When Esperanza Cervantes-Sanchez and her family made the decision to move from Torrance, California, to Las Vegas, she was brimming with hope for a new life filled with opportunity.
Her husband, Enrique, who worked in the catering business, was offered a job with MGM Mirage paying three times what he was making in Torrance. The extra income would allow her to pursue her master’s degree in special education.
Even more important, it meant extra peace of mind. Their son, Adrian, has Down’s syndrome and had already endured two minor and three major operations—including open heart surgery—all before turning six years old.
The public health program MediCAL made the surgeries possible, but children with Down’s syndrome are susceptible to many complications. Relying on publicly-funded medical assistance in a state with a mounting fiscal disaster is something any mother would avoid given other options.
So in September of 2006, Sanchez and her husband used their savings to make a one-way journey to a better life.
Two weeks before Enrique Sanchez was to start, his new job fell through, and the family’s pursuit of the American Dream quickly turned into a nightmare.
“It was really devastating,” said Esperanza Cervantes-Sanchez. “We had to start from nothing.”
Soon after they arrived in Las Vegas, Adrian started running a high fever and complaining about one of his teeth. A dentist said he faced more surgery, this time for an infected molar.
The risk of waiting was greater than losing a tooth. Open heart surgery had made Adrian extra vulnerable to any ongoing infection and the possibility that it would spread—and kill him.
For the first time, Esperanza Cervantes-Sanchez started applying for welfare and for assistance from the public health care networks Nevada Check-Up and Medicaid.
“They told me that they couldn’t help me because I didn’t have any income,” she said. “Does that make any sense?”
Nevada Check-Up sent her to Medicaid. Medicaid turned her away.
“I’m being bounced around here, and I’m asking who the hell is going to give me insurance?” she remembers saying, still haunted by the experience years later.
“I believe it when I hear of these things happening in other countries, but here?”
One third, or 842,000, of the state’s 2.6 million residents were without health insurance of any kind at some point in 2008, according to a study just published by Families USA last October.
With state unemployment exceeding 12 percent for the first time and a recession hammering the lifeblood industries of Nevada’s narrow tax base, demand for services is peaking as the funding runs dry.
“We’re getting a lot of calls from people who have never been in the position of having to look for a job, can’t find a job, are losing their homes, and are without health care coverage for their children or themselves,” said Nancy Whitman, executive director of Nevada Covering Kids & Families, an organization that connect families with public health services.
Moreover, Nevada has no central agency where those in need could file a single application for the array of available services, making delivery fragmented at best.
Those who work for the resorts and have an income that varies may qualify for Medicaid one month and then make enough the next to get automatically disqualified.
Worse, applications are pages long and take weeks or months to process, leaving those in the gap without a safety net.
Furthermore, the recession is penetrating deep into the middle class and anti-entitlement voting blocs have deprived the services they now need of fuding, according to Dr. Carl Heard, chief medical officer for Nevada Health Centers.
People seeking public aid for the first time have flooded a system barely able to handle regular clientele.
When a boom goes bust, said Heard, “it takes a disorganized system and throws it into chaos.”
That chaos, says Esperanza Cervantes-Sanchez, was devastating.
“Not even when my son was going through all of the surgeries early on and his life was in jeopardy was it worse than what we went through when we got here.
“Before, we knew that we were doing our best, that we were doing everything we could, but here, every door I knocked on, it shut on me.”
As Adrian’s infection threatened his life, his family’s luck began to turn. His father started finding sporadic work. His uncles were able to send some money from California.
Soon, Sanchez re-applied and this time she qualified for Nevada Check-Up.
Six months after Adrian was diagnosed, underwent surgery, ““I’m sure,” his mother said, “that if we hadn’t taken care of it then, it would have been a catastrophe later on.”
Sanchez’s desire to get her master’s degree in special education was inspired by her son, but her experience with the public health care system in Nevada took that inspiration in a special direction.
In late 2007, Sanchez landed a job at an organization called Family TIES. The second word is an acronym for “Training, Information, Emotional Support.”
She now helps people in her situation get public health assistance. “It’s their stories,” she said, “that drive me to do whatever it takes to help people become knowledgeable self-advocates.”
One was a woman, Sanchez said, who lost both legs from the knees down. She got around using a piece of wood with four wheels glued to the bottom and supported her two children for three years by cleaning offices at night.
When the woman finally discovered Family TIES, it took Sanchez another year to find a donor for the the artificial limbs she needed and doctor willing to attach them pro bono.
“The last time I saw her was last March,” said Sanchez. “And she thanked me not just for giving her her legs back, but for giving her her life back, and the life of the family she was supporting.”
Nevada has more financial stress than any other state because of its foreclosure rates and unemployment, according a Kaiser Family Foundation study.
Its services are underfunded and inaccessible. “We as a state, on average, return more federal dollars back to the government than other,” said Heard, the chief medical officer of Nevada Health Centers. “And the reason is largely because we don’t invest in Medicaid.”
When the state doesn’t invest, not only do they shortchange their own services, but they leave free money on the table.
The practice is akin to missing out on employer contributions by neglecting a 401k.
“This state leaves a lot of federal money on the table,” said Whitman, at Nevada Covering Kids & Families. She is skeptical when asked about any reform on the national level benefitting Nevada.
“Most federal programs require some kind of state match, and with the economy the way it is in our state, and the way our state thinks about health care, I’m not sure we can take full benefit of any of them.”
The result is a system in which preventative care for many is unavailable, leaving the emergency rooms as their first and last refuge.
“We’ve already had a bad problem with indigent populations that have turned to hospitals as a last resort,” said Launce Rake, spokesman for the Progressive Leadership Alliance of Nevada.
University Medical Center is the largest publicly-funded hospital in Clark County. Recent estimates indicate that UMC handles 40 percent of all uninsured claims statewide.
Nevada’s economic downturn has forced UMC to close its pre-natal and outpatient cancer care clinics. They were the only facilities of their kind in Clark County.
Nevada Health Centers has assumed much of the burden. “The closures had a dramatic impact on our company,” Heard said, “because we were the logical place for a lot of those patients to turn to.”
About $2 million in federal stimulus money is earmarked for Nevada Health Centers, which has a $27 million annual budget. But it’s not enough.
“If we just had a single point of entry, where you had one eligibility worker review all of an applicant’s information,” Whitman said, “it would be much more efficient for the family’s and we would save a lot of money.”
Beyond efficiency, investment early on in prevention can avoid the high cost of emergency room visits and end-of-life care for advanced conditions that ca caught and treated much earlier at significantly less cost to the state.
This January, Sanchez was asked to write her story for submission with a proposal to renew a grant for Family TIES.
The letter was so powerful that she gave it to Sen. Harry Reid’s (D-NV) office when he issued an open call for stories from Nevada to help renew funding for the State Children’s Health Insurance Program, or S-CHIP.
Reid asked her permission to read the letter on the Senate floor.
“I was surprised,” she said. “But it showed me that they’re not unreachable.”
In her letter, she told about her child with special needs and her family’s inability to qualify for Medicaid. The Sanchezes are a working family, she said, but cannot afford private insurance.
“Families like ours,” she said,” “can fall through the cracks of the system.”
[Watch Esperanza read the entire letter here]
Without the S-CHIP-funded Nevada Check-Up, she doesn’t think Adrian would be alive.
Getting the help that she so desperately needed, she said, was far harder than she expected in a state with so much money pumping through it.
Politicians, she said, hold the real solution. She had advice for all of them.
“Take into consideration that we are a big puzzle, and every single piece, whether it’s up in the left corner or down at the bottom, is part of the puzzle,” she said, “give the value of belonging to that big puzzle because when one piece is ignored, the whole puzzle doesn’t function.”