RISKY BUSINESS MORE SMALL-BUSINESS OWNERS, SELF-EMPLOYED GOING WITHOUT HEALTH CARE INSURANCE.

Byline: Evan Pondel Staff Writer

When Ray Weppler feels a sudden pounding in his temples, the plumber knows it's migraine season.

The medicine cabinet is usually close enough to his bedroom that he can take a few pills and easily fall back asleep. But in recent years, his usual stash of medication has grown thin, even more so since he canceled his policy with Blue Shield to save money.

``The health insurance was annoying like my headaches. The premiums kept rising and rising every month,'' said the 50-year-old from San Bernardino. ``I don't really feel like I need the health insurance, though. I'm just trying to stay healthy and my migraines don't come around as much.''

A greater number of small-business owners and self-employed go without health insurance these days. About 43.3 million Americans lack any sort of coverage, according to the most recent statistics compiled by the Kaiser Family Foundation. A significant portion of that number stems from small-business owners who simply cannot afford the cost of insurance. And with individual employees opting for more pay instead of coverage, the uninsured population is likely to increase as a lackluster economy requires a more disciplined budget at home.

The issue is garnering even more attention as Senate Bill 2 - a law requiring employers of 50 or more to provide some form of insurance - is likely to take effect in California in 2006.

A recent UCLA study suggests that SB 2 could actually help reduce the number of uninsured Californians. A fundamental problem is that the law doesn't encompass employers with fewer than 50 workers, according to Gerald Kominski, co-author of the study and a professor at the Center for Health Policy Research at the University of California, Los Angeles.

Despite industry and some political efforts for more coverage throughout the country, millions of consumers still can't afford the very coverage that some say would save everyone more money in the long run.

Uninsured Americans are likely to incur nearly $41 billion in uncompensated health care treatment this year, with as much as 85 percent of that care paid for by state and local governments, the Kaiser Commission found. Meanwhile, if the country decided to provide coverage for all of the uninsured it would cost about $48 million - an increase of 0.4 percent in health spending's share of the gross domestic product.

Health care executives agree that the uninsured is a growing problem, but ignoring those without coverage could be far more costly. ``Leaving 44 million Americans uninsured exacts a substantial price on society as well as individuals, while covering the uninsured would improve their health care without generating large increases in overall health spending,'' said Diane Rowland, executive director of the Kaiser Commission on Medicaid and Uninsured.

Larry Fletcher learned the value of health care the hard way. The 50- year-old owner of a Van Nuys print shop had been suffering from allergies when he tried to relieve his itchy eyes with a few drops of a breath freshener.

The product irritated his eyes even more and Fletcher rushed to a hospital where he encountered a three-hour wait in the emergency room.

``If I had coverage, I probably would have been able to see my primary care physician a lot sooner,'' he said. ``But I didn't, and I found myself in the emergency room taking away time from those people who had emergencies far greater than mine.''

Fletcher still doesn't have health insurance. He takes care of his decade-long bout with hypertension through the Valley Community Clinic, a nonprofit group that helps prevent uninsured people from ending up in the hospital. Fletcher said he would like to purchase insurance, but ``I can't afford monthly insurance payments of $600, nor doctor visits at $100 or more. After all that, how can I even think about affording coverage for my employees?''

If employers with under 50 workers aren't required to provide insurance, Kominski said it will take that much longer to reduce the overall cost of health care.

Convincing the uninsured to pay for coverage is yet another obstacle. That's because adult Californians will spend an estimated $2,793 for health insurance this year, while those without insurance are likely to spend about $963 out of pocket for health care.

``What we need to have is a baseline health insurance plan that's affordable and provides quality care without being too watered down,'' said Jerry Flannagan, lead advocate on health care reform at The Foundation For Taxpayer & Consumer Rights. ``And the fact that working families can't afford coverage is an even greater symptom of the affordability crisis.''

To offset this disparity, academics say, programs such as Medi-Cal should be better utilized, resulting in more federal funding. Creating tax breaks for those businesses that otherwise cannot afford health insurance is yet another method to stimulate more coverage, Kominski said.

From a health plan provider's perspective, educational campaigns to address the public are the most efficient way to tap the uninsured. At least half of the uninsured in California can afford coverage, and ``those are the people we need to go after,'' said Michael Chee, a spokesman for Blue Cross of California.

Health-plan providers have become particularly aggressive in marketing to the Latino community. Several insurers began accepting identification cards issued by the Mexican consulate last year. Banks have also been accepting these cards as valid forms of identification.

But Flannagan said marketing aggressively to the uninsured isn't always the most effective method of encouraging coverage. Oftentimes the products are of little value and work against the need for preventive care.

``And then community clinics will be used by families who are too rich for federal programs and too poor to afford insurance,'' he said.

Dr. Robert Hockberger, chairman of the emergency room department at Harbor-UCLA Medical Center, said if more of these patients had coverage to pay for their care, the industry as a whole would be better off.

``People also need to be active about preventive care, and that is done by addressing issues before having to visit an emergency room,'' he said.

Waiting for emergency room care could extend beyond several hours at Providence Saint Joseph Medical Center. Dr. Philip Schwarzman, medical director of the emergency department at the Burbank hospital, said insuring more patients would help eliminate those who could otherwise see their primary care physician.

``I don't have the privilege to care for all of the people who need medical attention,'' he said. ``At least insuring more people would help the emergency room better care for those in need of immediate attention.''

Evan Pondel, [phone]

evan.pondel(at)dailynews.com

CAPTION(S):

2 photos, chart

Photo:

(1 -- color) Ray Weppler, owner of Rayco Plumbing, no longer buys health insurance because of the high monthly costs.

LaFonzo Rachal Carter/Staff Photographer

(2 -- color) Dr. Larry Goldberg examines Maria Esparza at the nonprofit Valley Community Clinic in North Hollywood.

Michael Owen Baker/Staff Photographer

Chart:

THE TOLL OF HEALTH CARE

SOURCE: The Kaiser Commission on Medicaid and the Uninsured