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ROBERT SIEGEL, host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Robert Siegel.

MADELEINE BRAND, host:

And I'm Madeleine Brand sitting in this week.

As the health care debate continues here in Washington, NPR is bringing you the stories of how Americans get their medical care. Our new series is called Are You Covered? For one businessman in New Orleans, the answer is no. Just ahead, we'll talk with a lobbyist for small business about health care.

First, NPR's Debbie Elliott introduces us to one of the 46 million Americans who do not have health insurance.

DEBBIE ELLIOTT: Fernando Arriola spends his days keeping track of four or five small construction projects.

Mr. FERNANDO ARRIOLA (Owner, New Beginnings Enterprises): So, if Alex need to work, you know, overtime in order to build the cabinet, let's do that.

ELLIOTT: Arriola is a home builder in New Orleans.

(Soundbite of machines)

ELLIOTT: Here in the garden district, his crew is putting the final touches on this quaint mother-in-law cottage.

Mr. ARRIOLA: We are finishing the (unintelligible) with the bathroom and then we're going to start sanding and staining, finishing the floors and then do the touch ups.

ELLIOTT: Fernando Arriola is 58 years old. Four years ago, he bought a friend's contracting business, just as New Orleans was starting to rebuild after Hurricane Katrina. He named it New Beginnings Enterprises.

Mr. ARRIOLA: When I took over the company I feel, you know, it was a new beginning for me. It was a new beginning for the city. It was a new beginning for a lot of people that we were working with. So, I decided to change the name of the company.

ELLIOTT: And business has been good, he says. He enjoys working for himself and makes about $50,000 a year. What he's missing is the health coverage he had at his former job as a sales manager.

Mr. ARRIOLA: Oh, I had full insurance.

(Soundbite of laughter)

Mr. ARRIOLA: I have everything.

ELLIOTT: But since he's been self-employed, Arriola has been on a health insurance roller coaster. Initially, he bought a standard policy with a $1,000 deductible to cover his family, including his wife and two daughters. Then, when business slowed down and money got tight, he decided to temporarily drop the coverage.

Mr. ARRIOLA: When I tried to reinstate it, I could only afford catastrophic plan. I was paying about $900 a month for a $5,000 deductible. So, I was paying, in essence, $15,000 before I had one penny covered. And that was too expensive.

ELLIOTT: So he dropped that coverage, only to have second thoughts. And when he tried to reinstate it, he was denied even the expensive catastrophic policy. Arriola doesn't know exactly why, but acknowledges that he and his wife both have high blood pressure and are approaching 60.

Mr. ARRIOLA: Insurance is nothing more than just a business, okay. And they try to limit their liabilities. So where there's, you know, an older person, then they don't want to cover it.

ELLIOTT: Maria Arriola doesn't think it's fair that after years of paying for coverage and not having many claims, now when they are starting to have health problems, they can't get insurance.

Ms. MARIA ARRIOLA: There's nothing you can do about that. As you get old enough, things don't work this well.

ELLIOTT: The Arriolas did buy a policy for their two daughters, ages 22 and 16. But Fernando and Maria are uninsured and pay for doctor visits and prescriptions out of pocket. So, what if something major comes up?

Mr. ARRIOLA: If I were to have any emergencies or surgery or things like that, I would have to go outside of the U.S. in order to be able to afford that.

ELLIOTT: Arriola is a naturalized citizen and has lived in New Orleans since 1970. But last year, he traveled to his native Guatemala for arthroscopic knee surgery. It was a bargain.

Mr. ARRIOLA : Less than $1,000 to where over here it would cost me thousands. They have just as good doctors as they have over here. Most of them are graduated from here.

ELLIOTT: As for the debate on Capitol Hill, Arriola takes a businessman's approach to the issue. Open up the marketplace, he says.

Mr. ARRIOLA: If we were to have a national playing field and be able to shop around, (unintelligible) be yourself where you'd be able to have more options, I believe that will lower the price.

ELLIOTT: But he doesn't have a lot of faith that Congress will come up with a fix because of partisan politics. So, in the meantime, he's working to do something locally.

Mr. ARRIOLA: Okay, good afternoon. Thank you for coming.

ELLIOTT: Arriola is on the board of the New Orleans Faith and Health Alliance. The group is trying to start a health clinic in unused classroom space at a mid-city church. Patients would pay based on their income.

Mr. ARRIOLA: The purpose is to be able to provide the working uninsured medical services. There is definitely a need. And I'm a perfect example of it.

ELLIOTT: The alliance hopes to start providing care this fall. Arriola says he'll sign up. In the meantime, he prays that nothing serious happens. The way the system works now, he says, he'd have to experience a major calamity just to get coverage.

Mr. ARRIOLA: I will have to go into the hospital, I would have to lose my house, I will have to lose all my savings, I will have to lose everything for the government to be able to help me. So 40 years of work, 40 years of struggle has to come to nothing. I have to be totally destitute in order for me to be able to get some help.

ELLIOTT: Arriola says he doesn't want anybody to give him anything. He just wants affordable health insurance.

Debbie Elliott, NPR News.

BRAND: Our series Are You Covered? is produced in partnership with Kaiser Health News, that's a nonprofit news service.

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