The fortunes of Sterling, Ill., a small town of 14,000-plus, due west of Chicago, have moved up and down with the fortunes of Northwestern Steel & Wire (NW Steel). Today the fortunes of both are scraping bottom.

Over the past year, thousands of Sterling-area residents, long accustomed to free or nearly free medical, vision and dental care, have found themselves thrust into the hardscrabble economic landscape of the uninsured, where routine preventive care is an unattainable luxury and a patchwork of aid programs provides a hit-or-miss safety net for those unlucky enough to fall sick.

When NW Steel collapsed a year ago, 1,400 employees lost their jobs. But the shutdown of the region’s leading employer took a much bigger toll: When Northwestern went under, about 10,000 people – retirees, their dependent wives, surviving widows and, of course, the wives and children of active mill workers – lost their health insurance.

According to Russ Lovell, president of Steelworkers Local 63, the blow staggered the community. “There’s more to it than five miles of shuttered plants,” he told the World. “And it’s not going to get prettier anytime soon.”

“Even before the shutdown we had 2,500 retirees who were entitled to pensions and lifetime health care. Then we got 600 more retirees and another 600 who have lost their health care coverage. What happened is criminal, that’s what it is,” he said bitterly.

When asked how people were coping, Lovell said, “Many of them are dying – they’re not taking their medicines because they can’t afford them.” Lovell said retirees used to meet at a local fast-food restaurant to swap pills left over from past ailments.

But money is not the only obstacle. Kate Vos, a community-health specialist with the Whiteside County Health Department, told the Chicago Tribune that many older workers have been denied private insurance because they suffer from pre-existing conditions, such as heart disease or lung problems, that frequently develop in people who have spent a lifetime in the mills. “Some of these people are very sick,” she said.

Vos and other authorities are urging Gov. George Ryan to issue a rare “declaration of medical necessity” that would, among other things, allow for distribution of low-cost pharmaceutical products to uninsured area residents.

As the situation in Sterling and surrounding Whiteside County shows, when a steel company quits paying, workers’ health-care needs don’t go away – and much of the financial burden falls on the community, to be absorbed by a hodgepodge of understaffed government and private organizations.

Local health-care providers have been stuck with unpaid bills. Overbooked veterans’ hospitals have seen a flood of new applicants. Workers scurried to jump on the plans of working spouses, driving up insurance costs for area employers. Lovell said he knows NW Steel retirees who have taken jobs for $6 or $7 an hour, just to get some kind of insurance.

CGH Medical Center, the area’s biggest hospital, has seen its “charity work,” or uncompensated medical care, climb 50 percent in the last year, while the bad debt the hospital has written off has climbed as well.

What’s happening in Whiteside County is not an isolated incident. Over the past four years, 17 U.S. steel companies have folded, and about 125,000 active and retired steelworkers, widows and dependents have lost their health-care coverage.

“You never want to believe it will happen to you,” says Steve Nelson, who went to work at the mill two weeks after his 18th birthday, in 1974. “For 28 years, I never had to pay for medical care.” Now, Nelson’s two youngest children are covered under the state-federal low-income insurance program known as KidCare.

Nelson and his wife, hoping their health will hold, pay $200 monthly for a policy that carries a $1,000 deductible and has little value except to mitigate a medical catastrophe, such as surgery or a prolonged hospital stay.

When asked what could be done about the situation that sees more than 40 million people without insurance and, therefore, without adequate health care, Lovell said, “We need some kind of a national health care system. Things cannot go on this way.”

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