She has stood in front of the mirror, trying to practice her new smile. Because Linda Welch-Green can't afford the dentist, she has lost three front teeth. And Bell's palsy has paralyzed the right side of her face, so she struggles to pronounce words that start with "P." She never used to miss annual medical check-ups, but now she pretends not to notice when the dates slip by.
Green, 50, hasn't had health insurance for two years. Even though she is working full time, as a cashier at a downtown garage near Port Discovery, the Baltimore woman can't afford the $200 a month to cover herself and her 13-year-old son.
She tries to make do.
"You still need a good doctor," she says. "You can't do your own lab work. Everybody needs health insurance of some type, even for a cold."
Like Green, many people who don't have health insurance are employed. In fact, a report from the Kaiser Commission on Medicaid and the Uninsured shows that 80 percent of the country's 44.3 million uninsured people are full-time workers or their dependents, many of whom have low incomes.
The number of uninsured in America grew by 1 million people last year, according to figures released this week. Maryland, with its new total of roughly 837,000 uninsured people, or one-sixth of the population, had one of the biggest increases of any state.
Some employers, including half of Maryland's small businesses, don't offer health benefits. Many companies do, but the cost they pass on to workers is often more than employees such as Green can afford.
She has always had a steady job, working over the years for the telephone company, the Internal Revenue Service and the Postal Service. And for years she had the security of good health insurance, mostly Blue Cross and Blue Shield.
How she lost that insurance is typical of many Americans.
Two years ago, married and with savings, she decided to leave her job and do volunteer work at a church nursery. Months later, she became ill, landing in the emergency room with Bell's palsy. Paying out of pocket, she followed up with a neurologist for a few appointments.
Meanwhile, Green's nearly 20-year marriage was breaking up. She couldn't handle all the bills. And the yellow, two-story house in Howard Park that she had been living in and making mortgage payments on for almost 20 years was in jeopardy.
"I worked all my life to be there," said Green. "I was determined, if I could, to keep it."
Luckily, because of children's health programs, she was able to get her son, David, covered. For herself, she made a trade-off: She held onto the house, but gave up going to the doctor or dentist.
A year later, with no medical or dental care and after gaining many pounds, she realizes the price her body has paid.
"I can look at people with good health and envy them," she said yesterday. "I remember what it was like."
Postponing care is typical for people who don't have insurance.
Uninsured children, for example, are at least 70 percent more likely than their insured peers to lack medical care for common conditions such as asthma, according to the Kaiser report.
About 55 percent of adults without insurance said they postponed medical care, and a quarter said they didn't fill a prescription in the past year because they couldn't afford it.
In Baltimore, many like Green find their way to the Shepherd's Clinic, which provides primary health care for people with no health insurance. Founded in 1990 in the basement of a St. Paul Street rowhouse, the clinic has expanded and, last year, volunteer physicians and nurses treated about 4,200 patients.
Many of these people have diabetes and had to have limbs amputated. Others, with Parkinson's disease, lost many productive years.
Both situations could have been prevented, had the patients gotten prompt health care, said Dr. William Finney, a retired neurosurgeon and one of the clinic's founders. He spends much of his time trying to get pharmaceutical companies to donate medicine, which can run more than $100 a month for many patients.
"You can write them all the prescriptions you want, but if they don't have insurance," Finney said, "they can't get them filled."
Green visited the clinic for the first time last week to see if anything could be done to help resolve some of her facial paralysis.
During the appointment, doctors discovered that she had high blood pressure, a problem affecting almost half of the clinic's patients. A physician gave Green referrals, set up through an agreement with Union Memorial Hospital, for a neurologist, a dentist and a gynecologist.
But the low-tech doctoring seemed just as important.
Yesterday, a physician's assistant, Patricia Clisham, bent close to Green, giving her advice about a healthy diet and exercise.
"I want you to exercise, but don't push it too hard," Clisham told her.
Green nodded, smiling.
Later, she said, "I knew that, but you need that little extra hearing it. I need that extra encouragement."
Pub Date: 10/06/99