Anchorage Daily News

PALMER -- For months Laurel Carlsen ignored the lump on her collarbone.

She first spotted it in June 2007. But money was tight for the recent college graduate. Her job at the grocery store near the campus in Santa Cruz, Calif., didn't pay much, and she had no health insurance.

Besides, she said, "I wasn't really worried about it. I don't ever get sick, you know."

By the time she moved to Palmer in August 2007, the lump, which began as an invisible mass beneath the surface of her skin, protruded clearly from just below her shirt collars. By December it was the size of a golf ball.

Carlsen, 22, knew it was time to see a doctor. But her two part-time jobs at local social service agencies netted her less than $1,000 a month, she said, and she still had no insurance -- factors that at the time seemed more an inconvenience than a worry: Medical care meant more bills on an already meager budget.

Within days of her first doctor's appointment, Carlsen learned how worrisome those factors could be. She was diagnosed on Dec. 7 with Hodgkin's lymphoma, a type of cancer that invades the lymph system.

Though Hodgkin's lymphoma is one of the most curable cancers, according to the Leukemia & Lymphoma Society, Carlsen's diagnosis meant months of chemotherapy treatments.

But for the uninsured, fighting cancer means battling the health-care system as well, Carlsen said.

"I think a lot of people operate under the myth that they have to treat you. They don't have to treat you," she said.

She learned that lesson firsthand when her oncologist ordered a Positron Emission Tomography Scan, or PET scan, to stage her cancer and determine her treatment course.

When the imaging center he'd referred her to in Anchorage learned she was uninsured, it cancelled her appointment, Carlsen said.

"I asked if I could set up a payment plan and they still said no," she said.

With the help of her doctor, Carlsen says, she ultimately got her scan. But she was left with a $4,000 bill. She'd hoped public assistance would help her out with that.

SYSTEM KEEPS YOU DOWN

With an annual income that falls well below the poverty level and treatment that costs thousands and renders her unable to work, Carlsen assumed she'd qualify for Medicaid, a state-administered federal program that provides medical benefits to the poor.

But Medicaid covers only low-income children and families, pregnant women, the elderly and the disabled who need long-term care. As a young, single woman without children, Carlsen doesn't fit the bill -- a fact her sister, 30-year-old Chris Sheridan, finds outrageous.

"You know what, God forbid we have young women who go out and get college degrees and have things in the right order," Sheridan said. "The system is dinging her because she got sick."

But Carlsen, who holds a bachelor's degree in community studies, or the historical study of social movements and social justice, is not surprised.

"I know how screwed up the system is," she said. "You really have to fight for it."

Carlsen is not alone in that fight. According to state figures, more than 114,000 uninsured people lived in Alaska in 2007; only 18,000 of those were children and more than half the uninsured were employed. Most cited exorbitant premiums or lack of employer-offered insurance as the greatest barriers to coverage, according to state reports.

That lack of coverage puts the uninsured at greater risk for chronic health problems. They are less likely to receive preventative care than their insured counterparts, according to state and national studies. And their illnesses are typically diagnosed at later stages. Those later-stage diagnoses and a tendency among many uninsured to cut back on or skip medications to cut costs put many of them at a greater risk of dying. Uninsured cancer patients for all cancers combined, for example, are 1.6 times more likely to die within five years than those with insurance, according to the American Cancer Society.

Carlsen says she sometimes skips some of her meds -- the ones that ease the nausea from her bi-weekly chemotherapy treatments. But things should get a little easier this month, she said.

She recently qualified for Chronic and Acute Medical Assistance, or CAMA, through the state. CAMA will pay for her chemotherapy and for three prescription medications a month.

But CAMA won't cover the treatment she's received so far -- treatment that's already topped $100,000, she said. And to maintain her CAMA eligibility her monthly income, including the $170 worth of food stamps she now receives, can't surpass $300.

"The system really keeps you destitute," Carlsen said.

She's only a few months into her treatment and already she's bombarded with calls from bill collectors, Sheridan said.

"I come in and find her sitting on the floor with papers all around her and she's been on the phone for hours with people who don't give a crap about her. She should be in bed nursing herself back to health," she said.

BANKRUPTCY IS CERTAIN

Carlsen says she figures she'll likely file for bankruptcy someday to pay off all her bills -- a course taken by many in her situation, according to a 2005 Harvard University study. Daunting medical bills, the study showed, trigger nearly half of all personal bankruptcies.

Though she says her doctor tries to make sure she gets the care she needs, despite her inability to pay, she worries that that won't last forever.

"At what point am I going to get cut off?" she said.

And at what point will her sister and her sister's family consider her a burden, she said.

At Sheridan's insistence, Carlsen gave up the basement space she rented in the house next door to hers and moved in with her shortly after she was diagnosed in December.

Sheridan's husband and two young daughters now share their tiny Palmer home, Carlsen said.

"I know they don't consider me a burden," she said, wiping away tears. "But I feel like one. I don't know what people are doing who don't have family they can live with."

And she doesn't know what people do without friends, she said. Hers have showered her with help since she was diagnosed.

They set up a bank account for her and began donating money to help with her medical expenses.

They sometimes drop off gift cards to local grocery stores. And they've arranged a benefit for her at Vagabond Blues later this month.

"I feel so -- like this system is so screwed up it's not helping me at all. But at the same time I have this amazing community that's wanting to help me," Carlsen said. "That's what really matters."

If you go: Vagabond Blues is hosting an evening of food, music and a silent auction to help Laurel Carlsen pay her medical expenses. The event will be held 5 p.m. – 8 p.m. March 22 at Vagabond Blues, 642 S. Alaska St., Palmer.

To donate items for the silent auction, contact Chris Sheridan at (907) 982-4777. Donations can also be made directly to Laurel Carlsen’s medical account at any Wells Fargo Bank, account No. 6247487934.

ADVERTISEMENT