Patients can't pay: And problems getting worse, observers say
By JENNIFER BOOTH REED
jreed@news-press.com
She's been lucky so far, but Lina Narduzzi knows her health or fate can turn at any time.
Narduzzi, 61, lost her insurance almost a year ago when she lost her job as office manager of a medical practice.
The doctor kept her on as a patient, waiving fees until Narduzzi finds employment. She slips Narduzzi samples of medications for things such as osteoporosis prevention. But the doctor has also cautioned the Lehigh Acres woman.
"She said to me, 'Lina, it's very dangerous to be without health insurance,'" Narduzzi said. "I can't afford it. I don't have a job... My No. 1 priority is to find employment and the No. 2 is to get health insurance."
Narduzzi is part of a rising tide of Americans going without insurance, a population fueled by joblessness and the loss of employer-sponsored health insurance.
The U.S. Census Bureau estimated that 45.7 million Americans were uninsured in 2007, the latest figure available.
But a new study by the health care advocacy group Families USA and the Lewin Group, a health care research firm, finds the picture is much worse.
The organizations looked at people who were insured for all or part of a two-year period, 2007 and 2008, opposed to the census calculation, which considers people who report being uninsured for an entire calendar year.
Families USA found that 86.7 million Americans, almost one in three people younger than 65, were uninsured for all or part of 2007 and 2008.
The situation is similarly bleak in Florida, which already has high rates of uninsurance because of its small business and service-sector economy. The new report found 38 percent of Floridians younger than 65 -5.8 million people - went without insurance for all or part of those years. The Census Bureau figures suggested about 21 percent of Floridians were uninsured in 2007.
"The huge number of people without health coverage in Florida is worse than an epidemic," Families USA Executive Director Ron Pollack said.
Lee County, already one of the worst parts of the state as far as health insurance goes, hit a 11.5 unemployment rate in January.
"I think the unemployment rate in Lee County says it all," said Billie Jo DeBolt, the Lee Memorial director for business services. "The price of COBRA is so expensive, they just can't afford the premiums.
COBRA is the federal law that allows people to continue purchasing insurance through their former employer for 18 months if they work for a qualifying firm.
The number of area patients admitted to county hospitals through the emergency room are vastly above expectations. That suggests people are going without treatment until their ailments reach a critical state.
At one hospital, HealthPark Medical Center, the number of emergency room patients requiring hospitalization is 48 percent higher than Lee Memorial Health System officials projected. Other system hospitals blew projections by between 29 percent and 41 percent.
Overall at Lee Memorial, the percent of patients who are uninsured is up 19 percent for the first five months of the fiscal year, compared to the same period last year. Between October and February, the system had seen 29,675 uninsured patients.
"We've never had an increase that significant," DeBolt said.
The system had extended discounts to uninsured patients totaling $16 million during that five-month span, up from $8.8 million last year. Those figures are just for three hospitals; DeBolt did not have the other two immediately available.
Dr. H. Lee Adkins, a Fort Myers primary care physician who has worked to make his services affordable for people without insurance, reports that approximately 30 percent of his patients have no insurance.
And at the Family Health Centers, which takes patients regardless of income or insurance, administrators aren't reporting much of an uptick in uninsured adults - and in fact their uninsured Hispanic population is down as workers have moved out of state - it is seeing a jump in the number of uninsured children seeking care. Doctors and administrators believe parents may be foregoing treatment for their own illnesses but making sure their children can still see pediatricians, spokesman Bob Johns said.
Pollack of Families USA and other health care advocates are using the new report to increase pressure on lawmakers to take action. They said the recent federal boost in Medicaid money, new government subsidies for COBRA payments and expansion of the State Children's Health Insurance Program will help.
But Pollack said it was time the government pushed for changes.
"Meaningful health care reform can no longer be stuck on the back burner. These numbers demonstrate the seriousness of the problem," Pollack said.
In Florida, enrollment has started in Cover Florida, Gov. Charlie Crist's effort to offer lower-cost, private sector plans for people without health insurance. But critics contend the premiums are still too much for many Floridians and they question whether the coverage is comprehensive enough to make a difference.
Laura Goodhue, the executive director of Florida CHAIN, an advocacy group, said it's too soon to judge Cover Florida's impact on health care access and she encouraged Floridians to review the plans carefully before purchasing one.
She said Florida needs to take advantage of new federal money for Medicaid and children's health insurance. The state must offer its share of matching dollars to qualify for the funding.
But Goodhue thinks real solutions lie at the federal level.
"This is the year for it to happen," Goodhue said. "I think the political will is there."
Narduzzi, the woman from Lehigh Acres, said something must be done. She can't afford an individual insurance plan. She couldn't afford to stay on her former employers' plan through COBRA. And she's four years shy of qualifying for Medicare, the government plan for people age 65 and older.
"Unless I can get a job I can't get insurance. And I am just hoping and praying nothing happens to me," Narduzzi said.
Additional Facts
Resources for the Uninsured
The United Way can help link people to medical resources. Call its hotline at 211 or 433-3900.
Talk to your doctor or pharmacist to see if he or she has payment plans or self-pay policies for people without insurance. Ask pharmacists and physicians about switching to cheaper, generic drugs. Shop pharmacy prices, including independent shops. Drug prices can vary widely from store to store.
Visit the Family Health Centers, which charges on a sliding-scale according to income level: 278-3600.
Ask Lee Memorial Health System financial counselors about discounts for the uninsured. The minimum discount is 25 percent, up from 20 percent last year. People who pay at the time of service or who are considered low income can qualify for additional discounts.
Call Partners in Breast Cancer Care for help paying for screenings and treatment: 454-8583.
See if you qualify for Medicaid. Call the Department of Children and Families for information: 1-866-762-2237 or local 338-1431.
Enroll your child in Florida KidCare, which sets its premiums according to income level. Call the Lee County Health Department: 332-9576.
If you don't have a primary care physician and need care, consider an urgent care clinic rather than the emergency room. But people with serious symptoms such as heart attack signs should go to the emergency room or call 911.
Shop for insurance. Providers such as Blue Cross are beginning to offer lower-cost premiums for people buying individual policies rather than getting them through employers. Read the fine print, though, and make sure you understand your deductibles and other obligations as well as coverage limitations.
Check into Cover Florida, a new insurance plan for people who are uninsured. The Web site is: overfloridahealthcare.com.
