No choice but going to work, even in sickness

Latosha Smith’s office skills have served the Peninsula’s multibillion-dollar biotech industry dedicated to eradicating disease.

But the 32-year-old Burlingame mother can’t afford to get sick.

Smith reports to her sales support job when her head is pounding from a fever. A broken bone would spell financial ruin. She is one of as many as 62,000 adults in San Mateo County lacking health insurance.

As a temporary worker, Smith isn’t entitled to sick days and she’s still paying off the few times she went to San Mateo County Medical Center.

“I’d rather do self-healing, because I can’t handle the $3,000 bill that comes in the next month,” Smith said.

Though she is consistently employed, her jobs are contract positions found through a temp agency. She’s worked for many of the companies responsible for the area’s affluence — Sony Computer Entertainment America, Genentech, Google.

Earning as much as $23 an hour, Smith makes too much money to qualify for Medi-Cal. But as a single parent supporting both her mother and her 9-year-old daughter, she can’t afford to buy coverage on her own, which averages about $300 per month.

Smith is able to buy low-cost insurance for her daughter through California’s Healthy Families program. Her mother, who suffers from schizophrenia, receives medical benefits through the state.

And while Smith’s paycheck would put her firmly in the middle class throughout most of the country, she is teetering on the edge in the Bay Area, where it takes $79,946 per year for a family of four with both parents working to cover expenses.

“I’m stuck in the middle and I’m living paycheck to paycheck,” she said. “I pray to God nothing happens, because it would be a devastating blow to my livelihood.”

It’s a situation Dr. Susan Ehrlich said she sees each day at the county hospital’s medical clinics.

According to the California Budget Project, a Bay Area family of four can expect to spend $676 each month on its health care needs.

And it isn’t just the uninsured. Many people simply can’t afford co-payments and expensive presciptions. Common medications for conditions such as diabetes, hypertension, chronic hepatitis B and high cholesterol can cost patients hundreds of dollars per month, Ehrlich said.

Westley Powell, 53, is insured, but must still pay $600 out of pocket for a three-month supply of medication for his congestive heart failure and high blood pressure.

Powell earns $17.72 an hour as a retirement home cook, but has been cut down to 24 hours a week due to his health problems.

“People are often put in the very difficult decision of buying medicine or buying food,” Ehrlich said.

“People will take half the medication prescribed, or they may not take medication at all,” she said. “Often the patients will be very ashamed and won’t tell us what they’re doing.”

Tens of thousands in Peninsula lacking coverage

52,000-62,000 Total uninsured adults in San Mateo County

82,000 Adults without insurance at some point during the last year

Employed and uninsured in San Mateo County

84% Working uninsured adults ineligible for employer health benefits or whose employer doesn’t offer benefits

63% Uninsured adults working either full time, part time or sporadically

45.7% Uninsured adults working full time (more than 21 hours per week)

40% Working uninsured adults who work at a company with fewer than 10 employees

Who are San Mateo County’s uninsured?

49% Male

51% Female

52% Ages 19-39

48% Ages 40-64

51% Uninsured adults with children in their household

Length of time uninsured

12% 1-2 years

15% Never insured

17% 5+ years

17% 2-5 years

19% 1-6 months

20% 6-12 months


Racial makeup (percentage of total uninsured in San Mateo County)

55% Non-U.S. citizens

54% Hispanic/Latino

31% White

16% Asian/Pacific Islander

14% Black

Source: San Mateo County Blue Ribbon Task Force on Adult Health Care Coverage Expansion

Working to survive

Thousands of Bay Area residents live in poverty despite working full time. The Examiner looks at the choices they make to pay for necessities.

Monday: Introduction

Today: Health care

Wednesday: Housing

Thursday: Transportation

Friday: Child care

Bay Area NewsLocal

If you find our journalism valuable and relevant, please consider joining our Examiner membership program.
Find out more at

Just Posted

Cyclists have flocked to Market Street since private vehicles were largely banned from a long stretch of it in January. (Amanda Peterson/Special to the S.F. Examiner)
Plans for sidewalk-level bikeway on Market Street dropped due to costs, increased cyclist volume

Advocates say revisions to Better Market Street fail to meet safety goals of project

Anti-eviction demonstrators rally outside San Francisco Superior Court. (Kevin N. Hume/S.F. Examiner)
Report: Unpaid rent due to COVID-19 could be up to $32.7M per month

A new city report that attempts to quantify how much rent has… Continue reading

Music venues around The City have largely been unable to reopen due to ongoing pandemic health orders. (Kevin N. Hume/S.F. Examiner)
SF to cut $2.5M in fees to help 300 nightlife venues

San Francisco will cut $2.5 million in fees for hundreds of entertainment… Continue reading

Supreme Court nominee Judge Amy Coney Barrett departs the U.S. Capitol on October 21, 2020 in Washington, DC. President Donald Trump nominated Barrett to replace Justice Ruth Bader Ginsburg after Ginsburg’s death. (Photo by Stefani Reynolds/Getty Images)
GOP senators confirm Amy Coney Barrett to Supreme Court in partisan vote

By Jennifer Haberkorn Los Angeles Times The Senate on Monday confirmed Judge… Continue reading

Curator Tim Burgard looks over a section of the galleries comprising “The de Young Open,” a huge, varied collection of work by Bay Area artists. (Photo courtesy Gary Sexton/Fine Arts Museums of San Francisco)
Bay Area artists jam-pack vivid ‘de Young Open’

Huge exhibition — with works for sale — showcases diversity, supports community

Most Read