Californians without health insurance

By Sarah Arnquist



FAIRFIELD - Adam Boyles loves to ride his motorcycle across Solano County's country roads, but a crash last spring left him with a $13,000 hospital bill.



Boyles, 22, doesn't have health insurance, leaving him to chip away at the medical bills in small monthly payments.



"The financial burden is definitely on my mind," he said.



Boyles is not alone. At least 6.5 million Californians lacked health insurance at some point in the last year, according to the California HealthCare Foundation. That number will grow every year as health-care costs rise at double-digit rates and fewer employers offer health insurance, according to industry experts.



No one feels secure anymore, said Anthony Wright, executive director of Health Access, a Sacramento-based nonprofit that works toward expanding health coverage to all Californians.





"People are not only a pink slip away, but the next job may not offer coverage at all," he said.



No longer are only the uninsured crying for help. Hospitals, doctors and government programs cry out that they can't sustain the skyrocketing health-care costs. The uninsured are just one piece - albeit a significant one - to why costs are rising, but increasing numbers of uninsured threaten the stability of the health-care system that all Americans rely on.



Gary Passama, CEO of NorthBay HealthCare, which operates hospitals in Fairfield and Vacaville, said he sees the impacts of the uninsured every day in his packed emergency rooms, full hospitals and receding bottom line.



"There needs to be a society-wide resolve to solve the problem of the uninsured," Passama said.



Out of reach



Boyles wants health insurance, but his welding job doesn't offer it. Living in Vacaville is expensive, and Boyles said he can save money by not paying monthly premiums.



"It's just something that doesn't affect me day to day so I don't really think of it as a priority like rent, food and gas," Boyles said.



In 2004, annual average health insurance premiums in California cost $3,695 for individuals and $9,950 for families - 60 percent higher than in 2000, according to the California HealthCare Foundation.



Most of the uninsured work. According to the U.S. Census, about 67 percent of uninsured adults worked full-time in 2003. As income levels decrease so does the probability of having health insurance. Three quarters of Californians without insurance have household incomes less than $50,000, according to the California HealthCare Foundation.



About one quarter of the uninsured qualify for existing public health care programs such as Medi-Cal and Healthy Families but aren't enrolled. About 20 percent of all California's uninsured are children and half of them qualify for public programs.



Employers pay part or all of insurance premiums for about 60 percent of Californians, but industry experts expect more employers to drop coverage every year. Boyles' employer, for example, hires him as an independent contractor, partly to not offer him health insurance.



Dr. Michael Sexton, an emergency room physician and president of the California Medical Association, said society should care about the uninsured. That's because all taxpayers end up paying for uninsured patients' medical care, which often consist of emergency room visits - which are costly and inefficient, Sexton said.



"The insured right now are paying for the uninsured, but they don't know it," Sexton said.



Here's how the cost-shifting works, Sexton explained. Government programs such as Medi-Cal or disproportionate share funding, absorb some of the costs. Hospitals and physicians absorb the rest. To compensate, they raise their prices and that results in higher medical costs and insurance premiums, Sexton said.



People with health insurance absorb two-thirds of the $43 billion in care given to the uninsured through higher premiums, according to a study done by Families USA, a nonprofit advocacy and education organization. The study estimated that annual families' premiums in California are $1,160 higher as a result.



Patient impact



NorthBay Medical Center and VacaValley Hospital expect to see a record number of patients in their emergency rooms this year. The hospital emergency rooms treated 16,865 patients between January and April this year, about 1,000 more patients than the same time period in 2004.



According to the Centers for Disease Control and Prevention, visits to the nation's emergency departments reached a record high of nearly 114 million in 2003, up 26 percent from 1993. The emergency room is the primary portal to care for most of the uninsured, said NorthBay's Passama.



"Our two hospitals have been providing a safety net to this community, and we consider it part of our role, but that safety net is starting to develop a huge hole," Passama said.



In 2004, NorthBay HealthCare lost $7.2 million - largely because it provided great amounts of uncompensated care, Passama said. That loss impacts the entire hospital, he said.



"People are having to wait in the ER for a hospital bed because the hospital is full," he said. "That's a direct result of hospital crowding by people who come in terribly sick to the ER because they delayed care."



In the emergency room, Dr. Sexton said he sees patients who are far sicker than in years past. He recalled one case when a mother of two young children endured excruciating pain for four days before she came to the emergency room at Kaiser in Marin County. Doctors told her she needed an appendectomy. The uninsured mother refused the surgery because she knew the medical bills would financially wipe out her family.



She finally gave in and had the life-saving surgery, but death was near, Sexton said. With increasing frequency, people avoid seeing a doctor for cheaper, preventative care, he said. Uninsured people only see a doctor when their conditions become unbearable, and they need the most expensive treatments, he said.



The Institute of Medicine estimates that at least 18,000 people die each year from treatable diseases because they lacked health insurance.



Hopeful signs



The uninsured are not going away. Their numbers are increasing, and this places ever more economic pressure on the overall health-care system, Passama said. That pressure is creating crises in some areas such as Los Angeles and San Jose, where emergency rooms and hospitals have closed, Passama said. Government officials know the system is nearing collapse, but only a major crisis will draw the political will to find working solutions, he said.



But hopeful signs exist.



California legislators introduced nine bills this session that would expand health coverage. The bills range from creating a single-payer system to cover all Californians to simplifying the eligibility process and boost enrollment for Medi-Cal, the public insurance program for the indigent.



Many advocates think the best step toward reform is first insuring all California children. Gov. Arnold Schwarzenneger supports insuring all children, and so do four out of five California voters, according to a California Endowment statewide survey.



A program known as the Children's Health Initiative will launch this fall or winter to offer comprehensive health care coverage to all Solano County children regardless or immigration status. Society benefits from healthy children who have health insurance, said Jacque McLaughlin, director of the Solano Kids Insurance Program who spearheaded the initiative to insure all local children.



"The extent to which we as a community can solve this problem is a real win for this county," McLaughlin said.



Wright thinks reform is near. He points out that Proposition 72 - a 2004 ballot measure that would have required employers with 200 or more employees to provide health insurance - failed by less than 1 percent.



"I think there has been momentum from that close election to continue to explore different ways to expand coverage," Wright said.



He admits, though, that reform might not happen soon enough.



"There may very well be a tipping point where the health care system we all rely on collapses," Wright said.



Boyles said he knows little about health policy. At times, though, he wonders why all Canadians have government provided universal health coverage and Americans don't.



"I think that us being a country of such stature and for us not to be able to offer benefits for cheaper and more people, it's kind of scary."