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Even When Employed, Health Care A Challenge

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Zumba is a fitness craze; a high-energy dance and exercise program. You can find it in high-end gyms and even the community center in Hazelwood, Mo., where Casaundra Bronner, 40, lives.

Still breathing heavily, Bronner comes out to her car after one of the classes and turns on a small digital recorder she's been using for the past year to document her experiences.

"It was fun as always," she says. "But it's a lot of work."

Bronner is one of six people from the St. Louis area whom NPR has been following for a little more than a year. Like the others, she started 2011 unemployed and searching for work. Like so many Americans who have struggled in this tough labor market, the people we followed have had difficulty getting health coverage. And for some, including Bronner, it didn't stop when they got jobs.

Yes, she has fun doing Zumba, but as she explains into the recorder, that's not the only reason she goes to this class.

Fully Employed And Uninsured

"Because I don't have insurance right now, it's even more important that I stay healthy and keep any potential problems at bay," Bronner says. "I'm borderline high blood pressure. Both of my parents have diabetes and high blood pressure, so it's, you know, really important I try to stay as healthy as possible."

For the majority of Americans, health insurance is something that comes with a job. That's the way it always was for Bronner until two years ago when she lost her job in the marketing department at Anheuser-Busch.

"That's been kind of weird and different because I've had insurance for as long as I can, you know, remember," she says.

But just to be clear, she is one of the lucky ones. Bronner started working full time again back in March, but she still doesn't have health insurance. She works for a small event planning company and her boss says insurance is just too expensive.

"And she's married, so she's on her husband's [insurance], so she's covered," Bronner says of her boss.

On Bronner's salary — half of what she made in her last job — she can't afford to go out and buy insurance on her own. Her daughters, who are in elementary school, are covered under a state program for the working poor.

"I go to the doctor when I need to and I just pay out of pocket," Bronner says. "But hopefully nothing serious will happen."

Of the six people in our series, only one has had health insurance the entire time, and that's because his wife works as a teacher and he was able to get coverage through her plan. Everyone else has gone extended stretches without coverage. Even now, with everyone at least partially employed, half don't have insurance.

An Emergency Room Visit

"Today is June 4th, 2011. My name is Annica Trotter and I'm headed to the emergency room," Trotter, 26, says into her recorder.

She's having chest pains. It's been happening for a few months: aching pain in the middle of her chest that radiates out to her shoulder. It hurts, it slows her down, and on this day, it flared up while she was doing housework.

"At about 12 my chest just really started hurting, so I slowed down, then I just stopped cleaning completely, hoping that maybe it will go away, but it's not going away," says Trotter, sounding upset.

She is in the group that's having to do without. She had good coverage when she worked at a social services agency. In her new job as a receptionist making $14 an hour, she says the insurance barely covers the basics. She says none of her co-workers signed up for it, and neither did she because the monthly employee portion is more than she can handle.

"Not only am I worried about the pain that I'm having and how frequent it's been over the last couple weeks, I'm worried about the money," Trotter says. "I can't afford this. I cannot afford this today. I just got paid yesterday. It goes in one hand and out the other. I'm paying rent, paying car notes, insurance and all that stuff, and I know that I cannot afford to go to the emergency room today."

There's a history of cardiovascular disease in her family. She is frustrated and scared. She cusses into the recorder.

"As soon as I think that I am getting my ducks in a row, something like this happens," says Trotter, now in tears. "I know that I put this off for a really long time and I feel like I can't ignore it right now, so I know I just have to go."

Trotter doesn't take her recorder into the hospital. They perform lots of tests and ultimately tell her it's either a muscle strain or stress or both.

"And I just had instructions to reduce stress and call back if things got worse," she says later.

As Trotter puts it, all she got out of the visit was a big fat bill. Eventually, the hospital agreed to reduce what she owed, but months later, she's still chipping away at the bill.

And so, like Bronner, she just hopes nothing else goes wrong.

'Get That Insurance, And We'll Get That Looked At'

For Randy Howland, 51, the need for regular medical care is arguably even greater. But he hasn't had insurance in a decade. He's had seizures in the past, even once, a long time ago, when he was driving.

"And that was a full collision," Howland says. "I hit a school bus. The school bus luckily didn't have kids on it. Our car was totaled. I was limping for quite some time."

He takes medication for it, which he pays for out of pocket, and is supposed to get regular blood tests and other monitoring. But he rarely does. His attitude is almost fatalistic.

"Get that insurance and we'll get that looked at," he says.

But every time Howland has come close to getting insurance, he's either lost his job or realized that on $10 or $12 an hour, he simply couldn't afford it. On a number of occasions, he and his wife, Lisa, have chosen paying the mortgage over paying for insurance.

"I worry about his medical condition, and I worry every day he gets in the car," Lisa says. "There's nothing I can do about it. I just have to get up every day, say my prayers and hope that somebody's watching out for us."

This line of discussion clearly makes Randy uncomfortable. He pipes in and asks the last time his wife has gotten a mammogram. It's been years.

"I worry more about you than myself, dear," she says, looking over at her husband. "And you know that."

Randy Howland just started a new job that pays a little better than the last one. And he's hoping this time, finally, he will be able to get insurance.

Bronner has started looking for a position with a company that offers insurance, and she says employers seem much more responsive than when she was unemployed. And Trotter? She's not sure what to do.

Copyright 2012 National Public Radio. To see more, visit http://www.npr.org/.

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