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Ripple reaches health care

By Daniel Axelrod
ScrantonTimes Tribune
07/06/2008

 
The economic downturn is making it tougher for people to afford health care, sparking more emergency room visits, unpaid hospital bills and greater demand for state assistance, experts say.
 
But health care providers and state officials can’t quantify exactly how much the slowdown is exacerbating those trends, which they say have been going on for years.
 
“We get calls from people all the time saying we can’t afford health insurance, where do we turn?” said Amy Kelchner, spokeswoman for the Pennsylvania Governor’s Office of Health Care Reform. “The downturn is clearly having an impact.”
 
Yet, accounting for the soft economy’s influence on those rising figures “is complex,” said Ann Bale, a state Department of Public Welfare spokeswoman. The state and local hospitals don’t survey government-subsidized health insurance subscribers and visitors to emergency rooms — refuges for the uninsured — about their financial circumstances and why they need help.
 
Nonetheless, it’s clear more local low-income people are turning to the state’s Medical Assistance or Medicaid program. Pennsylvania’s adultBasic insurance, for those earning too much for Medical Assistance but not enough for regular coverage, and the State Children’s Health Insurance Plan have seen significant recent gains, too.
 
Echoing state trends, the number of adultBasic recipients in seven Northeastern Pennsylvania counties — Lackawanna, Luzerne, Monroe, Pike, Susquehanna, Wayne and Wyoming — grew about 24 percent to 4,233 from 3,422 since last June.
 
Between June 2007 and May, the portion of Northeastern Pennsylvania Medical Assistance recipients deemed “medically needy” rose 6 percent to 10,176 from 9,605.
 
Pennsylvaniastatistics indicate disabled individuals, the elderly and adults with chronic illnesses are driving increased demand for a range of Medical Assistance programs, from food stamps to health insurance, Ms. Bale said.
 
“Certainly (the increases are) related to the economy as fewer employers offer health care coverage because it is so expensive,” she added. “As families struggle with soaring energy costs, food costs and declining home values, they can’t afford to pay the premiums when (insurance) is available to them.”
 
Enrollment in SCHIP has steadily risen in recent years, too. But state officials say that’s also a product of heavy, targeted advertising to parents. The seven local counties’ SCHIP recipient totals rose 5 percent to 12,199 from 11,628 since last June.
 
Pressure Builds
 Meanwhile, the economy’s recent troubles are adding to years of financial pressure on Pennsylvania workers, said Ms. Kelchner, of the governor’s health reform office.
 
The health insurance premiums in the commonwealth rose nearly five times higher than wages and the overall rate of inflation between 2001 and 2006, according to a 2006 survey by the Kaiser Family Foundation. That nearly 76 percent climb in insurance costs contrasts with a 17 percent increase in inflation and a 13.3 percent rise in wages over that span.
 
On top of that, up to 18-month delays await the 6,705 Northeastern Pennsylvania residents seeking adultBasic coverage. As the adultBasic waiting list grew 65 percent since June 2006, emergency room physicians and small clinics’ practitioners administered primary care.
 
All the while, year-over-year patient volumes at Geisinger’s five Weis Markets-based clinics in Northeastern Pennsylvania have increased 50 percent, said Dean Lin, CEO of CareWorks Clinics. The clinics’ low out-of-pocket costs make them appealing.
 
“More people are uninsured or underinsured, and deductibles go up every year,” Mr. Lin said. “It’s forcing people to think more carefully about their health care options.”
 
In Scranton, visits to Mercy Hospital’s emergency room since the beginning of the year are up nearly 9 percent from the first six months last year. Compared with last May, Community Medical Center has seen a 3 percent rise, while Moses Taylor is projecting a 6 percent annual increase above emergency room visits in 2007.
 
Moses President and CEO Harold “Andy” Anderson projects his hospital’s uncompensated care total will grow to $8 million this year, up from $6.4 million last year. CMC has provided $13.5 million of uncompensated care so far, compared with $12.1 million at this point last year.
 
Other Factors
 However, Mr. Anderson said he’s skeptical the economy is mainly responsible for the upticks at this point.
 
Mr. Anderson, John Nilsson, CMC’s interim president and CEO, and Mercy’s leader said the weak economy has played a part in the increases, but it’s a bit simplistic to just blame the downturn.
 
“The economy is responsible for our escalation of bad debt and increased emergency room care, but I can’t say it’s solely responsible,” said John Starcher, interim president and CEO at Mercy Hospital.
 
The negative statistics are as much or more a reflection of larger issues involving the access and affordability of health care, the administrators said.
 
Deducing the downturn’s impact is one thing, “but the more important question is how do we help people and get them more access to health care,” said Rosanne Placey, spokeswoman for the state Insurance Department.