Marshall County has one of the highest rates of uninsured residents in the state of Iowa.
The U.S. Census Bureau released a report this week showing Marshall ranked 83rd out of Iowa's 99 counties with an uninsured rate of 13.2 percent. The state average is 10.7.
Longtime Marshalltown resident Bonita Galvez, 54, hasn't had health coverage since 2008. At the time she worked for Ace Precision in Marshalltown but when it went out of business Galvez' health insurance went with it.
Allamakee County Supervisor Larry Schellhammer looks on during an Aug. 19 meeting in Waukon. According to 2010 Census data, Allamakee County has the highest percentage of people without insurance in Iowa. A total of 18.2 percent of the population here lacks insurance, compared with a statewide average of 10.7 percent, based on the Small Area Health Insurance Estimates survey.
Galvez, who was born in California but has lived in Marshalltown much of her life, has found sporadic employment at road construction sites around the Midwest.
"I went everywhere. I even went to Michigan to work," Galvez said.
Though she worked on many Dept. of Transportation projects she was employed not by the DOT but rather a private business that did not offer benefits. She hasn't worked since August of last year when she injured her left ankle while on a job site.
A look at how local counties rank in health care coverage. Note, the top county with the lowest percentage of uninsured is Warren at 7.8%
State average: 10.7%
"I was in so much pain I wanted to crawl out of my skin," Galvez said.
That ankle is adorned with a black brace covering ashen and cracked skin. She's been diagnosed with everything from arthritis, to a fractured tibia to an unusual birth defect in which bones are fused. She doesn't know if her ankle will ever be healed.
"Mentally, I want to work but physically I can't do it," she said.
She's currently volunteering at House of Compassion ("it's something to do," she said) a homeless shelter on West Church Street. She's also a resident after moving out of her sister's house.
She's often used Primary Health Care on East Church Street to care for her ankle. Primary Health is not a free clinic but asks patients to pay based on their income.
"They wanted to pay them 20 bucks every time I went but I didn't have money. Now that I'm considered homeless I'm on another chart and I don't pay anything," Galvez said.
President Barack Obama's landmark Affordable Care Act - called "Obamacare" by critics - was designed for Galvez and the other estimated 48.6 million Americans that do not have coverage. But as the sweeping legislation nears full implementation, Galvez' comments indicate that the federal government has much work to do in explaining the law.
"I heard they are going to put a chip in everybody," Galvez said.
While such Orwellian schemes are not part of the law much mystery remains about whether it will reduce costs and expand coverage.
Nancy Haren, Public Health Manager for Grundy County, said many of the uninsured she works with don't understand the law, but it doesn't end there.
"I don't think any of us understand. I don't think until we can see those plans and how they look we'll understand," Haren said. "Hopefully when they have the marketplace open more people can purchase what they want and more people will qualify. At least I'm hoping that's how it ends up."
Medicare covers some living below the poverty line - though in many states adults without children do not qualify - but the law will expand coverage to those at 138 percent of poverty, adding millions to the rolls. Iowans can also enroll their children in Hawk-I which provides coverage to those younger than 19. IowaCare also offers coverage to adults slightly above poverty.
Those programs, though, vary in what is covered.
Karen Frohwein, Director for House of Compassion, said many of her clients can't afford medicine. The agency provides $3,000 to $5,000 a month in prescription drug vouchers but that money is spread very thin.
"People can get up to $100 a year," Frohwein said. "By the beginning of June I already had 50 families that had used up their $100. Anybody with a chronic illness uses theirs up very quickly."
Primary Health Care Director Susan Vititoe and Marshall County Public Health Nurse Pat Thompson did not return phone calls for this story.
Grundy County ahead of the curve
It is a pleasant mystery in Grundy County. Data from the U.S. Census Bureau shows that many rural counties in Iowa have high rates of uninsured residents younger than 65, with Allamakee in northeast Iowa having the highest rate at 18.2 percent. Grundy County, though, bucks the trend reporting an uninsured rate of 8.7 percent, seventh lowest of Iowa's 99 counties.
Grundy County, with a population in 2010 of 12,453, is mid-sized by Iowa standards and slightly smaller than Allamakee.
Small counties often have fewer jobs that come with health insurance benefits and residents often work on farms or run small businesses and must find more expensive private coverage. But despite being filled with gently rolling acres of farmland, Grundy County has consistently had a low uninsured rate.
"It's not that we don't have poorer individuals but for some reason we stick out like a sore thumb; a good sore thumb," said Nancy Haren, Public Health Manager for Grundy County.
Haren isn't sure why that's the case. Many people living in Grundy County work in Cedar Falls, Waterloo or Marshalltown, increasing the number able to get coverage through work.
"And we've got rich farmland so the farmers have been doing really well," Haren said.
Marshall County ranked 83rd with 13.2 percent uninsured and Tama was 87th at 13.9 percent. The state average is 10.7 percent.