Uninsured taking a toll on health care infrastructure

One in four people in North Idaho has no health insurance, and the number is changing the way health care is dispensed throughout the state.

Without health insurance, people tend to ignore symptoms until they can’t manage without a doctor’s help. Many eventually go to emergency rooms at public hospitals that won’t turn them away because they can’t pay. Patients wait as long as 20 hours for attention in some emergency rooms around the nation, Pulitzer Prize-winning science writer Laurie Garrett told Coeur d’Alene health workers recently.

“Hospitals are closing emergency rooms. Many are contracting out for services,” Garrett said. “Why? That’s where the uninsured go. People who don’t have insurance avoid health care as long as possible and are a whole lot sicker when they come into the system.”

Nearly 44 million – 16 percent – of the nation’s citizens have no health insurance, according to the U.S. Census Bureau. In Washington, 781,600 residents – 15 percent – are uninsured and nearly 44,000 of those people live in Spokane County. Idaho’s uninsured rate of 17.9 percent represents 204,100 people. Only six states have higher rates of uninsured than Idaho.

And few regions in the nation have a higher rate than Idaho’s five northern counties – 27 percent.

“Unbelievable,” says Karen Cotton, who manages grants designed to help North Idahoans with no insurance find health care. “And that number doesn’t include children.”

Idaho recently began tackling the problem. It expanded Medicaid, state-provided health insurance, so it reaches more children. It began helping employers pay part of insurance premium costs for families with children. This summer, the state will help up to 1,000 low-income adults pay their insurance premiums.

The expanded Medicaid for children – CHIP B – is available to children in families that live below 185 percent of poverty level. For a family of four, that’s $2,983 a month. Families with the insurance pay $15 a month and co-pay for some services.

Last year, the state started the Children’s Access Card for families living below the 185 percent poverty level. The card represents the state’s $100 per month contribution to the holder’s health coverage, either through a plan at work or an individual plan. The state will pay up to $300 a month per family. The idea is to help families keep their insurance.

So far, only about 150 families are using the Children’s Access Card. Still, legislators saw its value and approved a similar program – Access to Health Insurance – for adults. It will start this July.

Access to Health Insurance also will target people living below 185 percent of the poverty rate and pay up to $500 per family – $200 for adults and $300 for children – to help with health insurance premiums. At least to start, the program is limited to 1,000 state residents. Businesses who want to participate will register with Health and Welfare next month.

For uninsured people above the poverty level limits, federally funded community health clinics have opened in Bonners Ferry, Coeur d’Alene and Plummer. Another is scheduled to open this summer near Sandpoint. Most of the clinics offer primary medical care, dental services and mental health counseling. A mobile clinic travels throughout the five northern counties, offering medical and dental care to people with low incomes or without insurance.

Volunteer-driven free clinics operate a day or two each week in Sandpoint, St. Maries and Kellogg as communities do their best to help the people who live in them.

Two years ago, the Coeur d’Alene Chamber of Commerce formed a health committee to help businesses learn how they can continue to offer health insurance to employees.

“Sometimes it’s better to discuss these things on a local level because every community is different,” says Linda LaMott, a committee member and insurance agent.

LaMott’s committee put together a two-hour presentation called Health Insurance 101 for small businesses that employ two to 50 workers. It explained regulations, how rates are established and how to find a good agent, among much more.

“It’s difficult for small employers to wade through the insurance maze,” LaMott says. “The more information people have, the more comfortable they are to step forward and do something.”

The committee considered a chamber-sponsored health plan, but Regence Blue Shield was a step ahead. It’s marketing four special health insurance plans designed for chamber members to sell to chamber members.

“The overall cost is a bit lower,” LaMott says. “The intent is to reach small employers who couldn’t afford to offer health insurance.”

LaMott is skeptical about the statistics that show such a high rate of uninsured in North Idaho. Some of the people included in those numbers most likely were in the waiting period just before insurance takes effect. Others were eligible for Medicaid and hadn’t applied, she said. Still, she doesn’t argue that the absence of health insurance is a problem for North Idaho.

According to the state Department of Commerce, Idaho’s rate of uninsured has hovered between 15 percent and 20 percent since 1994. A report released by Health and Welfare in 2003 says adults in North Idaho and two other health districts in the state are more likely not to have health coverage than adults in the state’s four other health districts.

Cotton believes North Idaho was saddled with a high rate of uninsured as the service industry overtook the Panhandle’s economy. Jobs waiting tables and selling clothes paid less than work in the silver mines or logging industry. Service jobs typically offered fewer hours and no insurance or insurance that cost too much for $8-an-hour workers.

“Even places that provide insurance stopped providing it for part-time people,” Cotton says. “It costs too much.”

As companies that offered insurance closed or moved from the area, they often were replaced by businesses with no health insurance option, she said. Job-sharing grew as did agencies that find temporary work for people. Health insurance typically wasn’t available to workers in either.

Cotton was hired five years ago to help the uninsured find health care. She works at Kootenai Medical Center under a grant. She’s part of Idaho’s strategy to keep state residents healthy. The problem is overwhelming, but she’s determined.

“Idaho is trying to do something,” Cotton says. “It’s pretty innovative and it is hopeful.”