Requests For Indigent Care Swamping Kootenai County Officials Say Budget Is Straining To Keep Up With Growing Number Of Families That Need Help To Pay Bills
Milton Houchen has a splint in his heart. His wife, Mickey, has two fused vertebrae in her neck.
Between them, they’ve racked up more than $5,000 in unpaid medical bills and $2,400 in back rent payments. They have no health insurance. He doesn’t work; she works 16 to 20 hours a week.
And if it weren’t for the Kootenai County Assistance Office, they’d be in even more trouble.
Mickey’s family always has been poor enough to qualify for county indigent care.
The program paid for Mickey Houchen’s neck surgery, preventing the loss of her right arm. And it paid for surgery to remove one of her toes, because of diabetes complications.
Hundreds of families like the Houchens are tapping into the county indigent fund. One study suggests one-fourth of county residents are uninsured.
But help for the poor is getting more difficult to find.
Each month, the program gets nearly 180 applications for help with hospital, doctor and prescription bills or one-time rent and utility payments.
Already this year, enough people have sought help that the county has been forced to use up a $250,000 indigent fund surplus and $441,000 more. The county must plan for a similar expense next year and likely will use revenue from new growth and a 3 percent raise in property taxes.
County Commissioner Dick Compton said indigent care alone is expected to use most of the money earmarked for pay increases or new positions.
“It is a real problem. We feel it is an unfunded mandate from the state because their limiting of welfare planted it on our doorstep,” Compton said.
Counties are obliged, by state law, to pay medical and some other bills for poor people who don’t qualify for help from other programs. With caseloads increasing, the County Assistance Office’s budget is strained.
“It’s one of the few offices where we have absolutely no control,” said County Administrator Tom Taggart.
Health care providers and county leaders alike praise Marla Lewis - who administers the County Assistance Office - for her combination of savvy and compassion.
“It’s probably the most efficiently run office in the county,” Commissioner Ron Rankin said. “It’s just the sheer numbers of people coming to us for help.”
The average bill the county pays for indigent medical costs ranges from $3,000 to $5,000. If the bill is more than $10,000, the state pays the rest from its catastrophic fund. The county had 13 cases in 1998 for which it paid the full $10,000. Last year, that number climbed to 34, and this year those cases are projected to climb to 50.
When people come to Lewis for money for rent, utility or medical bills, she puts them through a gantlet of paperwork.
She spends weeks making sure that indigent care applicants have absolutely no other resources - no extra cars, no boats, no trailers - they could sell to pay bills.
She also makes sure there’s no other agency that could help, such as Medicare, Medicaid, welfare or Social Security.
If it’s determined that the county truly is someone’s last resort, Lewis cuts a check. But that process can take months, sometimes more than a year.
Mickey Houchen’s surgeries for her neck and toe are paid for. But the Houchens, both 49, still are awaiting word on whether Milton’s surgery last December will be paid for by the county.
Milton isn’t working because his doctor has ordered him not to. Mickey works only part-time because she’s recovering from the surgeries in May and June.
In the meantime, their medical bill collectors are patient, because they know how this process works.
The landlord, however, is a different story. Mickey spent Friday looking for apartments with cheaper rent and building standards that meet the requirements of other assistance programs she’s trying to tap into.
Of the applicants to the county’s program, one-third initially are denied, to see if they have other resources. It’s a frustrating, heart-breaking, credit-destroying process.
“I’ve cried with clients,” Lewis said. “I’ve gone to the funerals of my clients.”
Some indigent care patients are required to pay back what they’re given, at rates as low as $25 a month, for as long as they live. But most don’t pay.
This year, for example, the county should get about $150,000 in revenue from such payments - far short of the actual expense.
Health care providers also are getting pinched.
Kootenai Medical Center, which sees the bulk of the county’s indigent care patients, absorbed $10.6million in unpaid medical bills last year, said Joe Morris, the hospital’s CEO.
This year, KMC expects to write off $12 million.
Morris said a recent survey indicates that one in four county residents has no health insurance. Morris thinks it’s probably because of welfare reform and cuts to Medicaid based on the 1997 Balanced Budget Amendment.
“You insure that which you can’t afford to lose. You insure your life, your house, your car,” Morris said. “People don’t take that step forward and insure themselves for a new kidney, a heart. But they still show up at the hospital.”
Morris and others cite many causes for rising indigent costs.
Sandy Mamola, who runs the Dirne Health Clinic in Coeur d’Alene, said the clinic is paying out more and more for dental care - a trend Mamola links to rising methamphetamine use.
“Meth users grind their teeth,” Mamola said. “They’re so high, agitated, wired, and they are shattering their teeth, and that’s causing abscesses and infection.”
Michelle Britton, director of North Idaho’s health and welfare office, said massive health care changes, including an aging population and rising pharmaceutical costs, contribute to rising indigent care costs.
Lewis said Idaho’s nationally recognized welfare reforms have shifted the burden for lowincome people from the state to counties. Even if former welfare recipients are working, they may not be making enough money to afford health insurance.
With no coverage, they wait out illnesses until they eventually end up visiting hospital emergency rooms - which cost more than routine visits.
North Idaho’s beauty has lured many people here without jobs or insurance.
Lewis remembers a New Jersey couple who watched a television interview of former Los Angeles police detective Mark Fuhrman in Sandpoint.
“They saw the mountains in the background and decided they wanted to live here. They packed up the car and moved to Coeur d’Alene,” Lewis said. “They had no insurance, no money and they wanted us to help them pay rent.”
The real problem, Mamola suggested, is a political culture of believing that everyone ought to be able to fend for themselves - when reality proves that isn’t true.
That attitude plagues Houchen. She ponders it daily:
“What have I done that’s so bad I’m being punished for it?”
While no one is sure why indigent care cases are rising, all of the experts agree that costs can’t keep rising unchecked.
Compton recently asked the Idaho Association of Counties for help. Last week, the association faxed a survey to all other Idaho counties to see if they have similar rising costs for indigent care.
Mark Snider, spokesman for Gov. Dirk Kempthorne, said a quick call to the state catastrophic fund suggested that indigent care may not be as big a crisis in other counties.
“This may be a problem isolated to Kootenai County because of its growth,” Snider said. “We are interested in seeing the results from the Idaho Association of Counties survey to see if this is a universal problem.”
Lewis, and others, would like to see the state pull a little more weight.
For example, the state could lower the threshold for state assistance on indigent claims from $10,000 to $5,000. Compton suggested the state could use its much-coveted $54 million cash surplus to help pay for indigent care.
Morris, the hospital CEO, suggests funding more programs such as the Children’s Health Insurance Program, which provides insurance for children until they are 19.
Another idea is to offer tax incentives to businesses to provide health insurance to their employees. Or to offer state health insurance for every resident.
Morris says that if indigent care costs continue to rise along with the number of people without insurance, the widening gap between rich and poor will turn to a chasm.
“But there is no way really of controlling what happens with the number of indigent people who come in,” Lewis said. “It could be your neighbor, your friend, or you that ends up with a catastrophic illness and no way to pay that bill.”
Thomas Clouse can be reached at (208) 765-7130 or by e-mail at tomc@spokesman.com.