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The Health Care Debacle:
Feds lack answers, states lack funds,
but partnerships
are emerging by The Review Editorial Staff As spokesman for Health Access America in Saginaw County, Mike Nowlin doesn't have to look far to find an audience.
He
recently was offering information on the Saginaw Health Plan's
new Tri-Share project, which aims to help small business
provide medical coverage, during a breakfast interview at a
restaurant near Old Town.
The manager overheard him and
inquired.
"I don't qualify for any medical
help," she explained. "With my income, I'm described as
overqualified. I'm what they call a spend-down. I can get coverage
for my 14-year-old twin boys, but not for myself."
Her main concern is that she can't
afford a prescription to combat her high blood pressure.
"Doctors always say they are
accepting new patients, until you tell them you have no insurance.
Then they're accepting none. My doctor will be whoever is on duty in
the emergency room," she said.
Nowlin is familiar with the woman's
spontaneous testimony. He notes that more than 30,000 Saginaw
County residents are uninsured, about one in seven.
The statewide count is estimated at about 1 million, or one in nine
Nowlin started in March with a goal
of helping at least 1,000 Saginaw County residents find insurance
before the end of July. He already is about two-thirds of the way
there.
Tri-Share is a nonprofit
partnership geared t enterprises that employ fewer than 20 people. A
worker earning $12 per hour or less can set aside $53 per month for
personal coverage, or $100 to include a spouse. In turn, the
employer and the Saginaw Health Plan each will contribute the
same amount. Coverage is widespread with no co-pay deductibles.
Saginaw County is one of seven
communities across the nation selected for Health Access America,
created through a coalition of health care companies and an
organization based in Washington and known as the Healthcare
Leadership Council.
"We are taking our information
meetings out to all sections of the community," said Nowlin, who has
a session scheduled for 11 a.m. to 2 p.m. on June 5 at
the East Side Soup Kitchen, on East Genesee near Cherry.
Few answers from government Thirteen years have passed since the defeat of universal care plans proposed by former President Bill Clinton and spouse Hillary. The Clintons didn't try again after the 1994 debacle, which was fueled by fear tactics and disinformation from powerful insurance & health industry lobbies. President George W. Bush's lone major reform is a prescription drug benefit, and critics say the provision favors the pharmaceutical companies more so than the people.
At the state level as Review
Magazine went to press, legislators have decided against an
immediate 6 percent rollback in Medicaid funding, but the
issue will remain on the table with more budget cuts required down
the road. More than 44 million Americans lack any health
insurance, and millions more have only minimum coverage.
Most of the uninsured have jobs. The
lower the pay, the higher the odds that the employer doesn't provide
insurance. The Michigan Department of Community Health
reported that 84 percent of middle and upper-income families
receive coverage from employers, in contrast to 34 percent
among the so-called working poor, and the gap is growing.
Furthermore, employers at all levels
are cutting back. Average income in Michigan is up 16 percent
since 2000 and consumer prices are up 13 percent, but health
insurance costs have skyrocketed in comparison by 73 percent.
Federal action seems unlikely. The
national debt is $8.8 trillion, including more than $3
trillion accumulated during the first six years of George W.
Bush's presidency. The debt is the equivalent of nearly
$30,000 for each American.
The cost of the Iraq War alone
has surpassed $430 billion, which is the equivalent of more
than $1,400 per citizen. This same sum would allow an
individual to enroll in Tri-Share for 26 months.
Nowlin said he can't blame people for
having a bleak outlook, based on what they have observed in
politics.
At the same time, he said projects
such as Tri-Share and MIChild (the state's children's
health insurance program) offer options that can at least start to
tackle the problem.
"Progress is not impossible," he
said. "We can reduce the uninsured population by a meaningful number
by doing a better job of linking individuals without coverage to
resources that already exist."
State can't run debt In contrast to federal spending, Michigan's potential $48 million Medicaid cut may seem like small potatoes. The sum equals the cost of fighting the Iraq War for about five hours. The difference is that state legislators, unlike the feds, must balance their budget.
Lansing lawmakers must tackle not
only this year's shortfall, but also the annual loss of $1.9
billion from future elimination of the Single Business Tax.
"Medicaid funding is always at risk
and we've been fighting against cuts for years," said Jacqueline
Doig, a staff attorney at the Center for Civil Justice, a
regional group based in Saginaw.
"We want to advocate for the
strengthening Medicaid and MiChild, and coverage for the uninsured
and the underinsured, but with the budget situation right now, we're
busy just trying to convince the state legislature and the
administration to maintain what's there."
Democrats say they will consider
restoring the state income tax to 4.4 percent, the level that
existed before a five-year string of cuts reduced the levy to the
existing 3.9 percent. The Dems also are floating proposals to
abandon the flat tax and set higher rates for higher-income people.
Doig said the potential Medicaid
cutback is an example of a double impact.
"If we take $48 million from the
state budget, then we lose another $65 million in federal matching
funds, a total of $113 million in health care," she said.
"We need to have a revenue-based
solution to the budget. We can't cut our way out of this, and
cutting health care isn't going to help anyone. The costs of health
care are still going to be there. They will just be shifted to the
folks who have insurance."
Rhonda Miller, director of
revenue cycle for St. Mary's of Michigan, said the hospital
last year spent $19.3 million for uncompensated care of the
poor and community benefits. The potential state Medicaid cut would
drain another $1.3 million.
"We will not turn anyone away and we
will not increase rates," Miller said. "Our main concern is our
patients, and we are concerned that those with Medicaid as a primary
means of insurance will have less benefits."
Partnerships show potential Doig said that amid what is often described as a health care crisis, one bright spot is a growing emphasis on public-private partnerships.
"We had a state task force that
completed its report last year, but many of the members are still
meeting because they recognize that its in everyone's self-interest
to address this problem, as the business community realizes the
negative impact of an uninsured population on their bottom line,"
Doig said.
She referred to the Michigan
State Planning Project for the Uninsured, coordinated through
the Department of Community Health. One finding was that the
impact of cost-shifting, to help pay for health care for the
uninsured, added $730 to the annual cost of a typical family
policy or $274 to an individual policy.
Donna Graham is an example of
how partnerships can fill a void. She worked 30 years in Denver as a
paralegal, and returned to her Saginaw hometown six years ago. Since
then she has worked off and on, sometimes with health insurance but
sometimes lacking coverage.
She learned about Tri-Share in
April through local publicity. She didn't qualify for Tri-Share, but
outreach workers helped her find a place in another Saginaw Health
plan project. She received her card late in May.
"I don't have any major health
issues, but these are things you worry about as you get older,"
Graham said.
"I've avoided doing some things in
terms of prevention. Now that I have coverage, I'm going to find a
doctor and catch up on those things."
Mary Buck runs a home-based
child care center and has gone without coverage. She is hoping
enrollment in the Saginaw Health Plan will help her pay for
prescriptions to combat arthritis and high blood pressure.
"I have two prescriptions right now
that are sitting at the pharmacy because I can't afford to pay for
them," Buck said.
St. Mary's is a partner in
the Saginaw Health Plan along with Covenant Hospital,
Health Delivery Inc., HealthPlus of Michigan, Healthy Futures
CrxSP, the County Department of Public Health and other
community organizations.
For information on Tri-Share,
call toll-free, 1-888-874-7427. The Saginaw Health Plan
website is
countyhealthplans.org.
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