Rosalie sounded tired when she called me. And her words matched the impression her voice left.
She said she's 54, bedridden by arthritis, and living basically "off the odds and ends my nieces and nephew can give me." Working to support herself isn't an option, she said, because of the chronic pain.She called because she wanted to talk about the way Utah provides - or fails to provide - health care for those who are too poor to pay for it themselves or who don't have insurance.
That subject has come up a lot lately. The bulk of a meeting last week between the Department of Health and Utah Issues, an advocate for low-income people, centered around possible elimination of the Utah Medical Assistance Program (UMAP).
No definite plans have been made to eliminate UMAP, but because it is state funded - and optional - it becomes vulnerable when financial cuts are made in the Health Department budget. It's been cut before.
In the fiscal year 1989 budget, $1.6 million was transferred from the $6 million budget to supplement the Medicaid budget. Utah hospitals graciously agreed, for one year only, to accept a much lower reimbursement rate from UMAP in order to keep it alive.
Maybe $6 million sounds like a lot of money to provide what some people consider "charity care." But the number of people who have no income, no insurance, and very little hope is staggering.
Only a small proportion of that large number even qualify for UMAP, which has a statewide caseload of about 6,600 recipients.
The criteria is stringent: You have to be ineligible for Medicaid or Medicare, have a monthly income of less than $289 and countable assets less than $500 a person or $700 for a couple. Even then, UMAP won't help with run-of-the-mill medical problems.
The condition has to be acute, infectious or life-threatening. In a report, the Health Department listed examples of problems that might be eligible: heart conditions, heart attacks, prneumonia, cancer, AIDS-related conditions, diabetes, high blood pressure, accidents and injuries.
Rosalie doesn't qualify. She's miserable and in constant pain, but her condition is chronic. She's not going to die of arthritis, although I believed her when she said there are days she wouldn't mind. She's in agony. She's also in the well-populated land that exists between medical safety nets.
I can't help but question whether the whole system - not just UMAP, but Medicaid and other programs - is set up right.
Look at Medicaid's adult dental program (or lack of program). The state will not provide funds for low-income people to keep their teeth. It provides only temporary fillings and extractions. If you have enough extractions, it won't provide dentures.
But medical conditions caused by poor or non-existent teeth that become serious - even life-threatening - may qualify for care.
It would seem more cost-effective (and money's the driving force behind the problem) to take care of some of the illnesses earlier, when they are manageable and less expensive.
State officials agree, too, but they don't have a lot of say in the programs - they just administer them with the money the Legislature provides.
I understand that if there's limited money, you take care of those with the most serious problems. And you don't get more serious than "life-threatening."
But I also know that medical problems, when allowed to run rampant, generally get worse. I'm not talking about a cold that runs its course with or without treatment to relieve symptoms. I'm talking about genuine health problems that aren't life-threatening but can evolve to that stage. When that happens, the cost is frequently higher than the preventive or early treatment methods would have been.
UMAP and similar programs serve a tremendous - and humane - purpose. They help people like a 24-year-old from rural Utah who had cancer and required more than $30,000 worth of treatment before he was cured. UMAP has paid for major surgeries, helped diabetics, hypertensives and countless other people. It's been a humane program . . . as far as it goes.
I worry about what will happen to the poor if any more cuts are made. Until 1987, counties had an obligation to take care of their indigent populations. Then the state legislature removed that obligation, without designating anyone else to do the job.
But then, I worry about a lot of things. Like the quality of life.