WASHINGTON, DC—Because of rising pressures on medical care caused by the recession, health care reform can't come soon enough, said speakers convened for a news briefing about two reports from the Kaiser Family Foundation (KFF). But Diane Rowland, ScD, the Foundation's Executive Vice President, warned that health reform is unlikely to provide an immediate fix: “The health reforms—if and when they are enacted—will take place years from now,” she cautioned.
The first report, “Rising Health Pressures in an Economic Recession: A 360° Look at Four Communities” documents how the recession is squeezing Americans across the country. Cancer patients are being particularly hard hit, as documented by the second report, produced jointly by the KFF and the American Cancer Society, “Patients Under Pressure: Profiles of How Families Affected by Cancer are Faring in the Recession,” which documented that cancer patients are facing obstacles to continuing coverage after losing their jobs, especially finding an insurer who will sell them non-group coverage. Patients are also facing a limited availability of public coverage, mounting debt, and delays in care if they are uninsured even for short periods of time.
The report profiles six cancer patients, several of whom have delayed treatments or incurred medical debt to pay for their care. The data showed that from December 2008 through this May, calls to the ACS Health Insurance Assistance Service increased by 30%.
“It's not just a ripple effect; it's more like a tidal wave to those of us on the ground,” said panelist Barbara Edinberg, Assistant Director of the Bridgeport (CT) Child Advocacy Coalition. “We've cut our budget to the bone….If there is any positive [effect] coming out of the recession, it is that it's building support for health reform,” she added. The official unemployment rate for Bridgeport was 11.9% in June, but Ms. Edinberg said she believes it is actually much higher.
Art Kellermann, MD, MPH, Professor and Associate Dean for Health Policy at Emory University School of Medicine, agreed about the urgency: “We have got to get beyond the politics of ‘nope.’”
Dr. Kellermann, who co-chaired the Institute of Medicine's Committee on the Consequences of Uninsurance from 2001 to 2004, noted that that committee recommended that every American be covered by health insurance by 2010.
“This is crunch time. I would appeal as we go forward to seek balance....[As a consequence of the recession], “we're seeing a lot of people coming to Grady [Memorial Hospital] who haven't been our clientele before.” Grady, where Dr. Kellermann practices in the emergency department, is Atlanta's only public hospital and Level I trauma center. “Grady is a mirror of what we see across the country,” Dr. Kellermann said. “It's a very, very precarious situation.”
He warned that if Grady goes under because of the burden of uncompensated care, it could be dire for the residents of Atlanta. “If you took Grady out of the mix, the private hospitals in Atlanta would close one by one like dominoes,” he said.
Combination of Pressures
Statistics released by Robin Rudowitz, MPA, Principal Policy Analyst for the Kaiser Commission on Medicaid and the Uninsured, show a combination of pressures contributing to the health care squeeze: the national unemployment rate officially increased from 4.9% in December 2007 to 9.5% in June 2009; and there were concurrent increases of 4.5 million enrollees in Medicaid and the Children's Health Insurance Program (CHIP) and of 4.9 million uninsured Americans. During the same time, state tax revenues dipped by 11.8%.
“The recession is having a major effect on Medicaid programs; enrollment and spending trends are up and well above original projections,” Ms. Rudowitz said. Although passage of the American Recovery and Reinvestment Act of 2009 (ARRA) has been a crucial boost in helping states address budget shortfalls, “there are severe state pressures, and few states are able to move forward with coverage initiatives.”
Joan Henneberry, Executive Director of the Colorado Department of Health Care Policy and Financing, agreed: “This for us is very much a revenue problem. There are things that should be done that don't get done…We absolutely need some national solutions. We cannot continue to do this without major national reform.”
‘Striking Message from All the Presentations’
“The striking message from all these presentations is that we must move ahead with health reform,” agreed Cindy Mann, JD, Director of the CMS's Center for Medicaid and State Operations. “Until we have everybody covered, we really cannot be efficient about delivering care.”
In the “Patients Under Pressure” report, the six cancer patients profiled describe how the recession—in addition to their illness—has thrown them curve balls. For example, Larry, 63, a lung cancer patient, was laid off from his job while on disability and lost coverage after missing a COBRA payment. His wife Marie says, “Having cancer and losing the insurance is like having the bottom fall out from underneath you.”
Darla, 49, a breast cancer survivor, became uninsured when her former employer went bankrupt, which ended her COBRA coverage. “I didn't ever imagine at this age that I would be in this type of situation,” she said.
A new Kaiser documentary shown at the news briefing, “On the Edge: Health Care in the Recession,” also puts faces on the statistics: Mindy, a Florida bookkeeper with breast cancer says, “I can survive it [cancer] physically, but I don't know about financially.” Laurie, a thyroid cancer patient, describes how she lost her job and cannot afford the follow-up medical visits she has been told are crucial to monitoring her condition.
Taken together, the two new reports on the US recession and health care paint a grim picture, revealing that:
* Struggling American families view reform that ensures access to affordable care as an urgent priority.
* Most adults become uninsured when they lose their jobs.
* Extending employer coverage for unemployed adults through a temporary COBRA subsidy may help those who are eligible, but even with the subsidy the premiums are a strain on unemployed people.
* Workers typically qualify for 18 months of COBRA coverage when they lose their jobs (ARRA, the stimulus legislation, partially subsidizes the first nine months for those eligible). Once COBRA runs out, patients – especially cancer patients – may have trouble finding any affordable insurance.
* While cancer patients and survivors in 35 states may be eligible to purchase health coverage through their states' high-risk pool, many cannot afford this coverage. Despite subsidies, many of these high-risk plans have premiums that range from 125% to 200% of the standard market rate for insurance in the state, according to KFF/ACS statistics. Also, the cost-sharing in these plans can be unaffordable for people with serious conditions such as cancer.
* Many families have wiped out their savings; some are losing everything.
* Jobless families face deepening financial crises; there are no jobs.
* Uncoordinated assistance programs leave out families in need.
* The safety net is too narrow to catch many families hit by the recession.
* Many uninsured adults (and even insured ones) put off or skip important care or screenings, such as cancer screenings, and necessary prescriptions.
* Safety net providers are overwhelmed.
* US emergency departments are being used for primary care now more than ever.