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Isabelle Felder Gillis, RN (standing), medical clinic manager at the Native American Health Center in San Francisco, says her clinic treats some uninsured patients without payment because clinic workers see it as their mission to give the best care they can. The center’s mural (inset) was painted by four local American Indian artists, including the coordinator of the project, Melanie B. Bein, an art therapist at the center’s Family and Child Guidance Clinic.

More than once, Isabelle Felder Gillis, RN, BSN, PHN, has found herself on her couch at 5 AM, coffee in hand, making phone calls to find a hospital bed or an appointment for an uninsured patient who needs care. An increasing number of uninsured patients and a shrinking pool of resources mean Felder Gillis, medical clinic manager at the Native American Health Center in San Francisco, must get up before dawn to secure health care for her patients.

“Uninsured patients distort everyone’s concept of office hours,” she said. Despite her early rising, she often ends up with a spot on a waiting list rather than a bed or an appointment.

For Felder Gillis and many other nurses, the nation’s health insurance crisis is not just a newspaper story or a political debate. It’s a frustrating and heartbreaking reality they face every day.

Although almost all nurses working in hospitals receive health insurance benefits for themselves and their families, not all retired nurses and nursing students have adequate, affordable coverage. Nurses who work as independent practitioners or who run clinics feel the financial crunch when they treat uninsured patients who can’t pay but who have nowhere else to go.

Nurses in hospitals worry about sending home patients who won’t receive follow-up care for illnesses such as cancer or diabetes. In emergency departments and community clinics, nurses feel the strain of treating increasing numbers of people who have nowhere else to go. Home health nurses spend hours of their days looking for ways to help uninsured patients pay for their health care.

“How much nurses are affected depends on what their role is,” said Sara Jarrett, RN, EdD, MA, MS, associate professor at the Regis University department of nursing in Denver. “They’re all affected in different ways.”

Nurses’ opinions about the best way to solve the problem of the uninsured vary considerably, like those of the rest of the country. But most agree on two things: The discussion must be continued and nurses, as frontline health care providers, must take part in it.

Statistics show a health insurance problem in the United States of staggering proportions:

> Nearly 44 million people in the United States do not have health insurance. About one in five adults and one in 12 children did not have coverage in 2002, according to U.S. Census figures. About 85 million people did not have coverage at some point between 1996 and 1999, according to a study published last winter in Health Affairs.
> About 18,000 people die unnecessarily every year because they don’t have health insurance, according to Institute of Medicine reports. The reports estimated that the poor health and early deaths of uninsured adults cost the country some $65 billion to $130 billion annually.
> Some hospitals have closed or limited services because they could not afford the financial burden of caring for the uninsured, the reports stated. Tax dollars paid for an estimated 85% of about $35 billion in unreimbursed medical care in 2001. That figure is expected to rise to $41 billion in 2004, according to a report from the Kaiser Commission on Medicaid and the Uninsured.

Between 2001 and 2002, the number of uninsured Americans rose by nearly 2.5 million, according to census figures, and many expect it to increase. Employers pay for most health coverage in the United States, but pointing to rising premium costs, many say they no longer can afford full coverage for employees and their dependents.

Health care costs are the most cited reason for bankruptcy, said Catherine Dodd, RN, MS, district director for House Democratic Leader Rep. Nancy Pelosi (D-Calif.) and former regional director of the U.S. Department of Health and Human Services under the Clinton administration. “Everyone has a story, everyone knows someone who has been burdened by a major illness or an injury.”

Because of the nursing shortage, almost all nurses who work for hospitals have health benefits, said Deborah Burger, RN, a diabetes care manager at Kaiser in Santa Rosa, Calif., and president of the California Nurses Association.

But Burger said she knows two retired nurses who have returned to work a few days a month to pay for their insurance plans. One who has two preexisting conditions — high blood pressure and high cholesterol — pays $900 a month for her health insurance, Burger said.