Interview with Maria Gumaer

Hedrick Smith: We’re in Downey, California, talking to Maria Gumaer. Maria, tell me what do you do?

Maria Gumaer: I do accounts payable for a flooring distributor. I’ve been working for this company for over three years in October.

Hedrick Smith: Does your employer provide you with health insurance?

Maria Gumaer: Yes, they do but it’s very expensive. I can’t afford it. For a family of four, I think it’s almost four hundred dollars for the medical part. And the co-payments are twenty dollars per visit regardless of how many times you go to the doctor a year. And if you have to go to the hospital, you pay thirty percent of the bill regardless of how much money it is. And the insurance pays the other seventy percent. What makes matters even worse is the only thing they offer is just the medical itself; they don’t offer dental and they do not offer the optometrist.

Hedrick Smith: All right, now tell me about your economic situation and your family situation. How much do you make? How many kids do you have? So what’s your family situation?

Maria Gumaer: Okay, I make twenty-six thousand dollars a year. And if I had to pay for insurance — I also have to pay for my car insurance, my car payment, child care, and I have to support a family of three and my rent.

Hedrick Smith: So, you couldn’t handle the insurance?

Maria Gumaer: No, I couldn’t.

Hedrick Smith: Tell me a little bit about what it was like before you got Healthy Families. What kind of medical bills did you have with the old plan?

Maria Gumaer: Well with my old plan, the co-payment that I had before was twenty dollars per person. And my oldest one, Denika, she has asthma. That would go back since she was six years old that I could keep track of. And I have never, ever followed up on her medication or her follow-up with the doctor because every time she needed to go to the doctor at least twice a month, that was forty dollars. Then on top of that, every time she went in she was given a different medication between three and four types of medications, ten dollars apiece. Then I’d go back two weeks later and they’d tell me this medication’s not working, we’re going to prescribe this other for her. Here we go again. Forty dollars down the drain because this other forty dollars that I had spent on medication wasn’t good enough for her. So once she got better, I kind of became her own doctor. Once I saw her, she was doing better, her breathing was better, I just took her off the medication and waited until she got sick again. She’s never really been an asthmatic that I have to rush her to the hospital. But once she started getting sick like that, I would take her again and I will start all over the procedure and here we were back again to the same place that we were before because we’re talking forty dollars for the co-pay and the medication all over again.

I couldn’t afford it. That was too expensive. And then there was times — at one time all three of us got sick and I had to decide which of the three was worst off where I had to take her to the doctor because I didn’t want to spend the sixty dollars. Then you end up going to Emergency, you pay fifty, seventy-five dollars. Then go back on Monday and spend the twenty dollars for them to see their regular doctor.

So a lot of times, because of the twenty dollar co-pay, I would avoid the visitation to the doctor. Because, if I had to pay twenty, twenty, twenty, twenty that would be sixty plus forty dollars more in medication; that would be a hundred dollars. And if I have to spend a hundred dollars every two weeks, we’re talking two hundred dollars. Here you’re paying so much more money for the medical part, then on top of that you’re paying for ten dollars for the medication again and the twenty dollar co-pay.

Hedrick Smith: On top of your daughter’s asthma, were there any medical emergencies you had to deal with?

Maria Gumaer: Well, during the time that we didn’t have Healthy Families, she used to complain about headaches a lot, and I would take her to the doctor. And, you know, you go to the doctor, they check her, she’s fine, blah, blah, blah. Then she goes back a week later and the same thing over and over. So finally one day I took her to Emergency and unfortunately you have to exaggerate things for things to get done. And I had to exaggerate this; she was having headaches and she went in there and they gave her a CAT Scan and all that. And I don’t know exactly how - the bill came out to a thousand dollars. And out of a thousand dollars, we had to pay the three hundred.

Hedrick Smith: You've built up quite a lot of medical bills. Were there any other medical emergencies?

Maria Gumaer: There was a period that they did not offer medical benefits for any members of your family, just the employee. During that time, my daughter broke her wrist three times. And one of the times I took her to Emergency, I didn’t have insurance--any money for that matter. I took her in, they took care of, put her cast on and so on. I tried to pay them as much as I could, and I kept getting letters, but I’d ignore them because I’ve never been in a situation like that. The next thing I know, I get a court order saying that I owe six or eight hundred dollars, I quite don’t recall. And I ignored the letter too because I figure as long as I’m making my twenty-five dollar a month, monthly payments they’re not going to bother me. Well the next thing I know, my wages start getting garnished. And I tried going back to court or trying to fight this garnishment and trying to prove to them that I was a single mom with two children and I was trying to make the payments the best I could. But the judge didn’t care so they went ahead and took three hundred dollars out of my paycheck twice a month until they took all the six or eight hundred dollars, whatever it was, that I owed at the time.

Hedrick Smith: Where did you, where did you hear about Healthy Families?

Maria Gumaer: I’ve always heard about Healthy Families. I kept reading about Healthy Families; I kept looking at it on TV but I just thought there’s just no way; I don’t think I would ever qualify. You practically have to be poor in order for you to qualify for anything to do with the government. And one time I went over my parents’ and there was this brochure from Downey Community Hospital. I was waiting for my parents and I started reading every single page in that pamphlet.

When it came to the last page, there was Healthy Families and the phone number. Then when I went home, I just took it with me; for what reason I have no idea, I just took it with me. And when I came home I made a phone call. And that’s how I found out about Healthy Families. And when I talked to them, I told them my situation and for sure I thought they were going to say no. I told them how much I made and they said that I qualify. So when they said that, I got all excited, and I scheduled an appointment and here we are with Healthy Families.

My premium is fourteen dollars a month. If I pay for three months, I get the fourth month free. So that, if you divide that divided by four, that’s practically nothing. Now, when it comes for them — the co-pay is only five dollars, medications only five dollars.

Once you meet a minimum, once you meet a co-pay of two hundred and sixty-five dollars within a family group, not per child but within a family group, as far as the medical part goes, you don’t pay anything else for the rest of the year. You go into the doctors, no co-pay; you just go in. Doesn’t matter how big, how small this, whatever they’re feeling, I don’t even think twice about taking them to the doctor. And when it comes to Denika, all this time the poor child has been suffering through her breathing. She’s never been better in her life. She doesn’t have a breathing problem anymore.

Hedrick Smith: Why do you feel more comfortable with Healthy Families?

Maria Gumaer: I feel more comfortable with Healthy Families because I know that it’s funded by the government. Being that they’re part of the government, I feel more comfortable, more at peace knowing that they’re not going to mess with a child’s life, knowing that the government’s behind it.

Hedrick Smith: What’s the quality, not just of your financial situation, but the quality of medical care you and your children are getting?

Maria Gumaer: As far as the children, regarding their Healthy Family medical that they get right now, there was one time where I took Denika to the doctors and Katelyn wasn’t feeling well and this is when my co-pay was twenty dollars. And I asked Katelyn, I said, "Katelyn, are you sure you don’t feel well, honey? ‘Cause if you’re feeling okay, I’m just going to take Denika into the doctor now, and if you don’t feel well, I’ll take you to the doctor tomorrow." Now we were in a situation like that not too long ago and Katelyn was like just, she wasn’t so much complaining about not feeling well, she was just like leaning at me. I said, "Katelyn, if you’re not feeling well, honey, I can take you to the doctor right now." "No, mama." I was like kind of pushing her into going to see the doctor because I knew five dollars I was only going to pay ten dollars for both of them instead of paying forty dollars. And whatever medication they were going to give me, I was only going to spend five dollars versus ten dollars. So, when it comes to having Healthy Family, there’s definitely, definitely a big difference. I don’t think twice, at all, ever, to take them to the doctor now.

Hedrick Smith: So, so you’re saying then that your kids are getting better medical care now that you’re covered by Healthy Families, is that right?

Maria Gumaer: Oh, they’re definitely are getting, better medical care now because anytime they’re not feeling well, I don’t think twice, I take them to doctor right away. And what’s even better, we’ve already met our co-pay, we’ve already met our two hundred and sixty-five dollar mark. So now I go to the doctor and tell them I don’t have a co-pay, and it kind of feels weird.

So they’ve controled her allergies. She started when she started with Healthy Families with this new insurance and she had to see her regular doctor. Then after her regular doctor, she had to go see a nose and throat specialist and an allergist. If we would have went through this with my regular insurance, there’s just no way. Instead of making sure that I went into the doctor one after another I probably would have extended her first visit a month from now, her third visit another month from now, and most likely she would not be getting her allergy shots.

When she started, her breathing was so bad that the allergist could not believe that this child actually had asthma. When she went into the breathing machine, her breathing level was at a thirty percent versus regular people [whose breathing] would be at a hundred percent. Her lungs were so plugged up with mucus when she started there, they started her with like five or six different medications, taking two to three puffs a day of each one of them. Right now she’s down to two allergy shots a week. She’s down to one inhaler in the morning, two puffs, and a nose spray, one puff.

There’s this asthma medication you have to carry with you at all the times if you have an asthma attack. She used that every two hours. And the doctor couldn’t believe that she was using this, and you’re only supposed to use this on emergencies. But the reason she was using this is because I never followed through and nothing was ever really taken care of because I couldn’t afford it.

Hedrick Smith: So, she wasn’t getting adequate medical care before you went on Healthy Families?

Maria Gumaer: No, she wasn’t. It was too expensive for me to do that. I mean I would never put her life in danger. But she did struggle for many years because it was so expensive I just couldn’t do it.

The funny part now, any time I bump into people that I see that they’re struggling, that they complain they don’t have insurance, or even when I go to the doctor now and there’ll be a woman there with her child and she’s talking about how can she get credit and she has to make excuses of why she hasn’t made this payment, but can they please see their daughter right away, I pull out my paper, I give them the phone number for Healthy Families. I give them the contact name and I try to tell them a little bit about what I went through.

And a lot of times people are afraid to join anything like that the same way I was, because I wanted to make sure that if I joined Healthy Families, what happened down the line if I get a better job and I start making money where I’m able to afford a place, is the government going to come after me and take whatever money I use for medical benefits out of a house or whatever I was able to buy in the future. It has been explained to me that that won’t happen. That it’s there to help children right now if you cannot afford to have insurance.

Hedrick Smith: What was the state of your daughter’s health when you shifted from going from the very expensive employer’s insurance to Healthy Families? What was her health like? What did they discover?

Maria Gumaer: I had a brother that was an asthmatic and he was always rushed to Emergency. So, I would always compare Denika’s asthma to my brother. So, it was kind of hard for me to think, okay, she doesn’t really need to go to the doctor; she’ll be okay. And I would take her in when she was wheezing and so on and they would put her on this inhaler and then they would tell me, you know, leave it on for thirty days and come back in a month. And, of course, here, the money situation again, I wouldn’t go. Now with Healthy Families we’ve totally done a hundred and eighty degree turnaround. The medical health care she gets now versus what she was getting before with my expensive insurance, you cannot compare the two; it’s like oil and water.

To me, Healthy Families has been like winning the Lotto when it comes to medical insurance. There’s just no way I could have done what I’m doing now. And right now, I have not heard her breathe heavy since she’s been with Healthy Families; she started with so many inhalers and she’s down to two inhalers. And what I like even more is she gets her shots twice a week and every two months the doctor sees her. And he checks her heart, he checks her breathing and so on and he’s noticed she’s come a long way from where she was.

I would say these last six months have been the best six months of her life; she’s able to run; she’s able to do things the normal way. Before, even eating was an ordeal for her. Because she was struggling, she was trying to eat and at the same time trying to breathe with her mouth because she could not breathe through her nose. Even her dentist brought that up to my attention. I mean, everybody was willing to help, but I didn’t have the money to do it.

Last year I went to Wal-Mart and brought her the cheapest glasses I could possibly get her because I couldn’t afford them because my old insurance did not cover eye care. Now with Healthy Families, five dollar co-pay, they pay for everything and she got some nice glasses and it only cost me thirty dollars. Back when she had her old glasses, she’d complain about headaches a lot more than what she complains now. And I definitely know. That it’s been because she has a new pair of glasses.

I got those because of Healthy Family. And to top all that, they do not only have medical, they do not only have vision, but they also have dental. And their dental covers all their basic needs with the exception of braces, but it takes care of their cavities, their cleaning, making sure they don’t cavities in the future.

Hedrick Smith: What has Healthy Families meant to you and your kids?

Maria Gumaer: Having Healthy Families definitely has brought me peace of mind. Financially, I don’t feel that big of a burden anymore. If my daughters get sick, I don’t have to think twice about taking them to the doctor. Denika breathes a lot better, she’s able to perform in sports without having to stop and taking her inhaler or me running to her and giving her the inhaler. Like I said before, she was taking between five and seven medications a day. She’s now down to two medications and she’s only taking them in the morning, one puff of one and two of the other versus the other ones. The dental part, their teeth are taken care of. With the vision part, before I had to wait for the school testing to let me know whether my children needed glasses or not. Same thing with the dental, I take them every six months, whatever they want to do for them, I’m all for it. I have definitely seen a…dramatic change in their health.

Hedrick Smith: You couldn’t take her to the doctor as much as she needed it before you went into Healthy Families?

Maria Gumaer: No, because I had to think should I use this twenty dollars to go get milk or should I use this twenty dollars to take her to the doctor?

Hedrick Smith: So you’re saying that before you had Healthy Families, you felt your daughter wasn’t getting enough medical attention before because you didn’t feel you could afford it, is that right?

Maria Gumaer: Oh, definitely. Before we had Healthy Families, I didn’t realize how bad she was. Once we got into Healthy Families and all the testing and so on was done, I was shocked to know how bad her breathing was. It hurt me so much to know that here my poor child had to struggle for six years not being able to breathe correctly. I mean, I was sick one time and I couldn’t breathe and I thought my poor child had to go through this for six years. And now me having Healthy Families, I feel so blessed. I mean I wouldn’t want to switch that for anything in this world because she’s gotten all the attention she needs.