A health insurance dilemmaEstimated 1 in 6 S.C. residents live without it By Jill Coley (Contact)
The Post and Courier
Monday, May 5, 2008
Wade Spees Minnie Hopkins, 63, is trying to navigate her insurance, and lack of it, while facing breast cancer. Video
Listen to stories from Tricia Cunningham, Jacqueline A. Brown and Dawn Faherty, who struggle with health care coverage. Watch » What you can do if you're uninsured--Find out if you are eligible for Medicaid. For adults, the income level is very low, 50 percent of the federal poverty level, or $5,200 annually for one adult. Children in South Carolina can qualify for the State Children's Health Insurance Program (coverage for children from low-income households) at 200 percent of the poverty level, or $40,000 for a family of four. --Find a federal qualified health care center, which charges on a sliding scale. --Get payment, credit and charity policies from hospitals in writing and read them. If you don't understand them, find a relative or an advocate who can help you. --If you have an emergency, go to the emergency room. You may be charged later, but you will receive treatment for life-threatening conditions. --Be upfront with your physician about your ability to pay. Ask about less costly alternatives. --Encourage policymakers to legislate solutions. For three years, Minnie Hopkins pushed out of her mind the fact that she could have cancer. She had two lumpectomies to remove surgically what turned out to be benign breast calcifications. Then she lost her job and her health insurance. The 63-year-old North Charleston resident skipped her mammogram appointments, afraid a diagnosis would plunge her and her five adult children into debt. "Sometimes we tend to put things in the deep recesses of our mind," Hopkins said. "The more you think about it, the more it drives you crazy." Lynn Bailey, a Columbia-based health care consultant, said ignoring the problem is a common approach. "They ignore it," she said. "They pretend it's not there." Then when they have an emotional diagnosis, they are asked to navigate a labyrinthine health care system, Bailey said. "It is really, truly scary." Last week, several of those uninsured navigators came to talk during a forum sponsored by two nonprofits, Mount Pleasant-based Palmetto Project and the national Partnership to Fight Chronic Disease. Their goal was simple: remind policymakers of the humanity behind the numbers. Hopkins is one of the 700,000 to 800,000 South Carolinians, or 1 in 6 people statewide, estimated to go without health insurance. Sixty percent of the uninsured are working, said Palmetto Project Executive Director Steve Skardon Jr. Not all employers offer insurance, and not all employees qualify. About 53 percent of employers in South Carolina offer insurance, according to Cover the Uninsured, a Robert Wood Johnson Foundation project. The ranks of the uninsured are expected to swell along with the unemployment rate, which rose in South Carolina to 5.7 percent in March from February's 5.5 percent, one of the highest jobless rates in the nation. A 1 percent rise in the nation's unemployment rate is projected to increase the number of uninsured by 1.1 million, according to the Kaiser Family Foundation, a California policy group. Nationally, 1 million more people will enroll in Medicaid, increasing state Medicaid spending at a time when state tax revenues are falling. Compounding the problem further, insurance rates are rising faster than income, pricing more Americans out of coverage. People who get insurance through their jobs have seen premiums increase 10 times faster than their incomes in recent years, according to a study of government data by the Robert Wood Johnson Foundation. Sue Berkowitz, director of the South Carolina Appleseed Legal Justice Center, a low-income advocacy group, gets phone calls from people seeking help. If you're working and uninsured, Berkowitz said, "There's very few real solutions out there." Hospitals are feeling the pinch and asking uninsured or underinsured patients to pay upfront for nonemergency and elective procedures, which may include treatment for cancer. Officials at the Medical University of South Carolina, Trident Health System, Roper St. Francis Healthcare and East Cooper Regional Medical Center confirmed they ask for payments upfront, sometimes at discounted rates if patients do not qualify for charity care. The move is one of necessity to remain financially solvent, officials said. In October 2007, area hospitals released a report through the South Carolina Hospital Association stating they delivered more than $136 million in care that was uncompensated. Hopkins was lucky. After the life insurance company where she worked closed shop, she continued to see her primary-care provider, whom she paid out of pocket. When her doctor found out Hopkins wasn't keeping up with her screening, he and Hopkins' children urged her to get a mammogram. Ultimately, her son paid for the test, and she had cancer. Although she had a new job, Hopkins had missed the enrollment period for benefits. Hollings Cancer Center helped her navigate the Medicaid application process. But as that application process was closing, her employer-provided insurance card came in the mail. The two coverage possibilities canceled each other out. Medicaid wouldn't cover treatment because she was insured, Hopkins said. The insurer wouldn't cover the treatment because the cancer was a pre-existing condition. Hopkins still isn't sure how it worked itself out. She feels borne along the crest of paperwork and medical codes. Ultimately, Medicaid paid for the chemotherapy and radiation, she said. She is now in remission. "Half times I don't know what is going on," Hopkins said. "You learn how to tune out a whole lot of things." Beginning in January, she started receiving five or six benefit explanations in the mail weekly. Each one has a form for her doctor to fill out before benefits will be paid. And the cycle continues. Reach Jill Coley at 937-5719 or jcoley@postandcourier.com. |
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Comments
This article has 10 comment(s)
Posted by Early on May 5, 2008 at 8:27 a.m. (Suggest removal)
And what happens when we offer free health coverage?
I think more government stress needs to be applied to businesses that don't provide health benefits. Only 53% provide this crucial benefit, that's insane!
I also think that if you smoke or excessively fat, you should pay more in premiums!
I know if we put as much into the health program as we have the war, we would not be having this discussion.
Posted by eyfigueroa on May 5, 2008 at 9:34 a.m. (Suggest removal)
Dictating to businesses what to provide in the compensation packages offered to employees is the antithesis to a free-market capitalistic society.
The best employees are going to go to the employers who offer the best packages. Hence the better paying companies generally have the better comp packages.
Most mom & pop businesses simply cannot afford to give their employees huge packages.
So I'll say today what I've said so many times before, if you want to have a good salary as well as a good comp package, then you must make yourself marketable to the companies that provide those things. You cannot forego an education or not develop needed trade skills and expect companies to pay you well and offer you great comp packages.
I'm totally against universal health care and i'm DEFINITELY against forcing private employers to give employees benefits.
If your company doesn't do for you what you need, then find a way to do better.
Posted by BreezinIAm on May 5, 2008 at 9:59 a.m. (Suggest removal)
Painless way for us to look at healthcare options that work:
Frontline program: "Sick Around the World"
"Can the U.S. learn anything from the rest of the world about how to run a healthcare system?"
"Five Capitalist Democracies & How They Do it"
Watch online:
http://www.pbs.org/wgbh/pages/frontline/...
Posted by Early on May 5, 2008 at 10:14 a.m. (Suggest removal)
eyfigueroa, Cisco, GE or major companies can afford to do that but the mom and pop as you call them can also but choose not to, They can pool with other local and smaller companies to reduce rates to somewhere around $100 a week for family coverage. The choose not to because we have become a society where greed is over-powering and the F-you attitude is dominant. Do you think we were better off 30 years ago, in reference to healthcare? I do and, just like when dad worked after 20 years he got what they called a pension, then in my life that changed from a pension to a 401K and most all companies offered some type of healthcare assistance and now, it's mostly catastrophic coverage.
Posted by majorjohnson on May 5, 2008 at 10:44 a.m. (Suggest removal)
You shouldn't need anything but catastrophic insurance. Government meddling in health care and insurance is what has made health care expensive. In my own lifetime my parents could afford to take me to the doctor for routine or minor care, even having babies was affordable. We had insurance to cover major expenses like hospital stays and surgery, and that insurance was affordable. Now that government has mandated coverage by companies of a certain size and mandated insurance companies cover everything from heart surgery to getting a boil lanced, only the insured can afford to get a boil lanced. I'm a 50 year old single man, but the state mandates that my insurance policy cover pregnancy and autism.
If you look at medical procedures which are not covered by government mandate or insurance, like cosmetic surgery where there is a free market and competition, you'll see that it's actually affordable. More and more medical specialists do nothing but cosmetics because they don't have to pay an entire staff to do nothing but handle government and insurance paperwork.
If you think medical care is expensive now, just wait till it's free.
As far as early and his greed comment, I think he's greedy. He could take half his salary and share it with someone else, but no, he wants all of his money. Bet he'd even take a raise if it was offered. Talk about greedy! Try asking a welfare recipient for a job. After all, they aren't greedy like those dirty capitalist mom and pop business owners.
Posted by eyfigueroa on May 5, 2008 at 10:54 a.m. (Suggest removal)
i stand by my earlier comment. we've allowed government interference to create the economic chaos we're in. Forcing private businesses to provide benefits to its employess is only the beginning. It's going to get worse.
Posted by LowcountryMoose on May 5, 2008 at 11:09 a.m. (Suggest removal)
Taxpayers in Charleston, South Carolina have paid $87.8 million for the Iraq War thus far. For the same amount of money, the following could have been provided:
50,985 Children with Health Care for One Year
Posted by Early on May 5, 2008 at 1:02 p.m. (Suggest removal)
Major my johnson, I thought you were actually going to spew something that made a reasonable argument but,,, my bad!
I do give 53% of my income to taxes which pay for the programs you mentioned. You have absolutely no idea do you.
Americans pay for the R&D for companies that make medical equipment and prescription drugs. Our own government buys prescription drugs from Canada for the VA hospitals.
I know of guys who would go to France buy a CT scanner from an American company for $400,000 less than the Americans pay, would have to stay in France for 31 days and they would sell it back to the states for $200k less than one could purchase it in America and pocket 200k because,,,,of corporate greed! Anyway, attempting to have a conversation with you is very painful, I think I'll have a bowel movement now!
Posted by faelady on May 6, 2008 at 3:33 p.m. (Suggest removal)
My employer (based out of state) does offer health insurance - unfortunately, the insurance he offers is more than 1/2 my monthly salary for a family of four, which is outrageous in my opinion! Our family is working on a Health Saving Account, because we don't need "general" coverage - I want coverage for major illness or injury. I don't need it for the annual checkups, etc., I don't mind paying that out of pocket.
Posted by majorjohnson on May 6, 2008 at 7:43 p.m. (Suggest removal)
Thank your government for that faelady. Government mandates on insurance companies that they cover any little ache or pain (they call it comprehensive coverage) makes any medical procedure way too expensive and makes insurance against real need even more expensive.
Well, socialists like early have a lot to do with that too. They decided that government needs to intrude where government should not and the politicians can see where the votes are and made the mandates that priced you out of being able to pay for your medical needs or affording insurance.
It's kind of like where government costs more of your gas price than gas companies do, then they get people mad at gas companies for the price of gas. It's all about government making the money and blaming someone else.