Living with the consequences of living without insurance


AMONG THE 40 million Americans who can't afford health insurance and who live with the consequences is Joseph Rauh, a 54-year-old diabetic with cancer, a heart condition and a disabling psychological disorder. Last week, while Rauh was in a Baltimore hospital, a crew of workers threw his couch, his television set, his tables and chairs and a pile of other belongings into the street in front of his rowhouse.

Until recently, Joseph Rauh was the proud owner/occupant of a house on North Lakewood Avenue, near Patterson Park on the southeast side of the city. As of this week, he resides in the basement of his former son-in-law's rented house in Baltimore County. His wife, Alice, has been staying in the basement of a daughter's rowhouse many miles away. They are bankrupt and may be legally separated for a long time -- in the Rauhs' case, not a bad thing: It means the government finally might pay for Joseph's costly prescriptions.

That's where all the troubles apparently started -- with the high cost of Joseph Rauh's medicines.

The $9.27 Alice makes each hour she works in a Canton nursing home, combined with her husband's disability benefits, adds up to too much annual income -- maybe as much as $27,000 between the two -- and thus the government's unwillingness to spring for her husband's prescriptions. Plus, the Rauhs owned their own home -- a two-story Formstone for which they paid $6,500 in 1971 -- and such an asset makes them ineligible for further assistance, in the eyes of the government.

Many of the nation's working poor, who've tried to get help with medical bills, are familiar with these standards. The one-two punch of Reagan-era reforms and Clinton-era failures left 40 million Americans without health insurance and a government with higher, harder thresholds for handouts. Some call this compassionate conservatism. I call it ineffective and inviting cruelty.

Without irony, Alice Rauh reflected the other day that losing her house and being separated from her husband for a time might not be so bad. If they live apart and her pay isn't figured into the equation, Joe might be able to buy his medication without dipping into the $1,016 he gets each month in disability benefits, she said. He might be able to find a small apartment. He might live longer.

The Rauhs lost their house, but at least they're still alive, right? I even heard Alice Rauh say she was "grateful." This was after she stopped breaking into tears, telling me how embarrassed and sad she was at the turn her life had taken.

The Rauhs always lived modestly. Joe had various handyman, painting and home-repair jobs; he installed a lot of drop-ceilings in his day. Alice worked part time after their three children were born. They had a 30-year mortgage on the house and managed to pay it off in about 20. "We had no creditors, and we gave our kids a good education," Alice Rauh says.

But along the way Joe developed throat cancer and a psychological disorder -- "He had a hard childhood and things caught up with him," his wife explains -- and he stopped working regularly. He applied for -- and received, even under the more stringent guidelines of the Reagan era -- federal disability benefits. That made life more difficult for the Rauhs, but they managed to get by for more than a decade.

It wasn't until a few years ago, when a doctor warned Joe he needed surgery on his heart, that the Rauhs realized that a lack of health insurance could lead to financial crisis. Joe's prescriptions -- for diabetes, the heart condition and cancer treatments -- were taking almost every penny of his monthly disability benefits. Debts and bills from Joe's medical treatments piled up. The Rauhs borrowed money from friends and relatives.

About three years ago, they decided to take out a second mortgage to pay off their debts.

The refinancing left them with a monthly bill of $268.

Alice took a $7-an-hour job in a nursing home, walking more than 20 blocks to work every day. "We figured we could make it," she says.

But they didn't.

While Joe qualified for government benefits to pay for doctor visits and some hospitalization, he could not get help with his prescriptions, and that monthly expense ran to between $1,400 and $1,500. So, Joe says, he started making only partial mortgage payments -- a fact he hid from his wife, who had entrusted him with the monthly bills.

"I thought he was making the payments," Alice Rauh says. "I didn't know we had fallen so far behind."

She didn't know that Joe had received foreclosure warnings from the mortgage company.

"If I didn't get my prescriptions, I could have paid my bills," Joe explains. "That's the choice."

He chose prescriptions.

They lost the house in a foreclosure. It was sold at auction a few weeks ago.

The Rauhs were given a deadline for vacating and, each day for a couple of weeks, Alice Rauh walked home and packed up belongings in boxes and bags and tried to find places to store them. But she ran out of space and time, and one cold day last week a crew of workers cleaned the place out and tossed all that remained of Alice and Joseph Rauh's 33 years there onto Lakewood Avenue.

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