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Nelson Mendoza is a 19 year old from Houston Texas who just finished his freshman year at Yale. Nelson was one of our health policy fellows this last year. He is currently in India helping an NGO that brings vision care to rural areas of the country. He gave me permission to share his story.

Aside from a couple of months in eighth grade, Nelson did not have health care coverage until he came to college. His parents have always been uninsured to his knowledge; his father is a self-employed painter and his mother is a homemakers. His mother has several health problems including lupus. Nelson has two older sisters who are both teachers and now have insurance through their employers.

His family travels six hours each way Mexico, about twice each month, to both visit family and get health care. They cannot afford care in the US; prices in Mexico are far more reasonable. His mother takes several medications for her lupus, prescribed by Mexican doctors, and gets her prescriptions filled in Mexico. Even with more affordable prices for health care in Mexico, the family has to spread out the costs. Nelson’s father is healthy and consequently doesn’t get doctor appointments.

Growing up, Nelson didn’t see health care providers often. In eighth grade he briefly qualified for Texas’ CHIP program, but the family’s income increased slightly and he lost coverage. He remembers needing physicals for summer camp and that they were very expensive for his family. He also felt that they were very cursory – the doctor “didn’t do anything.”

His family is somewhat wary of the US health system. He is not certain that more available coverage, even with subsides, would be welcomed and an individual mandate might be resisted. There is a strong belief that doctors over treat you if you have insurance, they will “pile on services.” He thought that now as his sisters have consistent coverage and the family is having experience with insurance, that perception may be changing. He has often heard that when you are uninsured, the doctor will give you the “strongest” treatment to be sure the problem is treated, because you may not be back.
He finds having coverage through the Yale Health Plan “weird” and that he is expected to go to the health plan often. Coverage is costing him $1,800/year; he has had to borrow those costs and is worried about the loan payments when he is done with school.

He went to a dentist for only the second time in his life this summer. He had serious dental issues that he was told could have been prevented if he had gotten regular care.

He feels that his family is very lucky having few serious health problems. His mom had ovarian cancer, and had two surgeries in the US in the early 1990’s. It was very expensive; the extended family loaned his family money to cover the costs. In his community, this is the usual means of paying for large health costs. The loans are informal but there is strong social pressure to repay the family.

Nelson emphasizes that his story is not unique or “all that dramatic”. “I know lots of people in worse shape.”
Ellen Andrews