury, wants his family back.

Dodson, who has a 2-year old son and two stepchildren, just lost his job. “For three years, I was living in a house on Fairmount Avenue in Sunbury, which I then lost due to financial pressures,” he said.

His children are living elsewhere while Dodson lives in Haven Ministry, a Sunbury shelter. He’s applied for more than 20 jobs, but so far hasn’t been called back to interview at any of them. With no job in sight, it’s difficult to imagine having the money to pay for health insurance.

He is thankful that his children are covered by the state’s Children’s Health Insurance Program, but he has no coverage. “When I had insurance, if I was injured on the job and went to the emergency room, it was $100 a visit. Now, I have nothing. Thank God I haven’t been terribly sick since losing my insurance.

“It’s stressful to live like this,” he said, shrugging his shoulders. “Most of the times I have to tough it out. I have asthma, though, and need medicine. I don’t get sick but once or twice a year, and I worry about what will happen to my children if something serious happens to me.”



Employed, no health insurance

Johanna Myers (not her real name, at her request), of Northumberland, is afraid to be sick.

Myers, a social worker, said: “I’m alone and raising my grandkids, ages 10 and 11. Right now, it’s a struggle for me to raise those two little girls. Where I am currently working, I get minimum wage, $7.25 an hour, for 30 hours a week and get no health benefits at all.”

Myers said she is on a multitude of medications for various ailments. She often resists going to the doctor, even when sick.

Holding back tears, she said, “I can’t go to doctors. If something happens, I can’t run up to the hospital emergency room and have something done.”

Myers cut her toe a few months back and it was serious, but she couldn’t go to the emergency room to have stitches put in because she didn’t have insurance.

“The way I live,” she said, “I’m scared all the time that something might happen to me. My sister has leukemia, and I’m thinking, if that ever happened to me, I’m screwed. Yeah, it’s a very stressful way to live.

“There is nothing I can do about it. I just go through each day, and hope I can make it.”



Employed (two jobs), no health insurance

Jack Roberts (not his real name), of Danville, worries that if he ever needed hospitalization and surgery, he’d be forced to declare bankruptcy.

Roberts is a single man, with a healthy zest for life. He’s also constantly tired and stressed. He said he works two jobs to make ends meet, one at a local educational institution, part-time for $15,000, and the other at a cafe, for $7 an hour, about 30 hours a week.

Neither of his jobs offers health benefits.

“My total salary for the year is probably not $20,000, and with that, I can’t afford to buy health insurance,” he said. After his monthly expenses, he said he clears $100 for going out with friends.

Roberts lives in a state of constant stress, hoping he doesn’t get sick or get injured in an accident.

“I haven’t seen a doctor in four or five years,” he said.

“I live my life hoping nothing happens to me. Luckily, so far, I’ve been healthy. But I can’t afford medicines, even if I had a doctor.”

He feels like he’s riding a thin edge. If any serious illness hit him, he would be at a loss for what to do.

“If I broke my arm and had to take time off of my job, I wouldn’t get paid, since I’m a temporary worker, and eventually, I’d lose my job.”



Employed, Adult Basic health insurance

Freddi Carlip, of Lewisburg, couldn’t afford coverage until she learned about Adult Basic. “I didn’t even know such a state program existed,” she said. Self-employed, Carlip was uninsured for many years.

“It’s very scary,” she said. “You keep hoping you won’t need to go to a hospital.”

Then a friend told her about Pennsylvania’s Adult Basic, which provides basic health insurance for adults meeting certain income requirements and who do not have health care coverage. She has been in the program for about four years.

Adult Basic, however, does not cover prescriptions or vision and dental care.

“My allergy prescriptions cost a lot,” she said. “I have asthma, and the medication is expensive. I try and stretch them out between refills.”

While in the program, Carlip had cataract surgery, which was covered. The medication needed after the procedure was not. “But I had no choice,” she said. “Despite the cost, I needed it to recover.”

Carlip said the AB program is so successful, there is a long waiting list to get in it. “You have to qualify,” she said, “but if you do, it’s a wonderful program.”