For Some Uninsured, Medical Care Requires Community Intervention

The short-form version of Babs Headrick's story is Sharpied onto a big glass jar next to the cash register on the restaurant's front counter. One side says, "Mrs. Goodstuff has had a stroke and has no insurance." The other side says "Please help and any donation will help. Thank you so much."

Mrs. Goodstuff's Café is a family operation that built a devoted carry-out clientele operating out of a three-table hole-in-the wall at the corner of Fairmont Boulevard and Fairway Drive in 2008-2009. Last year, the Headricks defied the recession and made a daring move to a bigger space on Woodland Avenue across from St. Mary's Medical Center and just west of the Broadway Shopping Center. It is bright, sunny, and well appointed, with a display case full of Babs' made-from-scratch pies and pastries up front and her son Josh presiding over the kitchen.

The menu is binary, giving customers a choice of comfort food like homemade chili, soups, meatloaf, chicken and dumplings, Salisbury steak, and chicken a la king or Josh's fancy signature sandwiches, which bear names like the Taj Mahal and the Jack of Diamonds. The place has a cozy, neighborhood feel.

But looks are deceiving. Since his mother's stroke, Josh has been working 60-plus-hour weeks. Babs was admitted to the hospital March 21 and was unresponsive for four days. Josh is praying for her to recover, but worried that she will be "dumped" from the hospital prematurely because she has no insurance—and few options besides the glass jar.

When Tennessee took federal stimulus money last year, Gov. Phil Bredesen's office promised to reopen TennCare programs that have been shut down in 2008 for financial reasons. This is happening at a glacial pace.

The Headricks might qualify for TennCare under the "Spend Down" category, which covers families with no savings or resources to qualify for assistance. The restaurant, however, could be a stumbling block, although the building is rented and revenues are limited.

And in the meantime, Josh has immediate, day-to-day worries. Babs carries most of her recipes around in her head, and Josh is struggling to recreate them. The hardest thing, he says, has been trying to figure out how she makes her turtle brownies.

"They've been absent from the case since my one attempt to make them. Turtle brownies are a combination of three different recipes and two different caramel recipes. We always meant to write these things down, but for now the recipe is locked inside her head."

Mrs. Goodstuff's was pretty much built on those recipes in Babs' head and Josh's work ethic, imagination and knife skills—plus Babs' 401(k) account, which she cashed out when she retired from her last job with a plan to recreate the restaurant the family ran in Gatlinburg from 1995-2001.

Babs, 63, is a friendly, capable woman who was too young to cash in on Social Security and Medicare and too cash-strapped to be able to afford private health insurance. But her whole family—Josh, her husband, Julian, and daughter, Shea—took the leap of faith together, gambling that she would continue in good health until she became Medicare eligible.

The restaurant did well, but Babs didn't. Last year she got sick. As is typical of the working uninsured, she put off seeking medical care until she was so ill that she had no choice but to go to the emergency room.

"She went to hospital and found out that she had a double abscess on her colon," Josh says. "It was an enormous infection. Her blood pressure was sky high when we got her to the hospital and her temperature was 104. She was in the hospital for seven weeks and once they got her into a wheelchair and she could go to the bathroom, they pretty much pushed her out the door. She went to a nursing home for another three weeks and we were looking at $164,000 worth of medical bills. She's buried in it. We're buried in it."

Josh, who is 35 and a self-identified mama's boy, says she made an excellent recovery physically, and things started feeling normal again, except for the looming specter of that huge medical bill. They looked into TennCare and Medicaid, but owning a family business made her ineligible for any kind of assistance.

By this time, she couldn't have gotten insurance at any price due to her pre-existing health problems.

So she did what she'd always done and went back to work.

"Her mobility got better and she got back to cooking, working, napping, and she'd get up and start again," Josh says. "But the stress of all the bills and keeping the restaurant open and there's no relief in sight—how much more can you take?"

Then came the weekend in March when she couldn't get out of bed.

"Dad woke me up at 6 in the morning and Mom was dizzy and vomiting. She said her legs felt like they were made out of lead and she was having a hard time getting to and from the bathroom. They had fallen together, and he needed me to help. It was totally uncharacteristic of her, because she is the strongest woman I've ever met in my life. She doesn't complain and doesn't ask for assistance.

"At 7, he tried to wake her up and she opened her eyes one time and then closed them and immediately started snoring. Her face was loose and her lip was flapping as she was breathing. It was scary.

"I told Dad to call an ambulance, but he was afraid, because he didn't know how we were going to pay for it and he didn't think they'd come. I told him we had to call an ambulance."

At last check, Babs had fought off a serious infection, the tube in her head had been removed, and she was listed in stable condition. Julian stays with her as much as is allowed. Josh works such long hours that he doesn't get there as much as he'd like.

While Babs Headrick's options appear to be limited for now, things may be changing soon. Earlier this month, U.S. Department of Health and Human Services Secretary Kathleen Sebelius asked governors and independent insurance commissioners if they are interested in participating in a temporary high-risk pool program created by the new health-insurance reform law to cover people who are uninsured because of pre-existing conditions. States may choose whether and how they participate in the program.

Contacting the Tennessee Justice Center, a non-profit advocacy firm that specializes in these issues, would be an important step for them, but Josh says his father is a fan of talk radio who doesn't trust the government or "liberal" organizations.

He's still hopeful that his father will make that call.

"Maybe 2 percent of him comes from what he hears from people like Rush Limbaugh," Josh said. "The other 98 percent is all about mom and there's nothing in this world my dad wouldn't do for her. He would switch places with her in a minute, and if I said you have to go be locked in a Venezuelan prison for 200 years and be beat every day, if it would help mom, he would do it."