Over the last 22 years, that I have lived,
worked, and attended school in Champaign
C o u n t y, I have used nearly every possible
method to cover health care costs for my
daughter and myself: school insurance, Medicaid,
private HMOs, state-funded HMOs,
state-funded PPOs, and the “no insurance”
out-of-my-pocket method. My experiences taught me that
class affects one’s access to quality health care. However, I
d i d n ’t “wake-up” to the barbarism of our current health system
until I befriended a local Mexican family as part of a
language exchange. I’ll let their 4-year-old, alias Nina, tell
the story.
Hello, my name is Nina. I was born in Urbana, IL. I go to
Public Health for doctors. One time, when I was three, I went
to Public Health for my cavities. Usually there is a lady there
that speaks Spanish to me but I guess she was gone. They
made me go into a room all by myself. There were lots of
grown-ups talking but I didn’t know what they were saying. I
didn’t know when they were going to move the chair and the
things they put in my mouth made noises. I was really scared.
I wiggled a lot. The dentist didn’t look happy. I cried and the
dentist left. A lady in a white coat took me to my parents. She
didn’t say anything to me. She gave my dad a card but I didn’t
know what she said.
The next day Mom called her grown-up friend Marcia
about the card. Marcia came to my house. She said the card
had the names of special dentists for kids (I know that
because she said that in Spanish). Marcia called the dentists.
She said only one of the dentists could give me a special gas
so I wouldn’t wiggle. That dentist wanted my mom to pay hun –
dreds and hundreds and hundreds of dollars. Marcia said the
dentist didn’t take medical cards because special dentists
don’t get paid very much or they have to wait a long time to
get paid when people have a medical card. My mom said that
we didn’t have the money and Marcia looked worried.
I was worried. Even though I’d seen almost every form of
health coverage from the inside out, I didn’t expect to see a
child slipping through the cracks. On the drive home my
guilty anxiety felt like I’d swallowed a knife, with its heavy
handle in my gut and blade in my chest. To alleviate my pain
I called the only resource I could think of, the Champaign
County Health Care Consumers (CCHCC). The receptionist
suggested I contact Lisa Bell, who coordinates the Champaign
County Child Dental Access Program from her home.
“Nina” can tell you the rest.
Later Marcia called and said she I could see the special
dentist after all. Actually, since I live in the country, I’m not
supposed to go to Public Health for my teeth. I’m supposed to
see Lisa Bell. So my mom, Marcia and I went to see Lisa Bell
[4 months after the visit to Public Health]. Lisa let my mom
and Marcia come with me to the big chair. Lisa had a toy for
me to hold. After she looked at my teeth I got a big sticker.
Lisa said that she would call that special dentist and say we
wouldn’t have to pay (Marcia said that in Spanish). I think
Lisa will pay the dentist more money.
[A month] later my mom, Marcia and I went to the special
dentist. She had lots of movies and toys for kids and lots of
colors. I felt special. She also let my mom and Marcia come
with me to the big chair. After the special dentist said things
in English, Marcia repeated them in Spanish. That helped me
know about the gas. My mom and Marcia talked to me a lot
and held my hand and my foot while the dentist was working.
I was just a little scared and I knew to open my mouth really
big. I felt safe. When the gas ran out, I started to pull my hand
up close to my body because my mouth was hurting and I was
getting scared. I started to make a noise like I might cry and
the dentist stopped. She said she didn’t want me to be scared.
She noticed me. I got a toy and I didn’t cry.
My mom says we will go back to the special dentist to fin –
ish the cavities. I know it’s a long time from when I went to
Public Health because I’m 4 1/2 now and I know how to use
the pink fluoride water that the special dentist gave me.
After realizing how out of touch I was with the limitations
of public health care, I conducted a series of interviews with
local activists. Jim Duffett at the Campaign for Better Health
Care taught me that Nina’s experience was not too different
from the many people who use a medical card to cover health
costs. Medicaid recipients often hit a brick wall when referred
to specialists. Few, if any, specialty practitioners are willing
to accept patients with a medical card. Some refuse simply
because they lose money from 1) severely delayed and lowrate
state reimbursements, and 2) increased no-shows from
failed transportation. Others refuse because they do not want
to work with patients they deem to be the riff-raff (i.e., classism,
racism, prejudice…call it what you want). Specialty
programs like the Dental Access Program are often the only
way for Medicaid recipients to see a specialist, and even then
there are long delays (7 months to complete the work in
Nina’s case).
To learn more about the Dental Access Program, I visited
Lisa Bell in her home office. I was amazed at all the work she
does behind the scenes to ensure that children like Nina have
better teeth. She voluntarily educates school children about
brushing their teeth, staying up late to stuff child-friendly
dental kits with her son. She seizes every opportunity to voice
her concerns at a political level. In the middle of my interview,
she called the Illinois Governor’s office to seek more
information about their policies regarding children’s health
care. She works non-stop to secure continued funding for the
Dental Access Program. “Eventually, we’re going to run out
of money and children like you’re little friend will just suffer,”
she warned. I was amazed at how much work it takes for
just one child to see a dentist.
My final interview was with Dr. Ann Robin, a local gynecologist
working atUIUC’sMcKinley Health Center who quietly
puts time in at The Pavillion and Planned Parenthood sites
across central Illinois. She taught me that even though programs
that extend access to health care specialists exist, their
requirements still leave individuals with piecemeal treatment.
The DentalAccess Program is for rural children only: families
within city limits must pay specialists out of pocket. T h e
S t a t e ’s Breast and Cervical Cancer Screening and Tr e a t m e n t
Program covers mammograms and PA P smears and procedures
to remove breast or cervical lesions for income eligible
women. Uninsured women at middle income levels or women
with complicated cases are stuck (e.g., heavy bleeding from
fibroids precludes treatment for cervical lesions, but fibroid
removal is not covered). Women who are non-citizens can
have a medical card while they are pregnant, but only for 2
months after they give birth. Those women who need longterm
treatment (e.g., follow-up work from a complicated Csection,
support for post-partum depression, etc.) are out in the
cold. The medical card will cover specialty interventions for
things like diabetes but not the specialty care for infected
gums that so often accompany and aggravate this condition.
Dr. Robin rattled at least 5 more examples off the top of
her head, including problems with patients crossing state
lines, etc. The bottom line is that time and again people with
these more common complicated cases become rooted in a
vicious downward spiral. In the end, the “behind the scenes”
work for piece-meal treatment ends up costing far more than
providing quality comprehensive care in the first place.
My search ended in emotional exhaustion. Is this really the
status of health care in my community? Do we really de-value
people so much, especially innocent children, that we are willing
to let them rot away simply because they cannot pay?
One step toward bettering access is the Illinois All Kids
Healthcare Program proposed by Governor Blagojevich that
begins July 1, 2006. This program offers affordable health
insurance on a sliding scale for Illinois children 18 or
younger, regardless of family income, and regardless of legal
status and pre-existing conditions. Basically it extends programs
like Medicaid and Kid Care to higher income levels
and replaces the primary provider approach with a more
effective case management approach that follows participants
over time (i.e., to ensure comprehensive care).
As good as it sounds, only time will reveal this program’s
success. To ensure that the program is serving the truly “uninsured”,
children must be uninsured for at least 6 months
before being enrolled in the program (eventually this will
increase to 12 months). Even though it would not be “cost
effective” for currently insured families at higher income levels
to switch to All Kids, theoretically, families who are barely
covering health insurance costs could risk going “uninsured”
just to qualify for less-expensive premiums. Even
though a consultant for Gov. Blagojevich is spreading the
promise of timely payments at competitive rates, providers
may not sign on at the necessary rate, thereby overwhelming
an already drained system. Consequently, children like Nina
would have to compete for the few available slots with even
more children, many who could afford care elsewhere.
For the near future, it still seems we’ll be a lot closer to
filling the pockets of health insurance CEOs than putting
people over profit. Or, as Nina would say, “Insurance companies
will get to keep their big buildings.” After speaking
with several local health care advocates for this article, I am
more convinced than ever that we need a more streamlined
single payer system for health care, and I’d like to add a coste
ffective wrap-around program for families and young children
to that plan (e.g., prenatal and postnatal nurse home visiting).
I hope we get before my daughter, let alone Nina, has children.
worked, and attended school in Champaign
C o u n t y, I have used nearly every possible
method to cover health care costs for my
daughter and myself: school insurance, Medicaid,
private HMOs, state-funded HMOs,
state-funded PPOs, and the “no insurance”
out-of-my-pocket method. My experiences taught me that
class affects one’s access to quality health care. However, I
d i d n ’t “wake-up” to the barbarism of our current health system
until I befriended a local Mexican family as part of a
language exchange. I’ll let their 4-year-old, alias Nina, tell
the story.
Hello, my name is Nina. I was born in Urbana, IL. I go to
Public Health for doctors. One time, when I was three, I went
to Public Health for my cavities. Usually there is a lady there
that speaks Spanish to me but I guess she was gone. They
made me go into a room all by myself. There were lots of
grown-ups talking but I didn’t know what they were saying. I
didn’t know when they were going to move the chair and the
things they put in my mouth made noises. I was really scared.
I wiggled a lot. The dentist didn’t look happy. I cried and the
dentist left. A lady in a white coat took me to my parents. She
didn’t say anything to me. She gave my dad a card but I didn’t
know what she said.
The next day Mom called her grown-up friend Marcia
about the card. Marcia came to my house. She said the card
had the names of special dentists for kids (I know that
because she said that in Spanish). Marcia called the dentists.
She said only one of the dentists could give me a special gas
so I wouldn’t wiggle. That dentist wanted my mom to pay hun –
dreds and hundreds and hundreds of dollars. Marcia said the
dentist didn’t take medical cards because special dentists
don’t get paid very much or they have to wait a long time to
get paid when people have a medical card. My mom said that
we didn’t have the money and Marcia looked worried.
I was worried. Even though I’d seen almost every form of
health coverage from the inside out, I didn’t expect to see a
child slipping through the cracks. On the drive home my
guilty anxiety felt like I’d swallowed a knife, with its heavy
handle in my gut and blade in my chest. To alleviate my pain
I called the only resource I could think of, the Champaign
County Health Care Consumers (CCHCC). The receptionist
suggested I contact Lisa Bell, who coordinates the Champaign
County Child Dental Access Program from her home.
“Nina” can tell you the rest.
Later Marcia called and said she I could see the special
dentist after all. Actually, since I live in the country, I’m not
supposed to go to Public Health for my teeth. I’m supposed to
see Lisa Bell. So my mom, Marcia and I went to see Lisa Bell
[4 months after the visit to Public Health]. Lisa let my mom
and Marcia come with me to the big chair. Lisa had a toy for
me to hold. After she looked at my teeth I got a big sticker.
Lisa said that she would call that special dentist and say we
wouldn’t have to pay (Marcia said that in Spanish). I think
Lisa will pay the dentist more money.
[A month] later my mom, Marcia and I went to the special
dentist. She had lots of movies and toys for kids and lots of
colors. I felt special. She also let my mom and Marcia come
with me to the big chair. After the special dentist said things
in English, Marcia repeated them in Spanish. That helped me
know about the gas. My mom and Marcia talked to me a lot
and held my hand and my foot while the dentist was working.
I was just a little scared and I knew to open my mouth really
big. I felt safe. When the gas ran out, I started to pull my hand
up close to my body because my mouth was hurting and I was
getting scared. I started to make a noise like I might cry and
the dentist stopped. She said she didn’t want me to be scared.
She noticed me. I got a toy and I didn’t cry.
My mom says we will go back to the special dentist to fin –
ish the cavities. I know it’s a long time from when I went to
Public Health because I’m 4 1/2 now and I know how to use
the pink fluoride water that the special dentist gave me.
After realizing how out of touch I was with the limitations
of public health care, I conducted a series of interviews with
local activists. Jim Duffett at the Campaign for Better Health
Care taught me that Nina’s experience was not too different
from the many people who use a medical card to cover health
costs. Medicaid recipients often hit a brick wall when referred
to specialists. Few, if any, specialty practitioners are willing
to accept patients with a medical card. Some refuse simply
because they lose money from 1) severely delayed and lowrate
state reimbursements, and 2) increased no-shows from
failed transportation. Others refuse because they do not want
to work with patients they deem to be the riff-raff (i.e., classism,
racism, prejudice…call it what you want). Specialty
programs like the Dental Access Program are often the only
way for Medicaid recipients to see a specialist, and even then
there are long delays (7 months to complete the work in
Nina’s case).
To learn more about the Dental Access Program, I visited
Lisa Bell in her home office. I was amazed at all the work she
does behind the scenes to ensure that children like Nina have
better teeth. She voluntarily educates school children about
brushing their teeth, staying up late to stuff child-friendly
dental kits with her son. She seizes every opportunity to voice
her concerns at a political level. In the middle of my interview,
she called the Illinois Governor’s office to seek more
information about their policies regarding children’s health
care. She works non-stop to secure continued funding for the
Dental Access Program. “Eventually, we’re going to run out
of money and children like you’re little friend will just suffer,”
she warned. I was amazed at how much work it takes for
just one child to see a dentist.
My final interview was with Dr. Ann Robin, a local gynecologist
working atUIUC’sMcKinley Health Center who quietly
puts time in at The Pavillion and Planned Parenthood sites
across central Illinois. She taught me that even though programs
that extend access to health care specialists exist, their
requirements still leave individuals with piecemeal treatment.
The DentalAccess Program is for rural children only: families
within city limits must pay specialists out of pocket. T h e
S t a t e ’s Breast and Cervical Cancer Screening and Tr e a t m e n t
Program covers mammograms and PA P smears and procedures
to remove breast or cervical lesions for income eligible
women. Uninsured women at middle income levels or women
with complicated cases are stuck (e.g., heavy bleeding from
fibroids precludes treatment for cervical lesions, but fibroid
removal is not covered). Women who are non-citizens can
have a medical card while they are pregnant, but only for 2
months after they give birth. Those women who need longterm
treatment (e.g., follow-up work from a complicated Csection,
support for post-partum depression, etc.) are out in the
cold. The medical card will cover specialty interventions for
things like diabetes but not the specialty care for infected
gums that so often accompany and aggravate this condition.
Dr. Robin rattled at least 5 more examples off the top of
her head, including problems with patients crossing state
lines, etc. The bottom line is that time and again people with
these more common complicated cases become rooted in a
vicious downward spiral. In the end, the “behind the scenes”
work for piece-meal treatment ends up costing far more than
providing quality comprehensive care in the first place.
My search ended in emotional exhaustion. Is this really the
status of health care in my community? Do we really de-value
people so much, especially innocent children, that we are willing
to let them rot away simply because they cannot pay?
One step toward bettering access is the Illinois All Kids
Healthcare Program proposed by Governor Blagojevich that
begins July 1, 2006. This program offers affordable health
insurance on a sliding scale for Illinois children 18 or
younger, regardless of family income, and regardless of legal
status and pre-existing conditions. Basically it extends programs
like Medicaid and Kid Care to higher income levels
and replaces the primary provider approach with a more
effective case management approach that follows participants
over time (i.e., to ensure comprehensive care).
As good as it sounds, only time will reveal this program’s
success. To ensure that the program is serving the truly “uninsured”,
children must be uninsured for at least 6 months
before being enrolled in the program (eventually this will
increase to 12 months). Even though it would not be “cost
effective” for currently insured families at higher income levels
to switch to All Kids, theoretically, families who are barely
covering health insurance costs could risk going “uninsured”
just to qualify for less-expensive premiums. Even
though a consultant for Gov. Blagojevich is spreading the
promise of timely payments at competitive rates, providers
may not sign on at the necessary rate, thereby overwhelming
an already drained system. Consequently, children like Nina
would have to compete for the few available slots with even
more children, many who could afford care elsewhere.
For the near future, it still seems we’ll be a lot closer to
filling the pockets of health insurance CEOs than putting
people over profit. Or, as Nina would say, “Insurance companies
will get to keep their big buildings.” After speaking
with several local health care advocates for this article, I am
more convinced than ever that we need a more streamlined
single payer system for health care, and I’d like to add a coste
ffective wrap-around program for families and young children
to that plan (e.g., prenatal and postnatal nurse home visiting).
I hope we get