Uninsured patients a vicious circle for Tahoe’s health care | TahoeDailyTribune.com

Uninsured patients a vicious circle for Tahoe’s health care

Jim Grant / Tahoe Daily Tribune / Barton Memorial Hospital financial services coordinator Patty Fischer distributes information on the hospital's Helping Hand Patient Financial Assistance Program.

Linda Bolton would love for her family to get the level of health care they need. But like many others nationwide, that goal seems more like a pipe dream to them considering the challenges they face.

The South Lake Tahoe woman’s policy premium has quadrupled from $300 since she left her job at Harrah’s Lake Tahoe. Her son Michael, a local man who suffers from a mental disorder, doesn’t have insurance. Her daughter and Michael’s twin, Misty Brown, don’t either. She’s mounted a heap of medical bills in the thousands of dollars.

“She’ll never be able to pay them,” Bolton said, while waiting for Michael to be seen at Barton Community Clinic last week. “It’s a big problem. So many people don’t have it.”

Indeed, Bolton is right. A recent study by the Commonwealth Fund, a New York-based health care policy foundation, revealed the percentage of individuals without insurance rose to 28 percent in 2005. It was 24 percent four years before the update. The 2005 statistic nearly doubles for those earning less than $20,000 a year, placing a heavy burden on health care providers and social services in communities across the United States. About 45.8 million Americans did not have insurance in 2004, according to the Census Bureau. And the problem appears to be getting worse – with more than 16 percent of those without insurance residing in California. The numbers coming out of Barton Memorial Hospital and its affiliate clinics show the trend has reached Lake Tahoe.

The numbers of the uninsured seen at the Community Clinic have doubled in three years to 260 in the month of March.

“People come here because it’s the cheapest place to get care,” Randy Jones said, waiting in the clinic parking lot for his girlfriend. The uninsured South Shore man relies on alternative health measures like magnets to escape having to see the doctor. He wears them as an energy source. The self-employed construction worker has also cut down on high-risk sporting activities such as rock climbing and snowboarding.

Jones has thought about getting insurance in case something catastrophic would happen to him, but for now he believes “it costs too much.”

Multiple reports have indicated health insurance policies are rising at an alarming rate. And now those who have insurance are having their complaints about the state of health care. Some staffers have even opted out of their own employer-sponsored plans because they can’t afford the premiums and deductibles. The out-of-pocket expenses turned out to be a major point during contract negotiations between teachers and Lake Tahoe Unified School District a few years ago.

Despite the high rates, South Lake Tahoe insurance broker Malcolm Pribyl still recommends people bite the bullet and maintain the insurance. The alternative is too risky – especially with the prevalence of cancer and other catastrophic health issues.

“If an employee pays 50 percent of the policy cost, then it’s worth it,” he said as a threshold to those on the fence. Three quarters of his clients pay between $2,000 and $5,000 in deductibles. He suggests people go for the plans with higher deductibles and lower premiums.

Where will it all lead?

Health care providers and social service administrators are witnessing a vicious cycle occur. The overall cost of health care goes up when the uninsured fail to get preventive care and show up in the emergency room or in clinics with advanced stages of diseases. The topic becomes exacerbated with the top-of-mind issue of immigration, and critics citing undocumented workers draining critical government resources.

But El Dorado County Health Officer Gayle Erbe-Hamlin has another take on that assumption.

“The bottom line with the uninsured is it’s less related to someone’s immigration status than one’s ability to secure health insurance through their employer,” she said. “Not only that, Hispanics tend to pay cash for services and have a more difficult time getting other programs.”

And Barton has seen only two undocumented immigrants receive medical care under the federal government’s Section 1011 in the last few years. The regulation assists hospitals with reimbursements for treating them in the ER.

Erbe-Hamlin cited seasonal workers and employees in small businesses as the majority of those in need of government services. Even working for the county will cost an employee $15,000 a year, per person for a family of four. The county developed an educational program called Accel, with its primary mission involving dispensing information of the services available.

The goal is to provide a program for children under 300 percent of the poverty level – $9,800 for individuals and $20,000 for a family of four.

Barton chips in

The health care group has implemented programs to help the uninsured and underinsured. Otherwise, the hospital’s finance staff has discovered that without assistance some people like Bolton’s daughter feel overwhelmed with the costs. And some patients simply don’t pay their bills.

Barton has contracted with a company to help patients with their public assistance eligibility, hiring two people to work in that capacity. There’s also a staff person and a county Social Services worker helping them find relief. Barton has figured it gave out $1.5 million in charity care in 2005. And in the end, it’s given the health care provider relief in carrying bad debt, or worse yet, going under like other hospitals.

Barton’s bad debt has been cut in half to 4 percent in the last few years, Chief Financial Officer Dick Derby said.

Barton Uninsured Patients

Community Clinic: March 2006: 260 March 2005: 217 March 2004: 133

Memorial Hospital: March 2006: 321March 2005: 292March 2004: 184

Stateline Medical Center: March 2006: 203March 2005: 270March 2004: 246

Tahoe Family Physicians: March 2006: 22March 2005: 30March 2004: 52

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