Choice of purchasing insurance is tough question for working mom

Wednesday, December 16, 2009 | 5:24 p.m. CST; updated 5:54 p.m. CST, Wednesday, December 16, 2009
Sandra Hawkins sits by the fire with her son, Brayden, and dog, Lola, to relax after dinner. Hawkins has not had health insurance for her or Brayden, now 10, since he was an infant. Her jobs have not provided health coverage, and she cannot afford to pay for coverage on her own.

COLUMBIA – Sandra Hawkins has a choice: work full-time without health benefits and become ineligible for Medicaid coverage for her son, or continue to work part-time and get the coverage her family needs.

Hawkins just received a promotion to work full-time and a raise at Cool Stuff, an eclectic gift shop downtown. The raise could make her family ineligible for Medicaid coverage, and her employer can't provide health insurance.

Together, Hawkins and her boss, Arnie Fagan, have mulled over questions like, how many hours per week make her ineligible for Medicaid? Or what other health care plans could she consider?

Hawkins has not had private health insurance in more than 10 years and so has become familiar with Missouri’s Medicaid program.

When Hawkins was pregnant with her son Brayden, now 10, Medicaid kicked in to cover them both. The program covered Hawkins for six weeks and her son for six months after he was born, she said. Since then, neither Hawkins nor her fiance, a roofer, have had jobs that provided health insurance for their family.

They have had to pay medical costs out of pocket, which at times have reached $600. That's how much it cost for the medications, shot and emergency room visit  Brayden needed when he had strep throat, Hawkins said. “Without insurance, you get to stack up hospital bills,” she said.

Hawkins’ easy smile and heartfelt laugh make juggling these concerns look easy. In reality, Hawkins has become adept at steering her way through the Medicaid system when she qualifies – and paying for medical care when she doesn’t.

“The state does provide a lot of help for people, and I do appreciate that,” Hawkins said. “As far as Medicaid goes, you can’t make over a certain amount to qualify. It takes a couple weeks to get your notice back if you’re going to get covered or not.”

Now, Hawkins and her fiance are expecting a child – which, fingers crossed, means that her children will be eligible for Medicaid coverage. Next week on Dec. 21, Hawkins plans to fill out the necessary forms to update her family’s information with the state. She could potentially be covered until six weeks after giving birth, but she hopes the coverage will continue for her children.

“I think it can cover (a child) up to 5 years old, but I’m not sure. The baby will be covered for several months after,” Hawkins said. “It’s different for every family. Basically the only way that I could get on there was to take in a positive pregnancy test from my doctor.”

What's the solution?

Hawkins has mixed feelings about what a public insurance option would do for her family. “Some things about it are good. More people would have a chance,” she said. “But it opens up a lot of questions as to who’s going to be covered and payment. If my child has to go to the ER, would it be covered?”

Insurance companies and employees would be affected as well. Because she has  worked in the health insurance industry, Hawkins is skeptical about the repercussions a public insurance option will have. “It would be hard on individual and private insurance companies,” she said.

She is also nervous about the government potentially organizing and running a public option. “I think the government needs to butt out of some stuff, personally," she said. "I definitely hope that they plan it better before they get something going.”

Meanwhile, Hawkins and her fiance continue to do what they can to make sure their family has the care they need. They take it day-by-day and hope that they don't have serious health problems.

“It is something that we wish that we could have all the time, but it’s unfortunate that we can’t,” Hawkins said. “It’s almost like we get penalized for trying.”

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