Saturday, November 2, 2013

Uninsured are caught in the middle

The Cheyenne Regional Medical Center board of trustees voted to deny services to those who can’t afford full co-pays or deposits before receiving medical care. Shame on them.

CRMC trustee Marion Schultz voted against the policy. She doesn’t want people to think the hospital thinks more about money than people. It’s hard to avoid that conclusion as the hospital impedes traffic on Warren, building a huge new, costly edifice but cannot afford to provide adequate medical care to the uninsured or underinsured.

There is shame to go around. Most falls on the governor and the leadership of the Wyoming legislature. The politicians forced CRMC’s hand when they decided they’d rather be anti-Obamacare than pro-people. They refused an opportunity to expand Medicaid coverage to the uninsured, rejecting the entreaty of Wyoming hospitals that are losing more than 200 million dollars a year in uncompensated care.

The expansion of Medicaid coverage would have largely eliminated this shortfall and the federal government would have borne nearly all of the cost. Instead the uninsured will bear the cost. Medicaid would have saved not only that 200 million but ten-of-millions more in state general funds now spent on a hodge-podge collection of programs designed to help the uninsured.

But “the-governor-of-some-of-the-people” decided tea party myths about Obamacare were more worthy than healthcare for thousands impacted by his decision and the subsequent decision of the CRMC trustees.

The trustees took the responsibility off the governor and put it on the uninsured, voting to deny care to people who need care but cannot pay co-pays in full. Trustee chairman Joe Evans’ warned this fee is a barrier for people seeking care when needed. Still the majority voted to demand $180 from a new uninsured patient before allowing the first visit. That’s about three-quarters of a week’s pay for a low-income worker who is already in the red paying rent, transportation, utilities, and groceries. Those fees are unaffordable and will significantly increase the numbers of people in our community who will be unable to afford care.

Neither the governor, nor the legislature, nor CRMC are meeting their responsibilities. In the beginning CRMC should have done much more than it did to make their case to the legislature. There was a hesitancy to offend legislators on an issue of such political volatility. And now people who need care pay the price.

This decision has an adverse affect on public health. The uninsured and underinsured already experience significantly poorer health than those with insurance. The uninsured have much less access to care than those who are insured, and now that access is being further constricted in Laramie County.

People without health insurance have little preventive care. As a result, with cancer for example, studies confirm the obvious. Uninsured individuals are (1) less likely to receive cancer screening, (2) more likely to be diagnosed at an advanced disease stage and (3) less likely to survive than privately insured individuals.
The National Health Interview Survey showed that 54% of uninsured people between 18 to 64 years of age had no usual source of healthcare compared to just 10% of privately insured. The uninsured get sicker and die earlier than those with insurance.
Not having health insurance leads to additional costs. Without access to routine and preventive checkups, uninsured individuals develop serious health problems that are more expensive to treat without early detection. A lack of access to affordable medication also leads to serious health problems in the future that adequate insurance could have prevented.

Those statistics make the governor’s decision not to expand Medicaid and CRMC’s decision to deny care all the more unjust. In the end both CRMC and the state will spend much more money on much sicker people.
That’s not a surprise to CRMC. It’s always easier to focus on low-income families rather than speaking the truth to the governor about how his indecisiveness and the legislature’s callousness caused this. 
CRMC and its trustees should be advocates for, not impediments to, those who need medical services.

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