Healthy living isn't always easy or affordable

By Julie Moran Alterio
The Journal NewsAnnette Medina didn't know that asking for a raise would mean the end of health insurance for her 11-year-old son, but that's what happened when she started earning an extra dollar an hour.

The pay hike, though modest, put her over the limit to qualify for New York state's Child Health Plus plan. The premium to keep her son insured went from $15 a month to $172. That tops the $140-a-month raise - and is more than she can afford.

"The way the health system works is not fair. A lot of people want to be working, but they end up having not to work because they want their kids to have health insurance. So they'll work under the table, or at a low salary, just so that they can have the insurance," said Medina, a 40-year-old single mother who supports her son though her job as a medical assistant.

That's right, Medina works in a doctor's office, immersed in the health care field for 35 hours a week but unable to buy insurance coverage for herself or her child because her employer doesn't offer it as a benefit. "I shock everybody with that one," she said.

Medina and her son aren't living in poverty, but it's not easy to make ends meet. She earns about $32,000 a year. About half of her take-home pay goes to monthly rent of $1,100 on an immaculate and cozy apartment in Yonkers that's filled with homey touches.

The lack of health insurance is a constant source of worry for Medina, whose eyes often stray to a pile of almost $3,000 in medical bills she can't afford to pay. "What I hear from most of my friends is that they'd rather make half the money I make and have medical benefits," Medina said.

There are 46.6 million people in the United States without health insurance, many of them full-time workers like Medina. They struggle every day to keep up with the rising cost of being healthy, whether that means buying insurance, paying out-of-pocket for doctor visits, finding time to exercise or filling the grocery cart with fruits, vegetables and lean proteins that are pricier than fattening but affordable starches.

"It aggravates me because I wish I could afford to eat healthy all the time, especially with my family history of diabetes and heart disease," Medina said. "I wish I could buy the whole grains and the salmon and the blueberries and the good stuff. If you want to buy organic, it's double the price of the regular stuff in the supermarket. On my salary,
it's impossible."

Medina scours the grocery store circulars for deals, stocking up on chicken and salad when she can. The only time she eats brown rice and organic produce is at work.

"Some of the doctors that I work with bring it in, and I get to taste it. My God, I wish I could eat like this all the time. But it is too expensive. I have gone to Trader Joe's. When I get an income tax check or a little extra, I can go over there. That's probably the only time I can afford it,"she said.

On a recent weeknight, Medina cooked white rice and warmed up a dish of chicken, peppers and tomatoes.

"I'm Puerto Rican, so a typical meal is rice, beans and chicken or rice, beans and whatever-type meat. But it's usually the cheapest meal to get. You can buy a 10-pound bag of rice for three bucks. The beans sometimes you can get on sale. I buy the ones in the bag because it's more economical. You can make about three meals out of that one bag," she said.

But Medina's son, John, shunned the leftovers and ate a hamburger on Wonder Bread with barbecue sauce.

Medina worries about John's diet because he's already been diagnosed with
high cholesterol.

"My son is overweight, and I know a lot of it has to do with the products that we buy," she said.

The plight of parents in Medina's situation is familiar to Dr. Asaf Cohen, a family physician at the Open Door Family Medical Center in Mount Kisco.

Cohen said the patients who visit the clinic can't afford the healthy foods that more affluent families consume.

"The sad matter of fact is that for people with lower income, who could even be on food stamps, the cheaper food they have to buy is not the more nutritious food," he said. "When you have only a certain amount of money to feed a family, it's very hard to afford whole grain bread, any organic produce or even enough food with vitamins and minerals. You end up with a lot more obesity."

Cohen, who joined Open Door just six months ago after completing a residency in urban family medicine at Beth Israel, said he enjoys teaching his patients about nutrition and exercise.

"Our patients do have a very hard time with it. We see all the nannies and all the landscaping people, the people who clean houses. They're people who work extremely hard just to make a living and feed themselves and their families. They usually have multiple kids and it takes a lot of time in the office just going through their daily schedule to find time to exercise. They are working double shifts and coming home to a big family that's waiting for them to take care of them," he said.

One of Cohen's main messages is cutting out greasy foods.

"Most of them lack a lot of vegetables. They eat a lot of starches and a lot of meats. Those are the things that fill you up, they're pretty cheap and they taste good," he said.

Katonah resident Judith Rocio works full time at Mrs. Green's Natural Market, but can't afford to shop there despite a 20 percent discount. Instead, she waits for her husband to get off work from his landscaping job to drive them to the ShopRite.

With a salary of $10.50 an hour and a 13-month-old baby in the house, Rocio can only budget about $60 a week for food. Like Medina, Rocio doesn't have health insurance benefits despite a full-time job.

But in Rocio's favor is New York's Women, Infants and Children, or WIC, program, which provides coupons for healthy foods to pregnant and breast-feeding mothers.

Peekskill resident Dosoon Min, a WIC counselor at Open Door in Ossining and Sleepy Hollow, said the coupons can be used for milk, cheese, peanut butter, beans, cereal, juice and other vitamin-rich foods.

In summer, the coupons are good at farmer's markets, but persuading her clients to use them there is a struggle, Min said. The redemption rate in her program is 85 percent - compared to a state average of 45 percent.

"Fruits and vegetables are more expensive, so they have a tendency to choose cheap meats instead," she said. "They want to buy more in quantity than quality because they have to put food on the table."

Another venue for healthy food for lower-income workers are food banks, like those coordinated by Westchester Food-PATCH. Executive director Christina Rohatynskyj said a large percentage of food bank recipients are working families.

"All of them have to make choices about paying the rent or availing themselves of medical care or medicine or paying for utilities and food," she said.

Although much of the food that's distributed, by necessity, is non-perishable, a seasonal program called Green Thumb Fresh Produce puts 1,000 bags of fruits and vegetables in the hands of struggling families every week during the growing season.

Bud Coccodrilli, a deacon at First Presbyterian Church in Yorktown Heights and a volunteer for the food bank, said the recipients welcome the produce.

"One of the biggest concerns for clients is a desire for fresh fruits and vegetables," he said. "And these are very substantial bags, weighing from 5 to 7 pounds."

Coccodrilli said he meets a lot of young families, single parents and people suffering from illnesses such as cancer during the Saturday morning food giveaways.

One regular is a recently divorced woman in her 30s who is supporting two children without any help from her former spouse. "Were things to change for her, she'd be working as a volunteer, but right now she's up against it," he said.

The common thread among all the recipients is a dearth of money for anything but staples.

"These are people who don't have the luxury of going to ShopRite. They can't afford to spend $2.99 for 4 ounces of blueberries," he said. "They don't have discretionary income."

The gap in healthy living between the working poor and the middle and upper class needs more attention, said Georganne Chapin, the president and chief executive of Hudson Health Plan, a nonprofit insurance provider based in Tarrytown.

People who labor at low-wage jobs, like gas station attendants, landscapers, nannies, retail clerks and restaurant staff, can't afford to follow government recommendations about healthy eating and don't have the free time for regular exercise,
she said.

"There are tens of thousands of people in Westchester County who simply can't afford the basics that would keep them healthy," Chapin said.

Families live in neighborhoods that are too unsafe to let their kids venture out to play, so the children pass the time watching TV, a behavior that contributes to childhood obesity.

People without cars can't afford to take a cab to the grocery store and end up buying their food at a neighborhood convenience store where vegetables are scarce and even fast food can be expensive.

And there's no time, energy or money left after a day of back-breaking labor to go to the gym.

"Go tell a woman who scrubs floors for a living that she should exercise at night. The work she is doing doesn't make her healthy and limber, but she can't afford to go to a gym," Chapin said.

Recognizing the reality of these lives is vital for the editors of Hudson Health Plan's member newsletter. When they decided to include recipes, it was tricky finding ones with ingredients clients could afford, Chapin said.

"We had to work really hard to find recipes that were accessible to members," she said. "We can't expect people to travel out of their neighborhoods to a fresh fish market and spend $12 a pound on salmon."

The key to helping lower-income people become healthier is understanding the hurdles they face while at the same time not condescending to them, Chapin said.

"It's an insult to poor people to say they have no control over their lives. But the truth is, if you are poor, you're marginal in a lot of ways," she said. "You're taking the bus instead of driving. If you don't have a car, you are carrying groceries instead of going to discount stores where you can buy in bulk. You don't have a job with ample sick time, so you go to work sick. You wait a little longer before you go to the doctor.

"It's not like we're saying poor people can't be counted on to take care of their health. It's that life is harder when you're poor," Chapin said.