Some uninsured commercial fishermen are so scared off by the high cost of health care in Alaska that they are seeking medical treatment in Third World countries.
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Carter Hughes, a 44-year-old Southeast Alaska troll and longline fisherman, is thinking about getting dental work done in Thailand this year.
His reason: His friends are telling him the doctors of Thailand do high-quality work, at a cheaper price.
Hughes said Friday that he knows others who routinely schedule their medical examinations or procedures to coincide with their vacations in Mexico.
"The problem is getting so extreme with health care costs in (Alaska) that people are coming up with creative solutions," Hughes said.
Proposed state and national efforts would allow Hughes and other fishermen to develop their own health insurance plan.
Meanwhile some commercial fishermen have taken a different tack: joining Christian-run, unregulated national medical cost-sharing programs. Members pay into a fund to pay each others' medical expenses.
After the birth of their first child, the Klinglers of Sitka, both troll fishermen, decided they needed to get medical coverage. After getting some high quotes from Blue Cross Blue Shield and State Farm Insurance, the Klinglers decided instead to go with a cost-sharing program called Christian Brotherhood.
"What it boils down to is there wasn't really another option," Denise Klingler said, citing the major health insurance companies' high premiums.
With Christian Brotherhood, the Klinglers pay monthly costs of about $200. Their dollars pays for hospital visits only.
Other fishermen are avoiding the doctor entirely ... at least until they get hurt.
If they are hurt on the job, fishermen can get some assistance from a commercial fishing work-accident fund run by the Alaska Department of Labor, the Fishermen's Fund. The fund is not available to seafood plant workers or commercial fishermen's family members. Claims of more than $2,500 must be approved by a council that meets only twice per year.
The $2,500 limit hasn't changed since the fund was created in 1951, said Mike Monagle, the Fishermen's Fund program administrator.
The fund is necessary because commercial fishermen in Alaska cannot obtain worker compensation, Monagle said.
With no health insurance but in relative good health, Hughes said he squeaked by without a medical checkup for roughly a decade.
Just recently, the Pelican fisherman did get a full-blown checkup by a young Sitka doctor, mainly to learn his blood sugar and cholesterol levels. The office visit cost Hughes a few hundred dollars.
If Hughes ever has a serious accident or illness, though, he plans to fly to Thailand or Mexico.
"A lot of (Alaskans) are doing that now," Hughes said. "Health care costs in Alaska are absurd," he said.
Fishermen are just one of many self-employed or small-business-employed non-Native Alaskans who are suffering from lack of insurance. In contrast, all Native Alaskans have their own system of health coverage.
Fishing for a health plan
A couple of efforts are now under way to tackle the insurance gap at the state and national level.
The state Department of Health and Social Services is ramping up a $1 million research project to look at the problems faced by uninsured residents of Alaska. A 2002-2004 survey found that roughly 18 percent of Alaska residents - about 116,408 people - lack health insurance.
Also, federal legislation has been introduced in Congress to help set up commercial fishermen with their own health insurance plans.
The United Fishermen of Alaska tried before to set up a health plan for its members but found the barriers too difficult to surmount. Most group health insurance programs are for employers, not membership organizations, said Mark Vinsel, UFA's executive director
The UFA is now throwing its own weight behind the Commercial Fishermen of America's effort to promote the federal legislation for fishermen's health care plans, Vinsel said.
U.S. Reps. Barney Frank and John Tierney of Massachusetts have tucked the measure, called the Fishing Industry Health Care Coverage Demonstration Project, inside their proposed bill reauthorizing the major fisheries law, the Magnuson-Stevens Act.
The project is modeled after a successful fishermen's health care plan set up in Massachusetts - the only state that offers a health plan for commercial fishermen.
The fishermen of Massachusetts were able to get their medical plan by crunching numbers. In the 1990s, New England fishermen worked with medical researchers to prove that public funds in support of such a health care plan would save the government money - about $4 for every $1 spent.
Fishermen work in one of the most dangerous occupations in the country. But the government typically ends up paying the bills of the uninsured fishermen who end up in the hospital with serious diseases and injuries, said David Bergeron, executive director of the Massachusetts Fishermen's Partnership, which has offered the medical coverage since 1997.
"It's very likely a similar study may show the same thing in Alaska," Vinsel said.
The Massachusetts Legislature now provides $3 million per year to reduce the premiums of the fishermen's health plan. The fishermen pay 60 percent of their medical costs, Bergeron said.
The Frank-Tierney bill now in Congress would provide seed money for fishing groups in other states to "pull themselves together and develop a (similar) plan and a strategy," Bergeron said. The legislation would also supply federal matching money to help establish the health plans for fishermen at the state level.
Vinsel said it is becoming more difficult to obtain matching dollars from the federal government. But, he argues, at the "bare minimum" it seems reasonable to investigate whether a fishermen's health plan in Alaska would actually save taxpayer dollars.
In the meantime, people like Hughes and the Klinglers say they are forced to look outside the regular health insurance system to deal with their medical expenses.
The insurance companies "make it so expensive, it's not worth your while," Hughes said.