The high cost of health care

More can't afford needed help; solutions neither quick nor easy

Sunday, April 2, 2006

By BEN BOTKIN

The Register-Mail

Darrin Quick has cancer.

A year ago, he was healthy and not concerned about getting a serious illness.

But now, he has to have checkups and treatments that run up bills in the thousands of dollars.

Quick has no health insurance. He works as a bartender and does not receive coverage through his employer.

Now, as Quick continues to recover, he doesn't get phone calls just from friends and family members asking how he's doing.

Collection agencies call Quick, too, trying to squeeze money from him for his medical bills. He began getting calls from bill collectors while he was still going through chemotherapy.

"Most of what I hear is: 'How would you like to pay this today?' " he said.

Quick, an Oneida resident, is part of Knox County's uninsured population. A study spearheaded by the Knox County Health Department has identified the uninsured as a group that struggles to access affordable health care in the area.

The study, Knox County Healthy Communities Project: 2005, found in a survey of nearly 1,000 households that one out of seven, or 13.7 percent, were unable to get the needed health care. The top two problems are the cost of service and a lack of insurance, the study found.

Knox County is not alone. Although the closings of Maytag and Butler have left some without health insurance, the problem is similar in Illinois and across the nation.

Because of new medical technology, increased numbers of people using services, and an aging baby boom population, costs are increasing from a combination of factors, said Danny Chun, spokesman for the Illinois Hospital Association.

"There's no one single factor," he said.

The need

Those in Knox County's health care field see a need from uninsured people seeking medical care.

At OSF St. Mary Medical Center, administrators have seen an increase of people who can't afford health care. And an influx of patients without insurance isn't an issue that is limited to Galesburg, said David Adcock, the hospital's senior assistant administrator.

"They're not unique to Galesburg," said Adcock. "They're not unique to Maytag closing."

At OSF St. Mary Medical Center, the hospital provides millions of dollars worth of care that isn't compensated.

In fiscal year 2005, the hospital provided $2.7 million in charity care. That same year, the hospital had a shortfall of $1.4 million between the cost of care for Medicaid patients and what Medicaid reimbursed.

The hospital provided another $6.2 million in care that was never paid back.

That amount, called "bad debt," is different from charity care. With charity care, the hospital knows up front the patient cannot pay for the service.

Every year, the amount of charity care given at OSF St. Mary Medical Center goes up about 20 percent, said Curt Lipe, the hospital's chief financial officer.

At Family Planning Service of Western Illinois, patients often ask about medical care that the facility doesn't provide, executive director Val Harding said.

The facility offers annual exams for women with fees that are based on a sliding scale, Harding said, adding that Family Planning Service only offers care for the uninsured in a limited segment of the population.

People also ask the Red Cross for help with medical bills, said Lynne Tyler, executive director of the Western Illinois Chapter of the American Red Cross.

In some cases, the Red Cross may be able to help, but the organization doesn't have the resources to assist everyone without insurance, Tyler said.

Former Maytag employees cannot afford to buy insurance on their own, said Dave Bevard, a peer counselor with the AFL-CIO union who works with former Maytag workers as they rebuild their lives.

Maytag workers went from having health coverage to being put in a place where they are struggling to make ends meet and take their chances rather than pay for insurance, Bevard said.

There are government programs for children and seniors, but few choices for those who are between 18 years and 65 years of age, he said.

"What is there?" Bevard said. "There's nothing there. It's becoming very, very unaffordable."

For another peer counselor, Aaron Kemp, being forced to go without insurance is a difficult risk to take.

"The problem with that is, if I were to fall ill, I'd put my family in financial hardship," he said. "That hurts. That's hard."

In Quick's case, friends have helped organize fund-raisers to help with his medical bills. Quick said he appreciates having that kind of support while he recovers from his illness.

The financial hardship only adds to the difficulty, he said.

"If you can't afford it, it's too bad," Quick said. "I know I can't pay for this for at least a long time."

Since becoming ill, Quick sees a need for coverage on a larger scale.

"It's too bad we don't have a national health care plan across the board," Quick said. "People are sick, and they need help."

Possible solutions

The Knox County Health Department isn't the only group looking at the medical needs of the community. Twenty-two people, including Adcock, have been involved in the Healthy Communities Project.

As a result, the findings - and the need to take action - require involvement from others besides health department, said Greg Chance, administrator of the Knox County Health Department.

"It's not the health department's project," Chance said. "It's Knox County's project. ... It's a community effort. It's going to be up to us in the community to resolve the issue."

In a way, the real work is just beginning. Although the problem has been identified, the group that participated in the project continues meeting and looking for a solution.

It won't be the first time that community health officials have tried a solution. In 1999, a free clinic opened that was operated by the health department, Galesburg Clinic and both hospitals.

The free clinic was staffed with volunteer doctors and provided care for people without insurance who couldn't afford treatment. The clinic closed in 2004 when the Galesburg Clinic decided to no longer participate.

Although that clinic is no longer running, Chance said that doesn't mean there can't be a similar service.

The free clinic is just one model of how services can reach people, he said.

Adcock said OSF St. Mary Medical Center is interested in possibly participating in the future.

"We've had discussions internally and with the health department in terms of how we could provide care and candidly how we could fund that clinic," he said.

Knox County health officials may learn how to help the uninsured from Whiteside County, which lies in northwestern Illinois along the Mississippi River.

Chance has been in touch with the administrator of the Whiteside County Health Department, which recently was awarded a federal grant for a health clinic.

Whiteside County, like Knox County, has experienced rough economic times after major employers shut down.

In 2001, a steel mill shut down in Whiteside County, leave about 10,000 former workers and retirees without insurance.

Because of the need, efforts began that year to seek a grant for a federally qualified health care clinic, said Beth Fiorini, public health administrator of the Whiteside County Health Department.

Federally qualified health care clinics receive funding through the Department of Health and Human Services. In February, Fiorini found out about the grant award, which will provide $635,000 a year to help pay for the clinic's costs.

The clinic, which opens in May, will offer services on a sliding scale. For example, $15 doctor visits are available to those with incomes that are below poverty level.

"I think it's really the future of our health care system because there are so many people without insurance," Fiorini said.

Fiorini said community support is crucial for the clinic's success. And the clinic isn't viewed as a competitor, either.

Because it provides preventative care to the uninsured, the result will be fewer people making trips to the emergency room that they can't afford, Fiorini said.

"If we see them and we can control their diabetes, they won't end up in the emergency room," she said. "Our hospital is very, very supportive and is actually giving us some free labs and X-ray services. If we can help people that don't need emergency care, we're saving them money."

The future

The answer for Knox County won't come soon.

The workgroup plans to spend the next several months looking at the issue and coming up with possible solutions.

In June or July, they are expected to wrap up the brainstorming and have a goal picked out that they can begin working toward.

If they decide to apply for a federally qualified health care clinic, years of work could be ahead.

Fiorini says the application process wasn't easy.

"It's a long, tedious, hard process," she said.

Although the Whiteside County clinic opens in May, the work for the project began in 2001.

A community task force was needed. The task force had to complete a survey of the needs in the community.

From there, a 200-page application was written up detailing Whiteside County's health care needs and sent to the federal agency.

The first time, the application was denied. The second time around, Whiteside County was awarded a grant.

Regardless of what happens in Knox County, finding the right project will take time, Chance said.

"Some of these issues aren't going to be resolved overnight," he said.

As for Quick, he'll need surgery to remove tumors in his lower back. A golf fund-raiser is planned for June to help with the expenses.

He's not sure when his surgery will be, but he'll need six to eight weeks to recover.

From there, he'll return to work - and his bills.

"I could work until I retired and I probably wouldn't have everything paid off," Quick said. "I have no idea what's going to happen in the future."

By the numbers

- $1.2 billion: Cost of care provided by Illinois hospitals for which no payment is received.

- 15.8: Percent of Illinoisans without health insurance.

- 1.7 million: number of Illinois residents lacking health insurance.

- 15.7: Percent of people nationwide who do not have health insurance.

- 45.8 million: number of people in America without health insurance.

- One of seven households, or 13.7 percent, responding to a Knox County Health Department survey said they were unable to receive the needed health care.

- The 13.7 percent figure is nearly double the 7.8 percent rate found in a 1998 survey.

Sources: U.S. Census Bureau, Illinois Hospital Association, and Knox County Health Department.