Hospital use and payment of 65 years and over: 25 March 1964
Posts Tagged ‘over’
Hospital use and payment of 65 years and over: 25 March 1964
Tuesday, August 3rd, 2010Hospital use and payment of 65 years and over: 27 March 1963
Saturday, July 31st, 2010United Healthcare Seeks Greater Control Over Health Insurance Costs
Sunday, May 30th, 2010There is no doubt that health insurance can be costly. Both health insurance companies and medical providers share some of the blame for that. In general, patients have been caught in the middle: doctors and hospitals charge health insurers higher fees for services, which insurers then pass onto the consumer. Reimbursement rates are negotiated periodically, normally without controversy. However, United Healthcare is now playing hardball with a group of New York hospitals.Continuum Health Partners runs five major hospitals in the New York City area. Their facilities include St. Luke’s-Roosevelt Hospital Center and Beth Israel Medical Center. United Health Care is insisting on a stringent notification standard: specifically, that the health insurance company be notified of a patient’s admission to a hospital within 24 hours. From United Healthcare’s perspective, prices will go down while the quality of care improves. That is because a United case manager would be able to get involved quicker and control costs. For example, they would be able to ensure that the hospital is using approved, effective treatments that will be reimbursed–as opposed to those that may not be covered by the health insurance plan.Understandably, physicians and other hospital staff are leery of allowing health insurance companies inject employees with little or no actual medical experience into the decision-making process. Hospital groups in other states have also expressed objections to the onerous administrative burden, as well as the lack of accomodation for short-staffed facilities during holidays and weekends. Besides those issues, why is the requirement for timely notification so controversial? You would think that individual health insurance providers, such as United Health Care, already have such requirements. Technically, many of them already do (although some other major insurers, like Blue Cross Blue Shield, do not); the issue is that their noncompliance penalties are rarely enforced, or relatively minor. On the other hand, United Healthcare’s proposed penalty is significant. If hospitals fail to notify them of an admission in time, they will forfeit 50% of their reimbursment for treatment. That will cost them up to $20,000 for a joint replacement or $25,000 for bypass surgery. Being reimbursed for only half of the care they provide could make treating patients with United Healthcare health insurance unaffordable. As a result, nearly 85,000 United Health Care patients may no longer be able to use their individual health insurance coverage at Continuum hospitals.Why would United Healthcare make this move, which has the potential to anger customers? It is a matter of cutting costs. Healthcare reform may establish exchange markets to encourage price competition among health insurance companies, making cost reduction imperative for United Health Care and other health insurers. Meanwhile, even scaled-back proposals would forbid insurers from denying individual health insurance policies to people with pre-existing conditions. Doing so is currently one of the most common ways for private insurance companies to keep costs down. Therefore, the strict notification standard is a way to compensate for the potential shutdown of that revenue stream.For its part, United Healthcare claims that Continuum was becoming too greedy in its demand for increased reimbursement rates. Continuum claims that United has negotiated exceptions to the notification requirement with large hospital groups, instead squeezing the smaller guys for income. While United and major hospital groups have declined to disclose whether or not such immunity exists, it is likely. After all, the small percentage of United Health Care policyholders who use Continuum hospitals is a drop in the bucket compared to their million-plus individual health insurance policyholders in New York.
Seething Battle Continues Over Catholic Takeover of Hospitals in Denver
Friday, April 30th, 2010Backroom deals, multiple lawsuits and $600 million dollars mark the Sisters of Charity attempt to force religious medical directives on non-sectarian medical centers in Colorado.A controversial move to transfer operational control of three secular Denver-area hospitals to a Catholic healthcare system expected to take place on December 31 appears to be on hold pending federal approval.The unexpected delay by the Federal Trade Commission to bless the transaction may provide local critics with a last gasp effort to continue fighting the deal. Community members and medical professionals contend the transfer would unfairly subject comprehensive reproductive health and end-of-life care to church doctrine over patients’ needs. The Catholic church considers abortion, contraception, elective sterilization and termination of invasive life support as “intrinsically evil” and refuses to provide these medical services or respect patients’ advance directives.The disputed takeover in Denver exemplifies the very serious implications for the 127 non-denominational hospitals that succumbed to merger fever with cash-flush Catholic health care systems in the 1990s. According to a study by Catholics for Choice, half of merged secular-Catholic hospitals suspended most or all of their reproductive health care services. Eighty-two percent denied emergency contraception to rape victims — and more than a third refused to provide a referral.But for some tax-exempt, nonprofit hospitals co-owned by secular and church interests, there was little more than a wink and a nod to church mandates on care. Comprehensive reproductive healthcare services quietly remained available.These practices received higher scrutiny in 2001 when the U.S. Conference of Catholic Bishops revised its Ethical and Religious Directives for medical care to address “misinterpretation and misapplication of the principle of cooperation with other-than-Catholic organizations.” In other words, the church would no longer turn a blind eye to reproductive health and end-of-life care at its secular partner facilities that did not meet strict Catholic orthodoxy.More importantly, the local hospital policymaking was a little noticed precursor to the bare knuckles strategy on recent display with the church’s relentless lobbying for the 2009 Stupak and Nelson amendments to further restrict access to abortion care via publicly-subsidized health insurance plans. At the same time, the Catholic Archdiocese of Washington, D.C., threatened to end social service programs for tens of thousands of poor residents if the city council approved a same-sex marriage ordinance.Now, the Denver hospital takeover is offering a glimpse of the intense pressure being brought to bear by the church on its healthcare partners. The Vatican’s renewed insistence on complete doctrinal influence on patient care is bolstered by very real threats to hold desperately needed institutional capital funds hostage until its theological demands are met.And that once delicate balance between serving patient needs and adhering to strict Catholic medical directives is unraveling in plain sight.Another Example of Follow the MoneyExempla Lutheran in Wheat Ridge, Colo., and Exempla Good Samaritan Medical Centers in nearby Lafayette have been sponsored by the Community First Foundation, the former fundraising arm of Lutheran Medical Center, and the Kansas-based Sisters of Charity of Leavenworth in a complex joint partnership since 1997. The two organizations formed the non-sectarian Exempla Healthcare System to manage the hospital operations of the medical centers founded from the ashes of two former Lutheran facilities and St. Joseph Hospital, a 130-year-old institution in the city of Denver, which is wholly owned by the Sisters of Charity.With the three Denver hospitals in need of major infrastructure investments to keep pace in a highly competitive health care market, the Sisters of Charity began flexing their muscle by demanding complete say in day-to-day operations. The Catholic health system complained to the Kansas Business Journal that without administrative control it could not borrow money needed for capital improvements.Namely, that would mean the ouster of Exempla and its non-sectarian medical policies.Not surprisingly, the ultimatum raised the hackles of community members, patients and healthcare professionals at the Exempla-run hospitals. The initial offer sought to buyout Community First’s co-membership in Exempla for $311 million with the Sisters of Charity committing an additional $300 million in capital improvements to the hospitals – a deal the charitable foundation readily agreed to as a way to plump up its sagging recession-battered assets and its growing distaste for the healthcare business.The Community and Politicians Fight to Protect Women’s HealthcareThe Exempla board and a citizen group filed lawsuits in 2008 to block the sale citing, in part, concerns that non-sectarian medical policies would end under a Roman Catholic healthcare system. Community members formed Save Lutheran Medical Center and produced a petition signed by more than 9,000 local residents to reject the deal.But it was all for naught.Two years of lawsuits resulted in a June 5 binding arbitration agreement that nullified the cash payment to Community First as a violation of state law since the community, not the foundation, owns the assets of the tax-exempt, nonprofit hospitals.But in a blow to reproductive health advocates, Arbitrator William Meyer determined that the takeover could still occur as long as nothing of value exchanged hands between the foundation and the Sisters of Charity. He also disregarded the religious medical directive argument claiming that the founding documents of the two Lutheran hospitals didn’t require them to remain secular.While the cases played out in court and behind closed doors in the private arbitration hearing, Colorado state lawmakers worked to minimize the damage of losing hospital-based reproductive healthcare services.Issues of religious doctrinal interference in physician-patient decision making came to a head in 2007 when Gov. Bill Ritter signed a law requiring hospitals and pharmacies to provide sexual assault victims information about emergency contraception. However, a conscience clause was added to the bill in order to get conservative Democrats on board after heavy lobbying by the Colorado Conference of Bishops.Likewise, during the 2009 legislative session, the state passed a landmark Birth Control Protection Act to legally define contraceptive treatments, procedures and devices to stem future challenges to health insurance benefits or from “personhood” laws devised to give fertilized eggs civil right protections.Though, again, the Catholic church forced a compromise to exclude mifespristone, or RU-486, and other federally approved pharmaceuticals that induce abortion.Yet, despite the efforts of pro-choice lawmakers there are no safeguards in place to mandate other hospital-based reproductive health services, like sterilization or abortion, or in end-of-life care procedures that require the removal of feeding tubes or ventilators at tax-exempt, nonprofit facilities.An 11th-Hour Reprieve Wrapped Up in Red TapeSince the summer arbitration ruling, Community First and the Sisters of Charity have forged a new deal that keeps the foundation on as a co-partner but exempts it from any fiscal responsibility for the mounting $2.1 billion in capital needs at the three hospitals. The duo will then transfer control of Exempla to the Sisters of Charity, putting it in complete charge of the hospitals’ administration.Critics of the latest deal pinned their hopes on a 2008 state law that requires the state attorney general to review nonprofit hospital transactions that could substantially change hospital services the public has come to expect. Despite that law, Colorado Attorney General John Suthers, an anti-choice Republican, said in November there was no need to hold a hearing on the Sisters of Charity deal because it was now merely a change in bylaws and not a merger.Meanwhile, the two partners continue to finalize the phasing out of Exempla’s independence. A new board of directors, comprised of an equal number of appointees by Community First and the Sisters of Charity, was announced December 13.The last remaining obstacle to the church’s imposition of religious directives on care is the Federal Trade Commission which must approve the deal.A decision was expected by year-end but has not yet been made public. An FTC spokesperson could not be reached for comment about the delay.
Hospital use and payment method by age 65 and over: March 27, 1963
Tuesday, March 23rd, 2010Hospital use and payment method by age 65 and over: March 25, 1964
Saturday, March 20th, 2010Doubts Over New French Hospital Charges
Monday, March 8th, 2010 An historic agreement has been reached to control the fees of French hospital consultants, but it is by no means certain patients will benefit from the deal. Most doctors and consultants in France are self-employed professionals who receive fees on the basis of the treatment they provide to each patient. The fees they are able to charge for each type of treatment are set by the government. Some of the scale rates have barely increased in the past twenty years and rarely reflect the true cost of providing the treatment. As a result, since the early 1980s, the government has allowed some medical professionals to charge fees in excess of these rates, provided they do so with ‘tact and discretion’. The extra charges are known as dépassements d’honoraires. The problem has been that these extra charges have to be paid by the patient either directly, or through their complementary French ‘top-up’ health insurer. This might not have been such a large problem were it not for the fact that the charges have become the norm amongst a certain consultant groups (notably surgeons), and that around 40% of the complementary health insurance policies do not cover these charges. The government has threatened to sanction consultants who do not stick to the ‘tact and discretion’ rule, but they have consistently stopped short of an all out war over the issue, probably out of fear of that they might well lose it! So in order to break the impasse, a deal has now been reached which effectively legitimises the use of dépassements d’honoraires, but on very specific terms. Broadly speaking, three specialist groups of consultants (surgeons, anaesthetists, and obstetricians) will be able impose the extra charges provided that at least 30% of their consultations take place using the scale rates, and that for the remaining 70% of consultations the fee does not exceed 50% of the scale rate. As one impact of this change might well be that the income of some consultants would be lower, the government has also offered the carrot of a reduction in their considerable social security charges, in order to try and persuade them to transfer to this new type of contract. However, the new contract will be made optional, and not all of the trade unions that represent the doctors and consultants have yet to sign up to it! As a result it is by no means certain just how widespread will be adoption of the new fee structure. Although it may well be attractive to those consultants who do not earn a lot from their higher fee rates, those with higher levels of income may not feel it is in their interest to alter their fees. French Health Insurers Accept Charges As part of the agreement, the complementary health insurers have agreed ‘in principle’ that they will pick up the costs of the extra charges for those consultants who sign up to the deal. If they do so, it will clearly be good news for those whose complementary policy does not currently cover the charges. However, it is bound to impact on the level of insurance premiums, at a time when the insurers are already having to pick up other costs and taxes the government have dumped upon them. Some forecasts suggest that complementary health insurance contracts will increase by between 7% and 10% next year, and this is before the impact of the new agreement with the consultants has been factored into the equation. For those patients who do not have complementary insurance, then they may well find greater generalisation of the extra charges, at levels potentially higher than is currently the case. Consumer groups have protested against the change, arguing that the main problem is that the scale rates from the government need to be substantially increased. But with the French health system already facing a huge deficit each year, the government is clearly trying to craft out ways of keeping everyone happy while minimising the cost to the public purse. Amongst the other new charges next year is an increase in the forfait hospitalier, a daily hospital charge not picked up by the social security system. This charge increases from €16 to €18 per day. Not everyone will notice the increase as there are a large number of exemptions, and most ‘top-up’ health insurance policies do pick up the cost, if you have one. The level of reimbursements on some medicines not considered to be effective is also to be reduced from 35% to 15%, and some complementary ‘top-up’ health insurers are saying that if the government does not consider them to be of any use, then they will also refuse to cover them in their policies. Neither does the agreement with the consultants deal with the growing problem of the unequal geographic distribution of medical professionals across the country, with some parts of the country facing a real shortage in doctors and consultants. The government have previously proposed a series of measures to achieve a greater level of equality across the country, but the issue was not raised during the recent negotiations on fees. The new agreement is planned to come into operation in 2010
Most doctors and consultants in France are self-employed professionals who receive fees on the basis of the treatment they provide to each patient.
The fees they are able to charge for each type of treatment are set by the government.
Some of the scale rates have barely increased in the past twenty years and rarely reflect the true cost of providing the treatment.
As a result, since the early 1980s, the government has allowed some medical professionals to charge fees in excess of these rates, provided they do so with ‘tact and discretion’.
The extra charges are known as dépassements d’honoraires.
The problem has been that these extra charges have to be paid by the patient either directly, or through their complementary French ‘top-up’ health insurer.
This might not have been such a large problem were it not for the fact that the charges have become the norm amongst a certain consultant groups (notably surgeons), and that around 40% of the complementary health insurance policies do not cover these charges.
The government has threatened to sanction consultants who do not stick to the ‘tact and discretion’ rule, but they have consistently stopped short of an all out war over the issue, probably out of fear of that they might well lose it!
So in order to break the impasse, a deal has now been reached which effectively legitimises the use of dépassements d’honoraires, but on very specific terms.
Broadly speaking, three specialist groups of consultants (surgeons, anaesthetists, and obstetricians) will be able impose the extra charges provided that at least 30% of their consultations take place using the scale rates, and that for the remaining 70% of consultations the fee does not exceed 50% of the scale rate.
As one impact of this change might well be that the income of some consultants would be lower, the government has also offered the carrot of a reduction in their considerable social security charges, in order to try and persuade them to transfer to this new type of contract.
However, the new contract will be made optional, and not all of the trade unions that represent the doctors and consultants have yet to sign up to it!
As a result it is by no means certain just how widespread will be adoption of the new fee structure. Although it may well be attractive to those consultants who do not earn a lot from their higher fee rates, those with higher levels of income may not feel it is in their interest to alter their fees.
French Health Insurers Accept Charges
As part of the agreement, the complementary health insurers have agreed ‘in principle’ that they will pick up the costs of the extra charges for those consultants who sign up to the deal.
If they do so, it will clearly be good news for those whose complementary policy does not currently cover the charges. However, it is bound to impact on the level of insurance premiums, at a time when the insurers are already having to pick up other costs and taxes the government have dumped upon them.
Some forecasts suggest that complementary health insurance contracts will increase by between 7% and 10% next year, and this is before the impact of the new agreement with the consultants has been factored into the equation.
For those patients who do not have complementary insurance, then they may well find greater generalisation of the extra charges, at levels potentially higher than is currently the case.
Consumer groups have protested against the change, arguing that the main problem is that the scale rates from the government need to be substantially increased. But with the French health system already facing a huge deficit each year, the government is clearly trying to craft out ways of keeping everyone happy while minimising the cost to the public purse.
Amongst the other new charges next year is an increase in the forfait hospitalier, a daily hospital charge not picked up by the social security system. This charge increases from €16 to €18 per day. Not everyone will notice the increase as there are a large number of exemptions, and most ‘top-up’ health insurance policies do pick up the cost, if you have one.
The level of reimbursements on some medicines not considered to be effective is also to be reduced from 35% to 15%, and some complementary ‘top-up’ health insurers are saying that if the government does not consider them to be of any use, then they will also refuse to cover them in their policies.
Neither does the agreement with the consultants deal with the growing problem of the unequal geographic distribution of medical professionals across the country, with some parts of the country facing a real shortage in doctors and consultants.
The government have previously proposed a series of measures to achieve a greater level of equality across the country, but the issue was not raised during the recent negotiations on fees.
The new agreement is planned to come into operation in 2010.
Learn more at http://www.french-property.com/news/
Bristol Hospital, Anthem In Standoff Over Reimbursement Rates
Friday, February 26th, 2010Beginning next year, Bristol Hospital could be out of Anthem Blue Cross and Blue Shield’s network, meaning that Anthem members who use the hospital would be charged out-of-network rates for all but emergency care.Bristol hospital gave notice that it will terminate its contract with the insurer after the two sides were unable to agree on reimbursement rates. Unless they reach an agreement, the contract will end Jan. 1.The two sides are scheduled to talk next week but representatives of both the hospital and the insurer said they remain far apart.Bernadette Kelleher, Anthem’s vice president of provider engagement and contracting, said that the company has proposed an increase in rates for the hospital but that the increases the hospital is seeking are “a non-starter.”"It’s not something we could accept,” she said. “The challenge there is that the level of increase right now, with the current economic environment, individual employers, individual customers, they really just can’t continue to absorb very high, double-digit rate increases.”Peter Freytag, Bristol Hospital’s chief financial officer, acknowledged that the hospital is seeking a large rate increase, but said that is because Anthem’s previous contract paid lower rates than other private insurance companies.”They have been underpaying us for years,” he said.Anthem said the hospital is seeking an increase of more than 20 percent. Freytag said the hospital offered 9 percent as part of continuing negotiations.Freytag disputed the idea that an increase in payments from Anthem would require higher insurance rates for Anthem’s customers. He said the increase Anthem offered would make it difficult for the hospital to cover its costs and replace equipment necessary for quality care.Anthem’s proposed increase would still pay the hospital lower rates than the other private carriers, he said.Similar standoffs have happened in Connecticut this year, in one case involving Anthem. Hospitals typically offset some of the money they lose on Medicare and Medicaid coverage through the rates they charge private insurers.Anthem, which has about 1.4 million customers in Connecticut, accounts for 19 percent of the hospital’s business.Last March, Bristol Hospital briefly stopped accepting United Healthcare insurance after negotiations failed to produce an agreement. The two sides reached a new contract the following month.Around the same time, talks between Anthem and Middlesex Hospital over their contract broke down, leading Anthem to send letters telling its members the hospital would no longer be part of its network. The hospital and insurer reached an agreement before that happened.
Blue Cross, hospitals at odds over contract
Thursday, February 25th, 2010A dispute over insurance payments has stalled contract negotiations between the state’s largest health insurer, Blue Cross and Blue Shield of Louisiana, and the state’s largest health system, Franciscan Missionaries of Our Lady Health System.On Wednesday, Blue Cross, which covers more than 1 million people, announced that the Franciscans, the parent company of Our Lady of the Lake Regional Medical Center and five other hospitals statewide, had decided not to renew its contract and would drop from the Blue Cross network effective Feb. 1.The Franciscan system also includes The Tau Center of Baton Rouge; St. Elizabeth Hospital in Gonzales; Our Lady of Lourdes Regional Medical Center and Heart Hospital of Lafayette, both in Lafayette; St. Francis Hospital’s two campuses in Monroe; and Assumption Community Hospital in Napoleonville.A split would also affect the customers of Blue Cross subsidiaries HMO Louisiana Inc. and Benefit Management Services, according to Blue Cross.Both sides left the door open for continued contract negotiations, which if unresolved could affect tens of thousands of Baton Rouge-area residents and even more statewide. Patients who go to out-of-network facilities pay higher costs.Two years ago, the groups struck a last-minute deal for a two-year contract after weeks of public wrangling over rates.In the latest negotiations, Blue Cross Chief Executive Officer Mike Reitz said the insurer has spent months working with the Franciscan Missionaries to better understand its cost structure and the health system’s needs.“Unfortunately there was no justification for us to pay them the requested amount,” Reitz said.The Franciscans had asked for a single-digit increase in reimbursements, Reitz said. Blue Cross countered with a smaller increase or a contract extension, which still meant the Franciscans would receive Blue Cross’s highest payment rate in the state.The Blue Cross announcement caught the Franciscan health system by surprise, Chief Executive Officer John Finan said. But it was probably part of the insurance company’s negotiating strategy.Finan said he and Reitz met just hours before the announcement. The Franciscan Missionaries expected the next step in negotiations would be to bring in a mediator to resolve the dispute, he said.“This whole thing kind of defies logic,” Finan said. “Blue Cross is asking us to accept a zero or minimal increase in payments while they have already increased premiums.”The health system would be happy to consider little or no increase if the resulting savings went to patients and their employers rather than Blue Cross, Finan said. Blue Cross had indicated it will increase premiums by 9 percent to 10 percent in 2010.Finan said Blue Cross members represent a $200 million book of business with the Franciscans. Nine percent to 10 percent, or $18 million to $20 million, would be a considerable savings to consumers and employers.Reitz said it’s possible that keeping the Franciscan system’s reimbursements the same would mean Blue Cross customers’ premiums would increase by less in the future.Still, the request for an increase runs counter to what customers, Congress and the Obama administration have demanded: that the private market get costs under control, Reitz said. In order to do that, health insurers have to do something about high-cost providers.“They are the highest-paid system in the state, and the requested increase would have put them even higher,” Reitz said. “We offered them something that they were unwilling to participate in so they canceled their participation.”Finan said he doesn’t know if the Franciscan system is paid more than other health systems, and he’s not sure the issue is relevant.The Franciscans said Blue Cross justified its zero-percent increase offer, in part, by describing the system’s mission, which includes care for children, trauma services, people with mental health challenges, people with AIDS, screenings for early detection of cancer or heart disease, as a luxury.“We think we provide high quality service, high quality care, and beneficial services to the community that are under-reimbursed or unreimbursed that others do not,” Finan said.Describing the mission-oriented programs as a luxury is offensive, Finan said.Reitz said Blue Cross is not trying to tell the Franciscans how to run their business.“I am suggesting that the marketplace, our customers, are only willing to pay so much,” Reitz said.If the Franciscans are providing a lot of services not related to patient care, Blue Cross is suggesting that in this economic climate, the Franciscans should look for ways to increase efficiency or put more money into patient care rather than other things, Reitz said. Since the Franciscan system is already the highest-paid, there should be money available for mission-related services if the system is run efficiently.From July to April, the Lake had 52,510 encounters with Blue Cross members, and St. Elizabeth Hospital in Gonzales had 15,198, Lake spokeswoman Kelly Zimmerman said. The Franciscan system had 113,711 encounters in total.Zimmerman said the numbers did not represent total patients seen because there were repeat visits by some patients.
Code Red: Texas In Crisis Over Number Of Uninsured
Tuesday, February 23rd, 2010The American populace has been sufficiently bombarded by information on the “health insurance crisis,” the “healthcare crisis,” the “community crisis.” Despite living in a country where everyone is supposedly entitled to equal access, another horrifying and dismal piece of information seems to be released almost everyday on the declining state of healthcare for the uninsured and underinsured,
The uninsured die more often, receive less preventative care, less therapeutic care, and are diagnosed at more advanced stages of disease than the insured. One-third of those who went without insurance did not receive a recommended test or treatment due to cost in 2004, three to four times the rate of the insured. Texas is the hardest hit, with 25% of its population currently uninsured, in some areas more like 33%. What we have to ask now, knowing we have a major problem on our hands, is what all this actually means for those who lack individual health insurance.
It means that hospitals, clinics, and emergency rooms are shutting down across the country, including in major cities like Dallas and Houston, due to lack of funding, in part because of covering the costs of treating uninsured who had nowhere else to go. It means you may not have an emergency room in your community next year.
The number of doctors no longer accepting Medicaid “the government’s free insurance program for the low-income” is climbing, and the number of those accepted to the program is decreasing, due to a 2006 Congressional approval of $46.1 billion in budget cuts to the program over the next ten years. That means those foregoing needed medical attention, including those in Texas, because they simply can’t afford it, is also on the rise. The extent of this situation is difficult to even estimate, because those who don’t have insurance are less likely to get checked, and those who don’t at least attempt to receive care don’t make it into most of the studies. That means if, like so many, you are uninsured, this could be you.
According to the U.S. Census Bureau, 46 million, or 15.7% of the population, went without health insurance in 2004. Almost one-third of the non-elderly went without in 2002-2003 – 43% for Texas – and millions more were considered underinsured in the same years.
Texas has the highest percentage of uninsured adults, working adults, and children, only a portion of whom are actually in poverty. According to the Institute of Medicine, a large percentage of the uninsured are working individuals who can sustain themselves, but who cannot afford health coverage due to rising costs; premiums alone have increased an average of 15% over the last five years nationally, and employee spending for healthcare increased by 143% between 2000 and 2005.
It’s difficult, particularly for young people, to conceptualize the consequences of not having individual health insurance until a catastrophe, even a small one, hits.
“Yeah, it’s horrible,” grumbles David*, a construction worker who has worked in Arizona, Texas, and New Mexico. “There’s always work in the Southwest because the weather is so great, but most of the time I can’t do it anymore because of this,” he says, aggravated, pointing at his midsection. “It’s not the worst thing that could have happened to me, but it’s definitely one of the more damaging to my career.”
David, 29, suffered a hernia four months ago, a condition that is usually not life-threatening, but inhibits a person from performing certain activities, including heavy lifting. With no individual health insurance of his own, the only way it will be treated properly is if he can somehow pay for the expensive surgery himself. “Medicaid won’t cover me because my average income is too high, workers’ comp won’t cover me because it didn’t happen on the job, and the hospitals won’t cover me because it’s not a life-threatening situation. I don’t have my own insurance because the premiums are too high. So what am I supposed to do? Construction is the only skill I have.”
What this translates into, practically, is that David now has to choose between the lesser of two evils. He risks serious injury by taking assignments requiring heavy lifting – almost all construction jobs – but not working means he can’t pay the bills. As a high school graduate who went directly into construction, he has little experience outside of the field, and no other skilled trades. “It’s either this or fast food.”
Texas, with the highest rate of uninsured and some of the strictest guidelines to qualify for Medicaid, is a prime example of how difficult receiving adequate healthcare is without coverage. While Medicaid and the State Children’s Health Insurance Program is largely the state’s responsibility for those who actually make the cut, care for medically indigent patients is the county’s responsibility, and funding across the state varies widely. Some counties only provide for those without any, or with extremely low, incomes – which means that cities like Dallas, Houston, San Antonio, and Austin are absorbing the cost of patients coming in from other parts of the state. But Texas cities have their own problems; 28% of Houston residents, for instance, are uninsured themselves.
And the problem is not just with healthcare, but with all the aspects of personal life and the economy that poor health can affect. Poor health, for a notable example, negatively impacts educational status, which, in turn, negatively impacts health. The problem is so urgent in Texas that a Task Force of ten of the state’s academic institutions was created to address the crisis. The Task Force concluded – among other things – that, “in the absence of vigorous initiatives” to correct the situation, hospitals and emergency rooms will continue to close, the state’s economic power will decrease, and both state and county budgets will spin into crises.
So what does this Code Red for Texas mean exactly? It means that if you’re uninsured, you have less access to care, lower quality of care when you get it, and a higher chance of the care you get being too little, too late. It means that if you’re unfortunate enough to contract cancer while uninsured, you are statistically more likely to get diagnosed at a later stage of disease, more likely to receive less therapeutic (i.e., effective) care, and, sadly, more likely to die. It means that if you’re uninsured and diagnosed with HIV, or diabetes, or high blood pressure, you will probably suffer a similar fate.
Texas’ Code Red also means that, under the current conditions of the economy and healthcare system, you’re statistically more likely to survive, or suffer less severe consequences of a disease, if you invest in health insurance. While the country, of course, needs to fight the dysfunction that created this terrible situation, you had best protect yourself. It could literally be a matter of survival.
