Many with good jobs priced out of coverage
Hillsboro resident Amanda Smith, who is self-employed, said her life was easier and her medical care better when she was covered under her husband’s employer-sponsored insurance.
Smith agreed to speak about her struggles as a patient without medical insurance on the condition that her name be changed to protect her privacy.
When insurance rates increased exponentially over the past several years, her husband’s employer first stopped paying premiums for employees’ families, then made the employees themselves pay for a portion of their health insurance.
Continuing coverage under her husband’s plan would cost half his salary.
“We tried it, and we couldn’t do it,” Smith said. “I said, ‘We’re just going to take a gamble. Take me off.’”
She’s coped with having no insurance mostly by ignoring medical issues.
“I just don’t go,” Smith said. “I just suck it up.”
She has purchased animal medications and treated herself with that.
“Cattle antibiotics actually work well for humans, and you just get them at Orscheln,” Smith said.
When she can find other, less costly treatment methods, she uses them as well.
After a knee injury, she had an x-ray, then a magnetic resonance imaging test, and the results showed “possible” torn tissue that might eventually require surgery.
“I went to Walmart and bought a super nice knee brace for $20,” she said.
Another option, and it has proven so costly she’d rather not have to do it, is an agreement with a medical provider to pay off the debt over time and with no interest. She once had to pay off $3,000 medical debt in 12 months. Although the hospital charged no interest, the monthly payments were still high.
“My opinion of the whole health care things is just, ‘Wow,’” she said.
Uninsured or underinsured patients often find themselves overwhelmed with medical debt and feeling they have nowhere to turn.
Medical debt can lead to collections calls, court judgments, bankruptcy, and even arrest for contempt of court when the patient cannot pay.
Jeremy Ensey, CEO of St. Luke Hospital and Living Center, said the hospital had 950 visits categorized as “self-pay” last year.
That includes patients who use the MD Save program, which allows patients to save money for hospital visits, and Direct Access Lab services, which allows patients to order their own laboratory tests and pay a reduced price in advance.
Ensey said St. Luke Clinic had 363 office visits by self-pay patients.
“Some of those visits for both the hospital and clinic could be the same person,” Ensey said.
According to statistics from the Population Health Institute at University of Wisconsin-Madison, 12% of Marion County’s 11,986 residents are uninsured. Among those, 14% of adults are uninsured and 6% of children are uninsured.
Roger Schroeder, marketing director for the hospital, said the hospital offers interest-free payment options for those who are unable to make payment in full.
Jeni Smith, financial counselor at St. Luke Hospital, said a payment plan is what the hospital offers first.
“If that does not work for them, we do have a financial assistance program based on their income and poverty rates for the United States,” Smith said.
If the patient qualifies, the hospital may be able to write off part of the debt and arrange payments for the rest. But getting financial assistance is not automatic.
“They have to contact the financial counselor at the hospital to request the program,” Smith said.
Tom Bell, CEO of Kansas Hospital Association, said a recent article by ProPublica, “When Medical Debt Collectors Decide Who Gets Arrested,” describes numerous unfortunate circumstances and raises a host of questions that are not all easily answered.
“Even though our current system of medical debt collection appears to have failed many vulnerable people, there are some protections in place,” Bell said.
Congress has recommended steps and wait times that non-profit hospitals must adhere to before taking collection actions, Bell said. Those steps are detailed by the Internal Revenue Service.
Non-profit hospitals must provide notice of financial assistance policies, wait 120 days before taking collection action, notify the patient in writing 30 days before taking collection actions, and allow a patient to stop or reverse collection actions for up to 240 days in order to apply for assistance.
Hillsboro’s Dr. Michael Reeh recently applied for a federal grant to establish a health center in the county. The state has 18 federally funded health center organizations with 85 delivery sites. Health centers use a sliding fee scale and serve people with incomes up to 200% of federal poverty levels. The nearest one, Health Ministries Clinic, has offices in Newton and Halstead.
Reeh’s application for funding was not successful in this year’s round of grants, but he gathered information on unmet medical needs of towns in the county.