Health care gap
Job losses leaving more people without coverage
By Jill Coley
The Post and Courier
A gurney speeds in a blur past the entrance of the emergency room waiting area Friday at Trident Medical Center in Charleston.
Jennifer Barlett sees the cracks everyday. As a supervisor for MedAssist, a third-party recovery company that contracts with Trident Health System, her job is to try to fill the gaps.
She scours Medicaid, Medicare, charities and long-term payment plans to help uninsured people find ways to pay their medical bills.
In one family Barlett is counseling, the wife lost her job, and also the health insurance that covered her and her husband. The couple tried to go it alone, becoming self-employed, but when he fell gravely ill, they had to close the business.
"No health insurance. No money," Barlett said. They're waiting to hear from Medicaid and Social Security.
As more people lose their jobs, they also lose their health insurance, adding to a decade-long trend of an increasing number of uninsured.
Further, with health insurance premiums increasing at twice the rate of inflation, more businesses are cutting back their portion during tough times. Some have discontinued health insurance altogether.
Caught in the middle are health care providers and institutions, which must deliver care and remain financially sound.
Todd Gallati, Trident's president and chief executive officer, said "We're seeing a slight uptick in uninsured patients." Whether the increase is due to the economy or is a continuation of the ongoing trend, he was unsure. "It's been a significant problem for a number of years," he said.
South Carolina's 8.4 percent unemployment rate ranks third-highest in the nation. That means 182,900 workers are without jobs. Nearly 12,000 of those jobs were lost in November, the last month for which data is available. The state's unemployment rate is projected to top a whopping 14 percent by summer.
The South Carolina Hospital Association informally polled hospital CEOs on the effects of the recession, and about one-third of the hospitals responded. In the last year, 90 percent had seen an increase in uninsured. Nearly 60 percent had seen an increase in emergency room visits, coupled with a 70 percent decrease in hospital admissions for routine care.
"What you typically see is those without insurance don't seek care as early or as often," Gallati said. People wait until conditions worsen, then go to the emergency room. Trident has seen a 4.2 percent increase in emergency room admissions over last year, Gallati said. One in five patients who walked through the door Dec. 29 didn't have insurance, he said.
The American College of Emergency Physicians issued an indictment of the system in December. President-elect Angela Gardner said, "The emergency care system is a 'ticking time bomb,' accelerated by the financial crisis."
Medical University Hospital reported an increase in self pay and indigent care during the five months ending 2008 compared to the same period in 2007.
"We've also seen an increase in patients with third party coverage, such as Blue Cross, commercial insurances and HMO coverage," said Steve Hargett, MUSC Medical Center controller. "Anecdotally we believe ... that individuals are worried about losing their jobs and their health insurance and are choosing to have elective procedures performed now that might have been delayed in a better economic climate."
Roper St. Francis Healthcare also has experienced an increase in uninsured patients admitted this fall, according to Tricia Crimminger, director of corporate communications.
The Consolidated Omnibus Budget Reconciliation Act of 1985, or COBRA, was created to help people keep their health coverage after leaving a job. But the premiums are astronomical.
"Lots of people who lost jobs (and were) offered COBRA can't afford it," Barlett said. "It's more than $1,000 a month for a family of four." That's often more than unemployment benefits.
That leaves public coverage, or Medicaid, for children whose parents lose their jobs. To qualify for Medicaid, an adult must meet financial guidelines and belong to one of the following categories: parents of dependent children, pregnant women, disabled or elderly.
Increasing Medicaid's burden could not come at a worse time. The S.C. Department of Health and Human Services is already slashing services and programs in the face of a $137 million loss from the state this fiscal year. Add the federal match to those dollars, and the actual loss totals $459 million.
More uninsured people are turning to safety net providers, such as the Franklin C. Fetter Family Health Center that has nine sites in four counties. During the last three years, uninsured patients have increased to 46 percent from 36 percent, and in the last five months, that amount has spiked to 51 percent.
Executive Director Ronald A. Ravenell said, "This trend is not going to get any better. I think several factors are involved — downsizing of jobs, people being laid off and employers not offering health benefits. Even if they do have benefits, some can't afford them."
Reach Jill Coley at 937-5719 or jcoley@postandcourier.com.
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Chicago_Thug (anonymous) says...
See previous story;
Families at risk, backers say
Treating illegals for a none emergency in an ER, is costing the health care industry billions.
January 3, 2009 at 8:29 a.m. ( permalink | suggest removal )
katsplay (anonymous) says...
Although I have maintained my health care coverage through my employer, my adult daughter has unfortunately realized that she is going to have to give up her own coverage because she will be unable to pay the premium since losing her job in December. Her employer had paid a portion of the cost and now without that help, she is back to being uninsured. She does not fall into the requisite categories: parents of dependent children, pregnant women, disabled or elderly. I am thankful she does not have children but why is it that if she did get pregnant and have a child she would be better off than she is now? It shouldn't be that way. The fact is that she would cost the government very little if she qualified for assistance now but she would cost a whole lot more if she became pregnant and had a child!
January 3, 2009 at 9:10 a.m. ( permalink | suggest removal )
Tides (anonymous) says...
Doctors and hospitals are so greedy. From wages, salaries, and fees, they have become so out of control that a hospital stay wipes out a person's financial life. Look at the overly excessive salaries for the MUSC head. It's insane! Look at the bonuses the SC State Ports Executives have been getting as STATE EMPLOYEES! INSANE TOO! All of them are no different than greedy sales people and developers and loan officers. They have done their part in DESTROYING the USA. That is the clear and honest reality of it all.
Everybody wants to get rich. Just look at how the housing market went crazy with over-inflated prices. Simply put, GREED!
America brought this looming depression on itself. You have no one else to blame for it. Even our politicians are obviously corrupt. SC State government screams in need of a full audit to filter them out and punish them.
Until we weed these people out and punish them, nothing will ever change. Nothing at all.
January 3, 2009 at 1:13 p.m. ( permalink | suggest removal )
chucktonian (anonymous) says...
Here is a ground-breaking solution: allow people without insurance to pay the SAME LOW prices that insurance companies pay.
SHOCKING!!!!
The fleecing of self-pay customers with overpriced medical care...prices the major insurance companies never pay...is THEFT.
You hear that medical industry? THEFT! YOU'RE THIEVES!!!!
January 3, 2009 at 2:10 p.m. ( permalink | suggest removal )
coolfreaknbeans (anonymous) says...
chucktonian- You are on the money! Years ago I had health insurance that had a large co-pay for specialists. I called my Dr because I needed a refill, they said I needed to come in, to which I said this is starting to really add up! They said "Oh, no problem, come in and we'll treat you as uninsured. It's only 1/3 of your co-pay cost" I was shocked! Why have insurance if you can bargain and get a cheaper price?(I'm being facetious of course) But health insurance is way way too high. If you put aside the $1,000 per month in a high yield account rather than paying an insurance company, you'd be better off.
January 3, 2009 at 6:25 p.m. ( permalink | suggest removal )
wonderdog (anonymous) says...
I have health insurance through my employer and am paying for my daughter's coverage. I pay over $300 per month for her coverage, and it's like pulling teeth to get the ins. company to pay a claim. When my son was on my plan, he had to go to the hospital (preferred provider)for stitches, and the ins. company only paid $186 out of a $1000 claim. I wrote a letter and asked what they suggest we do to get ins. coverage in a medical emergency, and they paid an additional $430 toward the claim. I guess they were hoping we wouldn't appeal or ask them to pay according to the contract.
Health insurance is not that great unless you have a major illness or emergency, but I am not going to risk being without coverage.
January 3, 2009 at 6:36 p.m. ( permalink | suggest removal )
majorjohnson (anonymous) says...
The reason your health care is so expensive is that the government mandates your employer insure you for everything from a lung transplant to a splinter. The doctor who does nothing more than give checkups and prescribe medication for the flu and pull splinters has to maintain a full staff of people whose only duty is to understand and file insurance paperwork. That staff has to be paid for. On top of that the government only pays X dollars for procedures for medicare/medicaid patients, and that requires not only staff to keep up with those rules and file that paperwork, but because it doesn't actually cover the cost of those procedures that staff has to also figure out how to spread the amount that those set payments don't cover to the insured and uninsured payees, because that money has to be made up somewhere. You people who think government is the answer to the cost of health care are hiring foxes to guard your chicken coops.
It was within my own lifetime that we were able to afford routine healthcare out of pocket and we had catastrophic insurance for the big stuff...now thanks to government no one can afford to have a splinter pulled unless they have insurance or medicare/medicaid. And every time there is an audit of the medicare/medicaid system they find that it's littered with improper payments and fraud. The last audit carried out found that 35% of the payments made were erroneous and unretrievable. And you people can't wait until health care is free, and think the medical care system is the problem.
Further, the most affordable and competitive health care in this country is cosmetic health care. Cosmetic surgery is not covered by insurance or government. You'd better think long and hard before you let the government take over your health care.
January 3, 2009 at 9:21 p.m. ( permalink | suggest removal )
wonderdog (anonymous) says...
We don't go to the doctor for colds and minor illnesses, only if we are REALLY sick. I didn't even have a doctor for over 10 years - didn't need one. I don't want the government to take over health care - then we're really screwed.
January 4, 2009 at 12:52 a.m. ( permalink | suggest removal )
Chilldiesel83 (anonymous) says...
There are plenty and I mean plenty of insurance companies out there that offer Health Insurance. The problem is that everyone does get insurance through their employer. What does this mean? It means that you do not own the policy, often times there are only a few select plans that you can choose from whether they benefit you or not, and if you do become unemployed, you lose all benefits, and any tenure you might have had with that company or whatever is now all lost. I work for an insurance company and there are so many things wrong. First, I talk to people everyday about life and health insurance, and they either say, well I just got a brand new tv and I have to order high definition cable or I want to go buy a brand new car, or most commonly I have it through work. It bothers me to a great deal, and I ask people point blank. Why in the world would you want to not own yourself the most important consumer product you can buy out there, which is your life and health insurance. Why in the world would you want to leave your family's well being in the hands of corporate execs, etc, who can choose to stop offering this coverage at any point in time, with you hanging out in the wind. The fact is that private insurance is not as expensive as people think, but if you take employer benefits and then get dropped, you might not be able to get coverage elsewhere, because of age or pre-existing conditions.
January 4, 2009 at 11:02 a.m. ( permalink | suggest removal )
wonderdog (anonymous) says...
I have my health insurance through my employer because they pay for most of my premium. I pay for my child's coverage. One of my kids graduated from college and is now covered under his employer's plan. My policy now covers one dependent instead of two, and the premium went up.
I used to work 3 part time jobs and paid for my own coverage. When I turned 40, the premium tripled, even though I had made no claims the entire time I was covered. I get the same answer every time I ask why - "because they can". I had to leave the part time jobs I loved because I needed full time with health insurance coverage. No HD cable, no dinners out, and I drive a 10 year old vehicle. My priority is providing necessities for my family and paying for my kids to go to college (combination of scholarships and loans, and they work(ed) while going to school). I don't want the government intruding into my health care choices, and I will continue to pay the premiums.
January 4, 2009 at 12:48 p.m. ( permalink | suggest removal )
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