Monday, May 10, 2004

Uninsured risk crushing bills


More people can't afford or can't get coverage

By Tim Bonfield
The Cincinnati Enquirer

A year ago, Yolanda Webbquit a county job that provided good health benefits to launch her own cosmetics business.

Only after opening her shop did the 45-year-old entrepreneur discover an alarming truth: Health insurance would cost her more than $800 a month - an expense she could hardly afford.

'Cover the Uninsured Week' Events
More than 80 organizations are participating in events this week to help people obtain health insurance in Greater Cincinnati and Northern Kentucky. The Greater Cincinnati Healthcare Access Project and the Health Foundation of Greater Cincinnati are coordinating local events in "Cover the Uninsured Week," a national awareness campaign. Events include:

• 11 a.m. today: Cincinnati kick-off at Fountain Square including a health fair, a city proclamation and comments from people without insurance.

• 6:30 p.m. Wednesday: Community forum at the Health Foundation of Greater Cincinnati, 3805 Edwards Road, Suite 500. Events include a budget simulation on how to pay for health benefits.

• 9 a.m. Thursday: "Spreading the Balm of Gilead" event at North Presbyterian Church, 4222 Hamilton Ave. Faith-based and other social service agencies will learn about enrolling families in Healthy Start/Healthy Family Medicaid, health coverage for immigrants, prescription drug assistance, and building a health ministry.

• 8:30 a.m. Friday: Coming Together Forum at the Kingsgate Marriott Conference Center, 151 Goodman Dr. Speakers from other cities will discuss how they expanded access to healthcare.

• 1:30 p.m. Friday Connecting the Uninsured to Resources at Mother Of God Church, 119 West 6th St., Covington, Ky. Event offers tips for agencies and others on how to find free or low-cost health services.

For information about the events, call the Health Foundation of Greater Cincinnati at (513) 458-6600 or check the Web site www.healthfoundation.org.

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Now, Webb is one of more than 200,000 people in Greater Cincinnati and Northern Kentucky who lives without health insurance. That's enough to fill Great American Ball Park nearly five times.

Despite an improving economy, the ranks of the uninsured are growing here and nationwide.

An Enquirer survey of more than 600 area adults in January found that the rising cost of care is the region's No. 1 health concern. Nearly 57 percent said the health-care system is in a "crisis" - not because quality care is lacking, but because people fear they can't afford it.

Uninsured people may be the worst off. According to the survey, one of every 10 adults in the region lacks insurance. They're less likely to seek medical care than people who have insurance. They spend less time with doctors when they do get appointments, and they're less satisfied with their care.

They're not all poor, either. Separate studies show that nearly half of all uninsured Americans earn at least twice the federal poverty level, or at least $36,800 a year for a family of four in 2002.

People who lack insurance "get up and go to work every single day," Webb says. "It's ridiculous we can't get affordable insurance."

Who are the uninsured?

Locally, the uninsured rate has climbed from 7.6 percent of the population in 1999 to 9.6 percent in 2002, according to a 14-county health report issued last year by the Health Improvement Collaborative of Greater Cincinnati..

Four of every five uninsured people work, mostly for themselves, for small businesses or in part-time jobs with bigger corporations, according to the Employee Benefit Research Institute, a Washington, D.C., nonprofit policy group.

African-Americans are nearly twice as likely as whites to be uninsured. Most uninsured people are under age 35.

For the uninsured, bills can snowball fast. A doctor's visit and a few tests can cost more than $100. A hospital stay can cost thousands.

Medical bills play at least a factor in half of all individual bankruptcy filings in America, according to a 2001 study published in the New York University Law Review. One-third of bankruptcies involve "significant" medical debt.

Why people wind up without health insurance varies widely.

Some younger, healthier people choose to skip health insurance because they don't want another dent in their paychecks.

Some work for small businesses that don't offer benefits.

Some get fired from downsizing companies, then discover they cannot afford benefits through COBRA, a federal regulation that allows people to keep coverage temporarily by paying what their employer paid.

Some lose coverage after divorces, separations, deaths or injuries to bread-winning family members.

Mary Stuhlmanhas worked for 14 years for a local department store. She takes home $300 a week and had been getting coverage through her husband's employer. But then the couple separated, she lost coverage and discovered she couldn't afford paying $70 a week for insurance on top of rent and other expenses.

Last June, the 58-year-old Sharonville woman had a heart attack.

"I played Russian roulette and lost," she says.

Even as the life squad was rushing her to Bethesda North Hospital in Montgomery, Stuhlman told the crew and hospital staff she was uninsured and that she needed to go to University Hospital. She knew that University is the only hospital for adults in Hamilton County that gets funds from a county tax levy for indigent care.

SPECIAL SECTION
Your health, Your money
"They said don't worry about it. We'll take care of everything. Stupid me," Stuhlman says.

Now, she's more than $85,000 in debt for bills related to triple bypass surgery. In addition to the operation, she owes for emergency care, intensive care, medications, lab fees, home nursing care and for services provided by a flock of specialists - from surgeons to anesthesiologists to radiologists.

Bills arrive constantly. Bill collectors call almost every day.

Stuhlman feels trapped. She has skipped follow-up doctor appointments and has stopped exercising. She has stopped taking two medications her doctors prescribed, and plans to quit a third as soon as the free samples run out.

She has even given up on the cross-stitching, crochet and small wood crafts she once enjoyed.

"I would love to commit suicide. But the bills wouldn't go away."

TriHealth officials say they have talked repeatedly with Stuhlman.

"We cannot discuss the details of an individual case, but we do have a charity process even though we don't get any funds from the tax levy," says Todd Cole, director of patient accounting.

"All I can say is that customers should always call us. We usually can work a situation out," he says.

The underinsured

Trey Daly works every day with a growing list of people seeking low-cost legal help for health bills. He's a lawyer with the Legal Aid Society of Greater Cincinnati and says clients are being sued for bills as small as $600 and as high as $31,000.

chart "We seldom saw these cases in the past," he says.

Even people who qualify for Medicare - the federal health plan for the elderly and disabled - can be exposed to crushing medical bills.

Cecil and Chloeann, a married couple living in Sedamsville, are living examples of what health policy wonks call the "underinsured." They asked that their last name not be used to protect their privacy.

Cecil, 53, has diabetes and has survived a heart attack. Chloeann, 58, has arthritis and thyroid problems. Both also have mental illnesses that have required expensive medications and hospital care.

Together, they collect $1,500 a month in disability benefits for their mental illness, and they qualify for Medicare coverage. Still, they've accumulated more than $11,000 in uncovered bills in the past three years.

In February, they had to get expert help to convert a $5,000 life insurance policy into a trust fund for burial expenses, just to qualify for a Medicaid program that helps pay uncovered Medicare bills. But Daly says the couple still have to spend $600 a month on health bills before that starts to help.

So the couple still try to avoid medical expenses. Chloeann has skipped physical therapy. Cecil won't see a foot and ankle specialist because his wife owes the doctor $700 from previous treatments.

No easy solutions

Views differ on how to cover the uninsured: Some put faith in government programs. Others believe in private charity.

Daly says hospitals could do a better job of informing patients of financial options. He also says hospitals should offer uninsured people the same discounted rates that they give to big health insurers.

"Right now, the people who can least afford to pay are being charged the highest possible rates," Daly says.

In coming months, more hospitals will be considering charging lower rates to uninsured patients, due to a clarification of Medicare rules, says Lynn Olman, president of the Greater Cincinnati Health Council, an association of hospitals.

Still, it won't be easy, she says: "Nonprofit hospitals have a mission to provide charity care, but they also must show a good-faith effort to collect. It's not part of any nonprofit agency's mission to be stiffed on a bill."

Hospital billing administrators, who deal with hundreds of thousands of patient visits a year, say consumers could help by returning phone calls and working out arrangements before getting collection agencies and lawyers involved.

Many people don't even try to work with hospitals until threats are made, says Cole, the patient accounting director at TriHealth.

Hospitals frequently offer interest-free plans that allow patients to make monthly payments on bills. TriHealth typically sets up one-year payment plans, but sometimes agrees to longer terms.

"We have some people paying on accounts that are five or six years old," Cole says.

Some people say the uninsured problem is overblown.

"From what I have seen, health care (coverage) is not all that expensive, and the news media is freaking everybody out," Williamstown resident Steven Mosssays.

"I was downsized and lost my company-supplied heath care. Did I sit around and worry? No. I got out and did some research," he says. "I purchased a policy for my family which was better than what my company provided, and was much more cost-effective."

Eating up savings

[img]
Yolanda Webb sells cosmetics and performs makeovers at E'lan Cosmetics in Hartwell.
(Melissa Heatherly photo)
Finneytown resident Yolanda Webb sees things quite differently.

She knew she was taking a chance when she gave up her county job to open E'lon cosmetics in Hartwell in November. But she didn't know she would have such a hard time getting health insurance.

She ran into problems because she was diagnosed 20 years ago with Crohn's disease, a chronic and painful condition that causes the body to attack its own intestines - and can be costly to treat.

"We have gone through so many companies. If they choose to offer coverage at all, the lowest price I could find for myself was $800 a month," Webb says.

Without health insurance, Webb pays directly for health care - including a drug that costs $2,400 every eight weeks. To pay the bills, she has been burning through her retirement savings.

If she can't find affordable coverage soon, Webb says her business may be in danger. She says small business people should demand more help from Congress or state governments.

"I don't think enough small-business people have stood up and rallied around this as an issue," Webb says. "Most of them just muddle along, pass the costs to their employees, who can't afford to pay, or they just drop the plans."

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E-mail tbonfield@enquirer.com

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