Shelby County may be Alabama’s wealthiest county, but many residents still struggle with obtaining health insurance.

John Ramano, executive director of the Community of Hope free health clinic in Pelham, has seen that struggle first-hand at the clinic, which is a haven for uninsured, low-income clients.

In fact, it’s a requirement that clients must have no insurance and have incomes at or below 200 percent of the federal poverty line, Ramano said. Also, clients must be residents of Shelby County aged 19 to 64.

Ramano said if economic trends continue falling, he expects to see more clients at the free clinic who have lost their jobs.

“They’re losing their jobs, and they’re probably losing their insurance,” he said. “Some of these smaller employers don’t offer health insurance. They could be working and still not have insurance.”

Ramano said it’s estimated there are 7,000 uninsured Shelby County residents between the ages of 20-64.

He said the health clinic doesn’t see any particular age group more than others – anyone can be without insurance.

“I think it’s just people of all ages,” he said.

UNEXPECTEDLY UNINSURED

Eleanor Davis, director of Health Services at the University of Montevallo, knows that college students struggle with the sudden responsibility of getting health insurance.

“What happens to a lot of my students is that they might come off their parents’ insurance when they’re age 20 or 23,” she said. “When they’re no longer on their parents’ insurance, for them to get a policy on their own is extremely expensive.”

This isn’t just a problem on Montevallo’s campus. According to a March 2008 report by the United States Government Accountability Office, 20 percent of American college students, or 1.7 million people, were uninsured in 2006.

Some parents try to mitigate their children’s troubles by participating in the Consolidated Omnibus Budget Reconciliation Act, which allows dependent children to stay on a parent’s workplace insurance.

However, COBRA participants usually have to pay the entire premium instead of just a portion of it, which makes it more expensive.

“A lot of the times, the parents will try to continue paying for insurance, but can’t always do so,” Davis said.

She said college students don’t always understand the necessity of having health insurance.

“I think some students feel that way, because they have never had to deal with it,” Davis said. “Their parents have always dealt with the health insurance. They have no experience in paying medical bills, they have no idea what it costs.”

GETTING HELP

While Community of Hope offers medical help for those without insurance, the clinic also offers counseling to help clients find a way to get back on their feet.

Ramano said social workers refer clients to other agencies to help them get affordable insurance.

“We just wanted to be able to help people in need,” he said. “We’re not able to reach everybody, but we want to help the ones we can reach.”

Ramano said having insurance gives people the ability to take care of themselves, even in medical emergencies.

“Insurance will ease their minds about whether to go (seek help), because some people may not go,” he said. “Insurance will ease the burden.”

For Davis’ struggling college students, UM is trying to help. As part of a mandatory health fee, UM provides health insurance for all students. It’s common for colleges to offer health insurance, but this is the first year UM has offered any type of insurance coverage.

However, while the college’s insurance isn’t as expensive as an individual policy, it’s also not as comprehensive. However, every little bit helps, Davis said. She’s seen too many uninsured students get saddled with high medical bills.

“I tend to hear from my students after they have an injury and have to go to the hospital or the emergency room, and didn’t realize how much it would be,” she said. “They say, ‘What can I do?'”

At that point, all students can do is try to work with the hospital to set up some kind of payment plan or get aid, Davis said.

While students may have some coverage now, there’s always the possibility that a policy won’t be waiting for them upon graduation. Such a situation can be disastrous.

“It’s not always possible for a new graduate to get a job in their field that has benefits,” she said. “Most people want their child to get a job with benefits so they can have insurance. Heaven forbid they have a medical emergency and then, to pay that off, it’s like they’re always playing catch-up.”