Abstract

Forty-eight-year-old Arthur Johnson grew up poor in southeast Dallas with his mother and four younger siblings. At age 13 he dropped out of school in order to work to help provide for his family. At the age of 27 he enrolled in a trade school and became an electrician. Working 12- to 15-hour days, six days a week, he’s been able to purchase a modest house in an economically challenged neighborhood. He’s also begun to accumulate a small savings, relieving him of the burden of living paycheck to paycheck and with hopes of sending his two children to college one day. Arthur is a success story in his community, where he and his wife enjoy Sundays tending the front garden and conversing with their neighbors. His quick wit and eagerness to help have earned him close friends and many acquaintances, along with a loyal customer base. Despite a recent downturn in business, Arthur has remained upbeat, telling his wife that he’s weathered hard times before.

Arthur’s calm demeanor belies his physical health challenges. Arthur has diabetes and high blood pressure, which he manages with medication he pays for out-of-pocket. He would like health insurance but cannot afford the monthly premiums because of the variations in his income as work ebbs and flows. The long hours of work also make it difficult for him to engage in any meaningful physical exercise or eat small frequent meals as is prescribed for his diabetes. Arthur’s health and economic worlds collided last month when he suffered a substantial stroke paralyzing his left side and impairing his speech. Now home from the hospital, he requires physical rehabilitation and nursing care, which further strain his economic situation. He doesn’t know when or if he will be able to return to work and worries about the accumulating debt that threatens all he has worked for. “Why did this happen?” he asks.