Uninsured Turn to ER

Data released in July of 2009 reports that one-fifth of emergency department visits were made by people who were uninsured.  In response to the statistic, Secretary of the Department of Health and Human Services, Kathleen Sebelius said, “Our health care system has forced too many uninsured, rural and low-income Americans to depend on the emergency room for the care they need.  We cannot wait for reform that gives all Americans the high-quality, affordable care they need and helps prevent illnesses from turning into emergencies.”  When an uninsured person begins to face symptoms of serious illness, such as heart disease or diabetes, they face a terrible choice:  pay the money now and seek help immediately before symptoms get worse or wait until the situation becomes an emergency.

The Federal Emergency Medical Treatment and Labor Act (EMTALA) is a federal regulation that requires any hospital that receives taxpayer funding, in any form, to receive and treat any person who comes to the ER, regardless of their ability to pay.  While this is a step in the right direction towards universal health care, it means that many people are stepping into the ER to seek treatment for minor problems, causing long waits, overcrowded hospitals, and overworked medical staff.

For more interesting facts about emergency room overcrowding, click here.

Utahns Oppose ‘Obamacare’

According to a poll done by KSL and Deseret News, 67% of Utahns either oppose or strongly oppose the new health care overhaul that President Obama signed into law on March 22, 2010.  Despite the opposition, many Utahns say they agree with many of the components of the new plan many are calling ‘Obamacare’.

For example, more than three fourths of Utahns agreed with the part that prohibits private insurance companies to cover pre-existing conditions.  Utahns also overwhelmingly agree with closing the difference between what Medicare pays for prescription drugs and what seniors pay out of pocket.  They also like the idea of having a web-based health exchange where self-employed people and small businesses can shop around for good deals on comprehensive health insurance.

Perhaps the most strongly opposed portion of the bill is requiring Americans to be under some type of insurance plan.  This counters a former poll that reported that more than 80% of Utahns believe that basic health care is as basic a right as access to education.  They believe that Americans should be able to access health care if they want it, but should not be under mandate to do so.

Don’t Get Sick

“Our current national health care system is simple:  don’t get sick.”–Anonymous

I cam across this quote as I was researching different types of national health care.  We are a great country.  We stand for freedom, work, courage, and the power of the American dream.  This nation asserted these values through a powerful document called the Declaration of Independence.  Contained within this powerful document are perhaps some of the most well-known words in American history.

“We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.”

If our founding fathers thought it important to include the right to Life in that document, then shouldn’t our national government do the same?  In a time where insurance companies, businesses only interested in making a profit, essentially have the power to decide who lives and who dies, shouldn’t the government step in to protect our right to Life?  Insurance companies are lobbying hard to prevent the government from involving itself any further in the health insurance industry because they know that an affordable government option creates competition for them, and competition drives prices, and profits, down.  Granted, government is not perfect, but I trust that they have my interests at heart more than greedy businessmen do.  I think Ted Kennedy, the well-respected former senator says it best.

“Health care is not just another commodity.  It is not a gift to be rationed based on the ability to pay.  It is time to make national health insurance a national priority, so that the basic right to health care can finally become a reality for every American.”

We live in a time where people are afraid to get sick, and not simply because they are afraid of dying, but because they are worried how they will pay for it.  For a great nation such as ours, that is simply inexcusable.  Changes have been made, new policies have recently been signed into law by our President, but continued focus on this problem will be necessary in the months and years to come.

Health Care Bill Passed

As most Americans likely know, a new health care bill was passed in congress and signed into law by President Obama.  Putting all controversies surrounding the bill aside, it is important that we understand what the bill means for Americans and Utahns that are uninsured.  Articles from the White House and CNN help us understand what exactly is contained within the bill.

The major goals of health reform are to make health care more affordable, make health insurers more accountable, expand health coverage to all Americans, and make the health system sustainable, stabilizing family budgets, the Federal budget, and the economy.  The main objective of the bill is to expand coverage to 32 million Americans who are currently uninsured.  That means that 95% of the population will have health insurance coverage.  Here are some of the most important parts of the bill.

Cost: It is projected that the bill will cost $940 billion over ten year, but it is projected that the reform will reduce the deficit by $143 billion over the first ten years and by $1.2 trillion over the following ten years.

Paying for the Plan: Families that make over $250,000 a year will pay a 3.8% tax on investment income.  Also, for high end insurance plans (more than $27,500), insurance companies will pay a 40% excise tax.  Also, a 10% excise tax will be placed on indoor tanning services.

Exchanges: Small business owners and self-employed people would be able to purchase insurance through state-run programs (exchanges).  These programs offer competitive prices and comprehensive coverage.

Subsidies: The bill allows for people who live within 100-400% of the federal poverty level to buy into the state-run exchanges, as most of these people do not qualify for Medicaid.

Reforms: The bill will make it against the law for insurance companies to deny people coverage based on pre-existing conditions.  It will also fix some of the problems (such as prescription drug coverage) within the Medicare program.  Medicaid is also expanded.

Other: Abortions will not be payed for  with taxpayer funds.  Also, no illegal immigrants can buy into the exchanges even if they pay for it with their own money.  There will also be a $695 annual fine for people who choose not to buy insurance.

The Underinsured

With health care costs sky-rocketing in the last years, many people have been forced to cut out health insurance altogether in order to support themselves and their families.  Another striking problem arises, however, that is beginning to get more attention these days.  That is the problem of the underinsured.  The underinsured still have trouble getting the medical care that they need, despite having health insurance.  Trends in health insurance show that this problem may continue to rise.  One study estimates that 16 million American adults were underinsured in 2003.  In 2007 25 million adults were underinsured.

We are seeing major shifts in insurance companies not only in the cost of premiums, but in the types of coverage they are offering.  They have shifted from offering comprehensive benefits to having many restrictions to the benefits that they offer.  This means that people who have insurance still may not be able to afford the cost of the deductibles, and may not receive all the medical treatment that they need.  This can result in serious and even more costly health problems, only exacerbating the problem.

Here are some interesting findings about being underinsured:

• 2/3 of sicker adults who were underinsured went without needed care because of cost.
• Near half of the underinsured in poor health or with a chronic condition did not take prescribed medications as directed by a doctor.
• 38% did not see a doctor when sick, and one-third did not follow up with treatments or care recommended by their doctor.

Here are some charts from Commonwealth about problems facing the underinsured:

Horror Stories

Teen Dies Waiting for Transplant

Nataline Sarkisyan was diagnosed with leukemia at age 14. The disease had gone into remission, but following a relapse and a subsequent bone-marrow transplant, her liver failed due to a blood-clotting complication.  She died at 17, mere hours after her insurance company, Cigna, announced that it would cover a liver transplant, which it had previously rejected as being “experimental, investigational, and unproven.”

Domestic Abuse

Attorney Jody Neal-Post says she was beaten and choked by her ex-husband in 2002.  Following the incident, she was treated with counseling and Valium. When she tried to get health insurance in 2006, she was rejected because of this medical history.  Many insurance companies deny coverage due to past abuse, which means victims may become even more afraid to speak up about abuse if they have the additional worry of losing their health insurance.

Bleeding from Breast

Rosalinda Miran-Ramirez woke up with her shirt soaked in blood. Leaking blood from her nipple, she rushed to the emergency room. Doctors discovered a benign tumor.  Her insurance company originally agreed to pay the emergency room claim, but later changed its mind and sent her a bill for almost $3,000, because after reviewing the claim, the company decided Miran-Ramirez should have realized there was no emergency.

Irregular Periods

In 2001, Jacqueline Ruess underwent laparoscopic surgery for a growth her gynecologist thought could be ovarian cancer.  Four months later she faced a bill of more than $15,000 because of a lone mention in her file of “dysfunctional uterine bleeding.”  The insurance company deemed this diagnosis—a technical term for irregular periods—evidence of a preexisting condition.  Since the irregular periods (between 10% and 30% of women experience them at some point) weren’t related to any underlying medical problem, she never thought to mention them on her health insurance application.

Help for Utah County Citizens

Here are a couple of great resources for Utah County citizens that I have come across lately.  They are especially helpful for the county’s spanish speaking population, of which 37% are uninsured.

Mountainlands Community Health Center is a non-profit primary health care system that is based in Provo, Utah, and has been serving Utah county since 1992.  They provide primary care, urgent care, mental health care, and obstetric (maternity) care.  They also offer health education for patients diagnosed with diabetes and for pregnant women.  Many of the Mountainlands staff speak spanish, making care accessible and understandable to all populations.

Community Health Connect is also a non-profit organization based in Provo, Utah. Its mission is to “improve access to quality health and dental care for low-income uninsured men women and children.”  Those who qualify for services will meet with a Care Counselor, who makes an appointment for the client with doctors in a wide variety of specialties, such as dermatology, endocrinology, cardiology, oncology, OB-GYN, and many more.  Dental specialties such as orthodontics and oral surgery are also provided.

These two organizations often work in tandem, as Mountainlands provides more primary care to its clients.  The services provided by Community Health Connect are much more specialized.  The coordinated work of these two non-profit organizations are helping many people in the county.  More awareness, money, and donations from doctors are needed in order to serve even more people.  Click on the ‘Get Involved’ tab to find out how you can help.

45,000 Deaths Linked to Lack of Health Care

A study was conducted by Harvard Medical School claims that in the US 45,000 deaths are associated to a lack of health insurance every year.  The study was published in the American Journal of Public Health and claims that those who are uninsured are 40% more likely to die than those who are insured.  Perhaps the most grim statistic of all is that someone dies every 12 minutes due to lack of health insurance.

The study took into consideration factors such as education, income, smoking, drinking and obesity.  Even considering these factors, deaths linked to lack of insurance exceed the number of deaths caused by many common killers such as kidney disease.

There were two reasons given explaining the increased risk of death among the uninsured, the main explanation, simply being that the uninsured go for longer periods without seeking medical help.  They don’t receive vital screenings such as mammograms and blood pressure checks.  The lead author of the study and M.D., Andrew Wilper said “We doctors have many new ways to prevent deaths from hypertension, diabetes, and heart disease — but only if patients can get into our offices and afford their medications.”

Medicaid, Medicare, CHIP

In order to dispel some confusion that I have noticed going on lately, I am writing this post to clarify what exactly Medicaid, Medicare, and CHIP are, and who they benefit.

MEDICAID—Helps low-income people access health care services.  Persons receive services by meeting requirements set by law.  Each state law sets its eligibility requirements. Each person must qualify for Medicaid under a certain category.  The different categories in Utah are:

• Age 65 and older
• Blind or disabled
• Pregnant women
• Child under age 18
• Parent or caretaker of a child under age 19
• Woman with breast or cervical cancer

MEDICARE—Provides health coverage for those age 65 and older, for people under age 65 with certain disabilities, and for people of all ages with end-stage renal disease.  In Utah there are four parts to Medicare

• Medicare Part A–Hospital, skilled nursing, and hospice coverage
• Medicare Part B–Covers 80% of doctors visits, outpatient services, and some equipment such as wheelchairs
• Medicare Part C–Medical savings accounts
• Medicare Part D–an optional prescription drug coverage, patients must pay a premium for this service

CHILDREN’S HEALTH INSURANCE PROGRAM—CHIP is a state health insurance plan for children under age 19.  It covers services such as:

• well-child exams
• immunizations
• doctors visits
• hospital and emergency care
• prescriptions
• hearing and eye exams
• mental health services
• dental exams

10.8% of Utahns Uninsured

Rates of uninsured people in Utah are holding fairly steady, according to a report released by the Utah Department of Health (UDOH) on March 17, 2010.  Rate of uninsured Utahns reported for 2010 was 10.8%, compared to 10.6% in 2007 and 10.7% in 2008.  That means approximately 302,400 Utah residents lacked health care coverage.

When compared to the rates of uninsured from other states, Utah remains in the middle of the pack, ranking 18th.  As rates in the country continue to rise, growing concern for the escalating costs of insurance premiums are becoming a hot topic among government officials.

Especially concerning are the rates of uninsured children.  In contrast to the rest of the country, rates of uninsured children in Utah actually decreased in 2009, thanks to open enrollment in the CHIP program and Medicaid.  Dr. David Sundwall, the executive director of the UDOH said, “these programs are serving their purpose of making sure that children have access to needed medical care when times are tough.”

While rates for children dropped, rates increased for uninsured adults by over 10%.  With employer-based coverage eroding due to the bad economy, many adults lack adequate access to medical care despite holding steady jobs and being financially stable.