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32 percent of patients shoulder burden of health care costs
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BONITA SPRINGS — The Lee Memorial Health System and other hospital systems throughout the United States are facing a dilemma. They have an ethical obligation to treat the hundreds of uninsured patients who walk into one of its hospital campuses in the region, but at the same time they are facing a population unable to pay.
A number of political and economic reasons may factor into why more people than ever are being treated without insurance.
For one, the unemployment rate in Lee County has been reported as high as 8.4 percent, which is devastating for many people depending on employment-based insurance. The real estate crash coupled with inflation also has forced many local businesses to slash employee hours or begin laying off.
Traditionally, the extremely indigent have used emergency rooms or walk-in clinics to receive routine or preventative care. They’re residents who live far below the poverty line or undocumented immigrants with no chance of receiving state aid.
An emergency room can’t turn away any patient for not having insurance, and walk-in clinics will substitute a minimal fee for insurance coverage.
Many of those who are out-of-work have turned to these walk-in clinics, according to health officials, as an alternative to the emergency room. In south Lee County alone, there are three — Estero Urgent Care, NCH Healthcare System: Wound Healing Center Bonita Springs, and the Bonita Community Health Center.
“With your unemployment growth, there will be more people who use the ER because they don’t have a family doctor,” said Marilyn Stout, an LMHS board member. “There are more urgent care facilities in the county similar to an ER but I’m not sure everyone knows that they exist.”
Hospitals in the Lee Memorial Health System write off any bills from patients whose annual income falls below 200 percent of the federal poverty line, Stout said. For a family of four, that amounts to approximately $40,000.
“They are seen whether they have insurance or not. When presented with a bill, it depends on what their income is. We write off as charity care anything over 200 percent of federal poverty level,” she said.
Many who have been living without health insurance or who recently lost their insurance are also deciding to put off preventative care or medical examinations because they can still function at work or at home.
While this helps the uninsured in avoiding a visit to the doctor, and an expensive bill, a recent study published in the Annals of Internal Medicine found that one in three working Americans without health insurance had a chronic disease. Approximately 11.4 million uninsured Americans between the age of 18 and 64 were chronically ill, the report said.
Twenty-two percent of the uninsured in this study hadn’t visited a health professional in the last year and 26.1 percent had no fixed facility where they receive care.
Of course, even if a patient can receive state assistance, it won’t necessarily cover all of their treatments.
Lee Memorial Health System has been struggling against the Centers for Medicare and Medicaid Services for the last two years over new Medicaid rules that would eliminate the amount of money and approved procedures used to cover patients without insurance.
The health system reported that 32 percent of its patients — who are private payers with insurance — cover 100 percent of their profits plus any shortfalls that are produced from Medicare, Medicaid and the uninsured.
Furthermore, the uninsured population accounts for 8 percent of patients visiting the hospital, but only accounts for 1 percent of revenue.
“Generally speaking, it’s those with insurance that are covering those without insurance in premiums to insurance companies and hospital charges to cover the price of doing business,” said Stout.
A “hidden tax” is being levied against patients who have insurance and who are noticing higher premiums and higher costs for medical procedures.
John Donaldson, chairman of the hospital board, in a report he drafted in July 2008 entitled “Time to Get Real,” wrote that shortfalls in Medicare payments forced the hospital system to transfer $97 million to cover underpayments.
Lee County has the second highest population receiving either Medicaid or Medicare throughout the state, but the hospital system is incapable of raising taxes to cover underpayments because it’s not a taxing district and therefore can’t raise local sales tax to make up any shortfalls.
Lee Memorial’s dilemma is finding a way to treat the community, but at the same time, not go out of business. Of course, no indigent residents or undocumented immigrants will be turned away if they are in critical need.
According to the U.S. Census Bureau, there are 3.6 million Floridians without health insurance, although it is difficult to quantify how many of those residents are undocumented immigrants.
Bob Johns, spokesman for the Family Health Centers, a walk-in clinic, said that staff at the center doesn’t ask whether a patient is a U.S. citizen or undocumented immigrant.
“We are primary care so we won’t hear about that. Folks come in and get family doctoring with us. We don’t ask because our job is public health. It is fair to assume that some are, but we heard nothing about that,” Johns said.
This month, the national media reported how some Florida hospital systems are using their own funds to send undocumented immigrants back to their home countries. By law, a hospital needs to find a post-treatment facility for patients and Medicare doesn’t provide long-term coverage, so many hospitals are chartering trips for these immigrants to go home.
There have been no reports that Lee Memorial has performed any hospital-based deportation and local immigrant advocates said they haven’t heard of any instances of this happening. In most cases, hospitals and clinics don’t have an obligation to ask whether a person is a citizen or not.
“There are a lot of urban legends out there and I think this is one them,” said Anthony Olson from the Immigrant Law Firm in North Fort Myers. “In most of the cases, they (hospitals) wouldn’t want to draw attention to themselves.”
Pastor Robert Selle, spokesman for the Amigos Center, a faith-based non-profit that assists local immigrants, said that he heard of one case where a man was being sent home to Guatemala, but the story was just speculation. He also said there are a number of immigrants who use the walk-in clinics.
“I do know a number of people who live with what is going on until it gets so bad that they go to an emergency room in the hospital,” said Selle. “I am certain that immigrants do take advantage of those walk-in clinics.”
Comments
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Tough calls here!
Let's see: if car insurance is mandatory in Florida, why not make health insurance mandatory?
But that would only bring up other issues.
#1 Posted by dooley on August 27, 2008 at 9:32 p.m. (Suggest removal)
There is something so very, very wrong with this system.
#2 Posted by jim09091 on August 27, 2008 at 9:47 p.m. (Suggest removal)
http://www.bobbarr2008.com/issues/hea...
It is high time to say "no" to the status quo.
"The American people simply cannot afford more of the same," insists Barr, "which means more government spending; more special interest pay-offs; more fraud and waste; and continuing to treat American taxpayers like geese to be plucked rather than citizens of a free society and democratic republic."
A Real CHOICE ... restore freedom by reducing government
Bob BARR is the only candidate offering the combination of a crackdown on excessive government spending along with concern for civil liberties.
http://blog.bobbarr2008.com/2008/06/2...
http://www.youtube.com/watch?v=Kx11gy...
http://BobBarr2008.com
http://bobbarr.meetup.com/65
#3 Posted by jacktanner on August 27, 2008 at 11:24 p.m. (Suggest removal)
Every local resident should be required to read this article. Our present system for paying for medical care-employer sponsored insurance-is not working. It's not a question anymore of "will the U.S. join every other developed nation in the world and provide a system of healthcare for everyone"-the question is when this will happen. When 32 % of patients pay the bills for everyone, it's only a matter of time...doesn't matter which side of the issue you are on.
#4 Posted by swfljim on August 28, 2008 at 12:59 a.m. (Suggest removal)
I remember reading about floods along the Mississippi in the early '80's. The homeowners flooded out told news reporters that private flood insurance was so expensive they could not afford it. So the government stepped in, and bailed most people out with giveaways, grants, and below market loans.
Why would people purchase the expensive insurance?
The health care industry....sorry, industry actually produces something of value.....the health care segment of our economy is torn between accepting the bloated payouts of the government and insurance, and having to treat the seriously ill, but not "insured" public.
Sales agents are cold-calling offices offering "full coverage" for only $25/month for health insurance. They are preying on the young and old.
Don't get me started on the many $100K Mercedes in the parking lots of medical office buildings.
#5 Posted by volochine on August 28, 2008 at 1:07 a.m. (Suggest removal)
If you Red Necks want something good, like good health, stop whining and pay for it!
Why should I have to foot the bill for your botched tattoo or unplanned pregnancy?
If you're not happy, why didn't you postpone the boozing and beaching and put in enough time studying to go to medical school yourself?
Doctors deserve every Corvette and BMRs they can zoom!!!
#6 Posted by R_Popoff on August 28, 2008 at 4:23 a.m. (Suggest removal)
You yankees sure are smart, maybe thats why your paying for all us dumb rednecks?
#7 Posted by almostdone on August 28, 2008 at 4:56 a.m. (Suggest removal)
Don't worry, elect a democrat and this article will read..."100% Percent of America pays for Health Care whether they like it or not and if they want private health care, they pay twice without a choice" Long title, lol
#8 Posted by NeezDutz on August 28, 2008 at 7:40 a.m. (Suggest removal)
Hey Volochine,
What do you drive?
How about the personal injury attorneys out there driving Bentleys and living in 4 million dollar gulf front mansions with two or three more in other cities.
While their clients remain living in their roach infested double wides surrounded by flood waters thinking they have had justice served "for the people". Drinking, smoking, buying lottery tickets, and getting into the next scheme to not pay taxes with their "winnings", claim disability and get a free mobility scooter, eat McDonalds, and get on Medicare at the ripe old age of 40.
Personal responsibility is what we should be talking about. When down people deserve some help, but when it becomes a lifestyle choice it is a sign of a major cultural problem.
I can't believe you would feel such contempt toward a doctor for having a nice car but would not consider the others in our society that make millions of dollars a year off the vices and stupidity of others i.e. celebrities, CEO's, predatory attorneys, sports figures, bankers.
Next time you see a doctor, think about the fact that that person is there to help you and worked hard to get there and likely borrowed a lot of money to become a doctor. If their care for you is without value don't go to see them EVER. Then they won't be able to buy a mercedes. Supply and demand!
#9 Posted by scout on August 28, 2008 at 8:17 a.m. (Suggest removal)
32% paying for all the healthcare. Who needs change? The same 32% will still end up paying for all of it plus the governments administration costs.
#10 Posted by swampbuggy on August 28, 2008 at 8:18 a.m. (Suggest removal)
This is what happens in a Socialist society. And it will get worse if Barack Hussein is elected.
From the haves to the have-nots.
Where is the incentive to work hard and prosper, when the government takes it and gives it to the nonproductive and lazy?
The Democratic platform is to assure that the people are dependent on big government. That is why they continually preach- “I will give you free healthcare, free education, free childcare, free housing, free this, and free that”.
Well guess who pays for it; the working class trying to achieve the American dream.
#11 Posted by NaplesOutlaw on August 28, 2008 at 9:06 a.m. (Suggest removal)
NaplesOutlaw,
If you give up and complain about the incentive to work you are no better than the people who expect handouts. Governmental handouts are not worth wishing for.
Work hard and better yourself. The more you earn, the more you have, even after paying a higher tax rate.
The losers of the world eventually get what is coming to them, why waste your time worrying about them.
Maybe if everyone respected one another and was willing to be responsible for their actions (including the people who don't take advantage of the system) we would not have the problems we have in our current society.
Last time I looked no one promised anything free, you better check your facts out. Anything provided from government has a cost. But guess what, if you have to get it from private industry it has a cost also.
When 20% of society does not have health care it is more than people not working and taking advantage.
American's should not expect to be able to smoke, drink, abuse drugs, own a home, have a boat/vacation home, drive a luxury car/SUV, travel, have four credit cards, carry around cell phones and designer purses with no regard for their income.
Pay for your basic needs first (food, shelter, health care, education) if anything is left save for your future. If you want more work harder to better yourself. But don't complain about people who are looking to improve the system. The people you are critical of have just as many opinions about your views and prejudices.
Carrying on a calm intelligent conversation is what solves problems. I am no better than the next person and realize I have prejudices as well, but I believe it is not right to argue a point without all the facts. Maybe if the political powers could work together you could see results in society.
Even if you don't agree with someone please respect them enough to use their complete name (YES, his name is Barack Hussein Obama) but I'm sure there are thousands of people named Hussein and Hitler in this world that you would be honored to be friends with. Based on your "handle" most of us would assume you are in prison, but I doubt that is the case, and I hope you are a decent person. If not, everyone should still respect you despite your inability to respect them. When you realize that you can become part of the solution, versus contributing only rhetoric to the problems.
Both parties have members who are rich elitist persons taking advantage and those with secondary and sometimes hateful and harmful goals in mind, try to not be one yourself. In the end we are all human and have to live our short time on this planet together.
#12 Posted by scout on August 28, 2008 at 10:22 a.m. (Suggest removal)
I'm an American citizen and proud to be one and have lived in Canada at one time for a period of 10 years after being married to a Canadian citizen. I've experienced what could be in this country if we ALL had covered medical. Both my children were born in Canada and any hospital stays and doctor visits and such were covered - a bill was never received - and best of all - there were NO WORRIES when there was a medical problem to be dealt with. We are the RICHEST country in the world and all we ever do is help everyone else - we are in DIRE need of a healthcare plan for the CITIZENS of this country!!!! No everyone who is offered health care in their place of employment can afford it as they have other bills to pay for. With the pathetic hourly wages we offer so many people, how are they supposed to juggle all the rising costs of everthing??? I have a son who works his behind off and can't afford the health care as it's too expensive and he needs to pay for his home and food. EVERYONE in this country needs to see what it is like in another country where this IS NOT a problem. It was a pleasurable experience to be treated by wonderful physicians and not have to worry about the BILL after the fact. My family didn't suffer with that system and everyone in America needs to realize they would be so much better off with the same kind of plan here.
#13 Posted by goldengirl on August 28, 2008 at 10:40 a.m. (Suggest removal)
This article should be required reading for all our politicians, especially those against universal health care.
Also, it would't hurt to just get information from patients about their immigration status. If they can't produce ID, then still treat them, but mark it down and count them up. We need to know how many illegal alien no-pays are using our healthcare system. Counters the "illegals don't cause problems" argument.
#14 Posted by Bramble on August 28, 2008 at 10:50 a.m. (Suggest removal)
Scout-
It sounds like we have more in comment then against.
PS- the “Outlaw” comes from my favorite movie “The Outlaw Josey Wales”
#15 Posted by NaplesOutlaw on August 28, 2008 at 10:54 a.m. (Suggest removal)
I think the Gov should have federally sponsered medical schools where students sign a contract for their education. After free medical school they work for five years at a reasonable sallary at a government clinic/ hospital. No need to build the schools or hospitals there are so many going broke. People can get the care they need for a small co-pay based on a sliding scale. If the students bail-out they are forced to pay the cost of the tuition plus penalties. If you are rich and can afford better then use it. It would keep the two apart and reduce the burden on the insured.
Howerver, if you prefer to live in a third world country with no medical benifits, infrastructure or public schools you can move south, there are plenty of islands waiting for you.
The crime is high but the taxes are low, just watch out for the machete.
#16 Posted by Caliban on August 28, 2008 at 2:18 p.m. (Suggest removal)
LOL......
#17 Posted by volochine on August 29, 2008 at 12:30 a.m. (Suggest removal)
#9,Oh you forgot to mention Realtor's. If you really want to know where the Health Insurance premiums are going,just stop in to your local casino. There are thousands of people pumping $5.00 a pull into penny machines that are pre- programed to lose with no hope of winning. It' funny how people who look and dress like bums have money for that. So I do agree with #6 why should we have to pay for people who can't control there bad lifestyle.
#18 Posted by onlnr on August 30, 2008 at 2:21 p.m. (Suggest removal)
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