The Press-Enterprise Riverside -

Nov. 23: The state major risk health insurance pool that covers less than 2 percent of all California’s medically uninsurable residents could become more ineffective as the number of eligible participants is expected to increase and program funding drops, health experts say.

California’s Major Risk Medical Insurance Program, created in 1991, offers coverage to residents who do not qualify for other health insurance programs, have been denied coverage or offered unaffordable coverage.

However, program funding, which is less than $40 million, limits enrollment at 7,100 and sets benefit caps at $75,000 per year and $750,000 per lifetime.

Participants pay $450 annual deductibles. Premiums range between $8,300 and $10,080 per year, making the program unaffordable for some people.

As an example, a 40-year-old Inland resident with one dependent could pay as little as $676.58 a month in premiums, according to the program’s Web site.

In a February survey, nearly 35 percent of enrollees who dropped out of the program said they did so because of the cost.

Inland enrollment in the program dropped by more than half between 1998 and 2005, from 1,594 participants to 690, state statistics show.

Despite its enrollment and cost limitations, the program still is needed because it serves a small population who would not otherwise be insured, experts said.

“For some people, it is their only chance to get access to health care,” said Dylan Robey, a research scientist at the UCLA Center for Health Policy Research. “They can stay uninsured and get care in the emergency room, or they can spend so much money that they qualify for Medi-Cal.”

Last week, 165 people were on the risk pool’s waiting list, according to program statistics. Waits sometimes last several years, which can dramatically reduce someone’s ability to participate in the program, Robey said.

“In that time, someone who would qualify could become sick, wouldn’t have the ability to work anymore and would have to sell his business,” he said. “Then you don’t have the money to pay $800 to $1,000 in premiums. The odds are you are going to get on a government insurance program before you get on” the Major Risk Medical Insurance Program.

Experts say lawmakers need to fix the program soon as more residents lose jobs and employer-based insurance coverage and look to the risk pool as their safety net. The program’s structure, including funding, some of which comes from dwindling tobacco taxes, and benefit caps are among reasons why the program doesn’t qualify for federal funding.

“More than 1 million California residents may find themselves among the uninsurable population by 2010,” states California health care consultant Peter Harbage in an August report.

Harbage, who is president of Sacramento-based Harbage Consulting, advised Gov. Arnold Schwarzenegger on health reform and was an assistant secretary for the California Department of Health and Human Services between 2001 and 2003.

During their last session, lawmakers passed a bill that would have improved the program’s funding and eliminated its annual benefit cap by requiring insurance companies to contribute to it. Schwarzenegger vetoed the bill.

“This bill would allow health insurance companies to pass the fee onto their enrollees, making (coverage) more expensive,” Schwarzenegger said in a written statement. “A bill such as this only exacerbates their burden.”

Dr. Jeffrey Luther, president of the California Academy of Family Physicians, said passage of the bill would have been a piecemeal approach to improving access to health care. Limitations of the risk pool and other state insurance programs show that California needs meaningful health care changes, he said.

“We need it to be for everybody, and we need it to be equitable,” said Luther, who practices in Long Beach.

He said he is hopeful that health care change is on the way because of the county’s economic downturn and President-elect Barack Obama’s commitment to fix it.

Bryan Liang, executive director of the Institute of Health Law Studies at California Western School of Law in San Diego, said the risk pool is useful because it helps some people get much-needed health insurance. But it’s a temporary solution because it does not spread risk among healthy and sick people who would participate in a group insurance program, he said.

“High-risk pools are fated to ultimately fail because of the increasing adverse selection, particularly in the bad economic times, where more and more will go into these high risk pools sicker and quicker,” Liang said.

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PR Newswire -

Nov. 18: Seattle – Results from Milliman’s 2008 Group Health Insurance Survey indicate estimated premium rate increases for January 2009 renewals are 8.4% for Health Maintenance Organizations (HMOs) and 10.7% to 12.1% for Preferred Provider Organizations (PPOs). The PPO results were compiled for a high deductible plan and a standard lower deductible plan, respectively.

The reported annual increase in premium (July 2008 versus July 2007 assuming no changes in benefit or cost-sharing levels) was 9.7% for HMOs and 10.3% to 10.7% for PPOs.

The Milliman survey is unique in that it asks HMOs and PPOs to respond to a given set of benefits and demographics. The survey thus removes three important factors that often skew the results of other health cost surveys:
differences in benefit design, cost-sharing levels, and member demographics. These trends, therefore, reflect the increase in medical utilization and costs experienced by the HMOs and PPOs.

The 2008 survey also reports that the average premium savings incurred by switching from a $250 deductible to a $1,000 deductible is almost 12% and over 20% by switching to a plan with a $2,000 deductible.

“High deductible plans are an integral part of consumer driven health (CDH) plans, for which health savings accounts (HSAs) and healthcare reimbursement accounts (HRAs) are used to help cover the deductible and other out-of-pocket healthcare expenses,” notes Doug Proebsting, co-author of the report. The survey shows continued growth in CDH plans, with respondents anticipating 6% of their premium income to come from these products in 2009.

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The Sacramento Bee -

Nov. 24: Things are looking up for substantive reform of America’s troubled health care system. No one who knows the history of such efforts, from Harry Truman’s administration through Bill Clinton’s, needs to be reminded of the difficulties that inevitably confront any plan to overhaul one-seventh of the U.S. economy and bring quality medicine to millions of the uninsured.

But developments at both ends of Pennsylvania Avenue last week and across the country pointed up both the urgency of the problem and the prospects for significant action.

When Barack Obama’s transition team let out word that former Senate Majority Leader Tom Daschle would be his choice to run the Department of Health and Human Services, and quarterback his work on health reform, it signaled that Obama is serious about his campaign promise to make that issue a first-term priority.

Daschle would not leave a lucrative job at a law firm to twiddle his thumbs. Only with a clear understanding that the new president will put his own political capital at risk in this cause would the South Dakotan sign up for the job.

Daschle can be of great help to Obama in achieving the goal. He has made his own in-depth study of health care issues and brings a genuine passion to the subject. And he knows the Senate, where past efforts have foundered.

But there are positive signs within the Senate as well. Max Baucus of Montana, the chairman of the Finance Committee, one of the two main centers of Senate action, moved first by releasing a detailed outline of his preferred piece of legislation. Sen. Edward M. Kennedy of Massachusetts, the chairman of the other committee of jurisdiction Health, Education, Labor and Pensions quickly asserted his right to be at the center of action. He organized three task forces within his committee and reached out to Baucus to suggest that their staffs start exchanging ideas as well.

One issue that could have clouded House prospects was resolved when the Democratic caucus voted to make Henry Waxman of California the chairman of the Energy and Commerce Committee, replacing John Dingell of Michigan. Both are skilled legislators; Waxman is closer to Speaker Nancy Pelosi.

A fast start is important because it takes untold hours to work through all the complex issues involved in comprehensive health care. When Bill Clinton delayed in getting Hillary Clinton’s legislative proposal up to Capitol Hill until the end of 1993, his first year in office, he made it much easier for opponents to throw up roadblocks.

The architects of the Clintons’ defeat were Newt Gingrich and Bob Dole, then the leaders of GOP forces in Congress. Gingrich has now become an advocate for systemic change in the way health care is financed and delivered. His approach differs from Obama’s, but it starts from the same premise: The current system is too wasteful and unproductive to be sustained.

And Dole told me in an interview last week that today’s circumstances make a repetition of those scorched-earth Republican tactics inappropriate. Dole and Daschle have both worked for the firm of Alston and Bird for the last few years, and it would not surprise me if Dole finds ways to be helpful to Daschle and Obama in the coming fight.

Some have argued that Obama will be forced to delay his promised effort at health care reform, either because of the urgency of the economic problems facing the country or because there will be no money in the budget to pay for such an enterprise.

But every indication is that he will not wait. Indeed, he could well argue that the current plight of the Big Three automakers stems, in part, from the burden Ford, General Motors and Chrysler are carrying for the failures of our employer-based health care system.

One of their basic competitive disadvantages stems from the fact that Japanese and other foreign carmakers are operating in countries where the government and society as a whole pay the costs of health care not individual companies.

No question, it will still be a tough fight. But you can see the possibility of success.

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BestWire Services -

Nov. 23: Last year, the eyes of the health insurance industry turned to California, After the 2008 elections, observers are looking to toward Washington, D.C.

The failure of comprehensive health care reform in the nation’s largest state in January 2008 helped chill momentum for large-scale, state-based solutions that began when Massachusetts adopted its first-in-the-nation reform in 2006.

Since then, various states, including California, have considered targeted reforms while calling on the federal government to act. With the election of Barack Obama to the presidency — and increased Democratic majorities in the House and Senate — states will generally take a wait-and-see approach to health insurance legislation, said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans. “With so much momentum happening at the federal level, it doesn’t look like many states will do large comprehensive health reform proposals as we’ve seen in the past,” Zirkelbach said.

With states experiencing major budget stress, a significant factor in California’s failure to adopt a plan, “states are operating within a limited arena for health insurance,” said Jordan Estey, director of legislative affairs and education for the National Conference of Insurance Legislators.

“The legislators want to do something regarding health insurance,” NCOIL Director of State-Federal Relations Mike Humphreys said. However, action will be targeted on issues where states may have some flexibility, including rescissions and care for children and low-income residents, he said.

States may also pursue legislative and regulatory action on health information technology and to promote greater transparency, Zirkelbach said. “States are more likely to look at market reforms and smaller steps toward expanding access and providing affordability,” he said.

Jessica Waltman, senior vice president of government affairs for the National Association of Health Underwriters, said states to watch include Massachusetts, where the health plan is experiencing financial difficulties; Maryland, where Gov. Martin O’Malley has proposed premium subsidies for low-income residents; and Pennsylvania, where Democratic Gov. Ed Rendell is gridlocked with legislative Republicans over health measures. In Utah, a legislative task force is recommending bills to expand options for insurance coverage.

But don’t count California out, said Alan Katz, an insurance consultant and past president of both NAHU and the California Association of Health Underwriters.

Gov. Arnold Schwarzenegger vetoed targeted health care bills at the close of the 2008 legislative session, including a measure that would have limited health insurers’ profits and administrative expenses by mandating that health insurers spend at least 85% of their premium costs on medical care and another that would have barred health insurers from rescinding a policy unless the policyholder intentionally misrepresented or omitted health information on the application for coverage (BestWire, Oct. 7, 2008).

While Schwarzenegger vetoed the bills as individual items, he may back their provisions in a new try at a comprehensive approach, Waldman and Katz said, even with California’s continuing state fiscal shortfalls.

“Schwarzenegger doesn’t like to give up, so part of it is sheer ornery stubbornness,” Katz said. “He also has a deep commitment to the issue.”

However, he said, the momentum has shifted to the nation’s capital, not the state capital: “Washington may move too fast for Sacramento.”

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Business Wire -

Nov. 10: Los Angeles – Steven Sell has been named president of Health Net, Inc.’s largest subsidiary, Health Net of California, Inc.

“We are delighted Steve is taking on this new role within Health Net,” said Jim Woys, chief operating officer for Health Net, Inc. “In his 11 years with Health Net, he’s successfully led teams through times of change and demonstrated exceptional overall results. And he is well-known to the California employer and broker community through his work as president of MHN, our behavioral health subsidiary, as well as from his leadership in our Government and Specialty Services division that helped produce strong business growth.”

“I’m excited by this opportunity,” said Sell, 42. “I look forward to bringing the experience I have had working with health care providers and customers to help refocus and grow Health Net of California, enhance the company’s strength and stability, and leverage the power of our associates to deliver quality solutions for our customers.”

Prior to joining Health Net, Sell consulted to several health care and financial services clients on behalf of Booz Allen Hamilton and he held a variety of strategic and operational roles at The Prudential. He received his bachelor’s degree in economics and political science from Swarthmore College and his master’s degree in business administration from Stanford University.

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Los Angeles Times -

Nov. 8: Doctors across California and in two other Western states are owed millions of dollars in backlogged Medicare reimbursements, leading some physicians to turn away elderly patients and pushing others to the brink of bankruptcy.

In the most extreme cases, doctors have not been paid since February. Others are owed hundreds of thousands of dollars. Doctors who serve high numbers of Medicare patients say they are defaulting on rent, laying off staff and begging drug suppliers not to stop shipments. One cardiologist said she’s even resorted to doing the office laundry to cut costs.

Medicare owes Dr. Tim Ganey and his Bay Area practice of oncologists $750,000 in outstanding claims. He sought grace periods from vendors for his drug payments, but now he’s running out of time. He won’t be able to order more chemotherapy treatments unless he pays his bill.

The holdup is twofold. By May, doctors were supposed to be using a new universal identification number assigned by the Centers for Medicare and Medicaid Services. Without the new number, which is like a Social Security number, doctors can’t get reimbursed.

Then, as scores of doctors still waited for those numbers, in September the federal agency switched to a new claim processor for its 90,000 California providers. The move to Palmetto GBA in South Carolina, part of a national effort to reform Medicare contractors, compounded the billing issues and left even doctors who had their universal identification numbers waiting months for reimbursement.

“This is just a complete disaster,” said Dr. Dev Gnanadev, medical director and chairman of the Department of Surgery at Arrowhead Regional Medical Center in Colton and president of the California Medical Assn. “I know people who have turned down their office to minimal size. Some are even considering closing temporarily. If you don’t get paid, then you’re in deep trouble.”

Rep. Henry Waxman (D-Beverly Hills), whose office was contacted by at least two dozen doctors, called the transition to the new contractor “marred by missteps.”

“I have been hearing from numerous doctors who have been waiting for months for hundreds of thousands of dollars in reimbursements,” he said in a statement. “The delay in payments threatens to compromise patient care and provider solvency.”

Palmetto has also been the subject of complaints from doctors in Nevada, which switched to the processing firm in August. The state has the fastest-growing Medicare population in the nation.

“If we’re still dealing with this in January or February, Medicare patients are going to have serious access problems,” said Larry Mathies, executive director of the Nevada State Medical Assn.

So far, Medicare patients have been largely insulated from the reimbursement fight, though they may have difficulty making new appointments. Some doctors, particularly those with specialties that get minimal Medicare reimbursements, say this could be the tipping point that makes them abandon their participation in Medicare altogether.

“There are patients waiting to be seen, and I can’t see them,” Wong said. “Without completing my enrollments, I can’t take Medicare patients.”

Mike Barlow, a Palmetto vice president who oversees California, Nevada and Hawaii, said company officials are aware of the issues and have acted to address them. The company has hired and trained more people to field calls. Teams are in place to fast-track the most severe cases. This week, some Palmetto staffers were on site in Reno and Las Vegas trying to process complaints in person.

“We are accelerating to the extent that is humanly possible,” Barlow said. Palmetto has taken the brunt of the doctors’ ire. The cover of Southern California Physician magazine that hit mailboxes this week features a huge picture of a cockroach, also called a Palmetto bug, with the word “INFESTATION!” stripped across the front. The article opens with one doctor telling Barlow, “I wish I had a tomato,” as he stood before an angry crowd at a California Medical Assn. meeting last month.

Critics of the switch say the federal Medicare agency is also to blame for undertaking two major transitions within months of each other. In an effort to cut costs, the agency picked a contractor that was not equipped or prepared to handle California’s Medicare providers, they contend.

But federal officials defend the choice. Torris Smith, an associate regional administrator for the agency, said Palmetto has more than 40 years of experience as a Medicare contractor and was selected after a “full and open competition.”

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New York Times -

Nov. 7: In another sign of the economy’s toll on the nation’s health care system, some hospitals say they are seeing fewer paying patients even as greater numbers of people are showing up at emergency rooms unable to pay their bills.

While the full effects of the downturn are likely to become more evident in coming months as more people lose their jobs and their insurance coverage, some hospitals say they are already experiencing a fall-off in patient admissions.

Some patients with insurance seem to be deferring treatments like knee replacements, hernia repairs and weight-loss surgeries the kind of procedures that are among the most lucrative to hospitals. Just as consumers are hesitant to make any sort of big financial decision right now, some patients may feel too financially insecure to take time off work or spend what could be thousands of dollars in out-of-pocket expenses for elective treatments.

The possibility of putting off an expensive surgery or other major procedure has now become a frequent topic of conversation with patients, said Dr. Ted Epperly, a family practice doctor in Boise, Idaho, who also serves as president of the American Academy of Family Physicians. For some patients, he said, it is a matter of choosing between such fundamental needs as food and gas and their medical care. “They wait,” he said.

The loss of money-making procedures comes at a difficult time for hospitals because these treatments tend to subsidize the charity care and unpaid medical bills that are increasing as a result of the slow economy.

But many hospitals are responding quickly to a perceived change in their circumstances. Shands HealthCare, a nonprofit Florida hospital system, cited the poor economy and lower patient demand when it announced last month that it would shutter one of its eight hospitals and move patients and staff to its nearby facilities.

Some other hospitals, while saying they have not yet seen actual declines in patient admissions, have tried to curb costs by cutting jobs in recent weeks in anticipation of harder times. That includes prominent institutions like Massachusetts General in Boston and the University of Pittsburgh Medical Center, as well as smaller systems like Sunrise Health in Las Vegas.

A September survey of 112 nonprofit hospitals by a Citi Investment Research analyst, Gary Taylor, found that overall inpatient admissions were down 2 to 3 percent compared with a year earlier. About 62 percent of the hospitals in the survey reported flat or declining patient admissions.

Separately, HCA, the Nashville chain that operates about 160 for-profit hospitals around the country, reported flat admissions for the three months ended Sept. 30 compared with the period a year earlier, and a slight decline in inpatient surgeries.

Many people are probably going to the hospital only when they absolutely need to. “The only way they are going to tap the health care system is through the emergency room,” Mr. Taylor said.

And now, as the economy has slid more steeply toward recession in recent weeks, patient admissions seem to have declined even more sharply, some hospital industry experts say. “What we have not seen through midyear this year is the dramatic slowdown in volume we’re seeing right now,” said Scot Latimer, a consultant with Kurt Salmon Associates, which works closely with nonprofit hospitals.

While the drop-off in patient admissions may still seem relatively slight, hospital executives and consultants say it is already having a profound impact on many hospitals’ profitability. As fewer paying customers show up, there has been a steady increase in the demand for services by patients without insurance or other financial wherewithal, many of whom show up at hospital emergency rooms — which are legally obliged to treat them.

In California, for example, the amount of bad debt and charity care among hospitals has been steadily climbing, to $7.1 billion last year from about $5.8 billion in 2005. Those numbers could approach $8 billion for 2008, according to an analysis by Kurt Salmon.

The situation is exposing a main vulnerability of the nation’s hospital care system, which executives say relies heavily on private insurance to subsidize certain services. When there is a decline in profitable procedures paid for by private insurance, hospitals have less money to offset the relatively lower fees they receive from government insurance programs like Medicare and Medicaid.

“What happens in our country is that there’s really a hidden tax built in,” said Richard L. Gundling, an executive with a trade group for hospital financial executives, the Healthcare Financial Management Association. “Hospitals have to balance the mix of patients in order to survive.”

Mr. DeMichiei said Pittsburgh was mainly trying to reduce administrative jobs as a way to keep ahead of the worsening economy. Because large hospital groups like his have become more professionally managed in recent years, he said, they are no longer slow to reduce expenses.

Another source of financial anxiety, hospitals say, is the continued difficulty in raising money through the credit markets. The majority of the nation’s hospitals are nonprofit, and they often raise capital through the municipal bond market to erect new buildings or make other significant capital investments. Because many hospitals say they are still unable to borrow easily, they have reacted by scaling back projects or holding off on major purchases.

“We are being extremely cautious about approving spending in these 60 to 90 days, until the markets stabilize,” said Michael A. Slubowski, the president of hospital and health networks for Trinity Health, a large Catholic system based in Novi, Mich., which operates nearly four dozen hospitals, mostly scattered across the Midwest.

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New York Times -

Nov. 10: In the first of an expected avalanche of post-election regulations, the Bush administration on Friday narrowed the scope of services that can be provided to poor people under Medicaid’s outpatient hospital benefit.

Public hospitals and state officials immediately protested the action, saying it would reduce Medicaid payments to many hospitals at a time of growing need. The new rule conflicts with efforts by Congressional leaders and governors to increase federal aid to the states for Medicaid as part of a new economic action plan.

President-elect Barack Obama has endorsed those efforts. At a news conference on Friday, he said that legislation to stimulate the economy should include “assistance to state and local governments” so they would not have to lay off workers or increase taxes.

In a notice published Friday in the Federal Register, the Bush administration said it had to clarify the definition of outpatient hospital services because the current ambiguity had allowed states to claim excessive payments. “This rule represents a new initiative to preserve the fiscal integrity of the Medicaid program,” the notice said.

But John W. Bluford III, the president of Truman Medical Centers in Kansas City, Mo., said: “This is a disaster for safety-net institutions like ours.

The change in the outpatient rule will mean a $5 million hit to us. Medicaid accounts for about 55 percent of our business.” Alan D. Aviles, the president of the New York City Health and Hospitals Corporation, the largest municipal health care system in the country, said: “The new rule forces us to consider reducing some outpatient services like dental and vision care. State and local government cannot pick up these costs. If anything, we expect to see additional cuts at the state level.”

Carol H. Steckel, the commissioner of the Alabama Medicaid Agency, said the rule would reduce federal payments for outpatient services at two large children’s hospitals, in Birmingham and Mobile.

Richard J. Pollack, the executive vice president of the American Hospital Association, said these concerns were valid. “The new regulation,” Mr. Pollack said, “will jeopardize important community-based services, including screening, diagnostic and dental services for children, as well as lab and ambulance services.”

Herb B. Kuhn, the deputy administrator of the Centers for Medicare and Medicaid Services, defended the rule. “We are not trying to deny services,” Mr. Kuhn said. “We want to pay for them more accurately and appropriately.

Payments for some services were way higher than they should be.” The rule narrows the definition of outpatient hospital services to exclude those that could be provided and covered outside a hospital.

In May, the White House said it wanted to avoid the rush of “midnight regulations” that had occurred at the end of other administrations. But Bush administration officials said this week that they still intended to issue, or relax, many economic, environmental, health and safety rules before they leave office on Jan. 20.

Medicaid, financed jointly by the federal government and the states, provides health insurance to more than 50 million low-income people. Services can often be billed at a higher rate if they are performed in the outpatient department of a hospital rather than in a doctor’s office or a free-standing clinic. Hospitals generally have higher overhead costs.

Matt D. Salo, a health policy specialist at the National Governors Association, said, “The new rule is consistent with the administration’s effort to squeeze, shrink and flatten Medicaid spending.”

In a recent letter, the governors urged Congress to increase the federal share of Medicaid for at least two years. With state tax revenues plunging, many governors are considering cuts in Medicaid and other programs. Such cuts, they say, would further depress economic activity.

Ann Clemency Kohler, the executive director of the National Association of State Medicaid Directors, said: “The new rule is a pretty sweeping change from longtime Medicaid policy. Since the beginning of the program, states have been allowed to define hospital outpatient services. We have to question why the rule is being issued now, three days after the election, with a new administration coming in.”

The rule was proposed in September 2007. It takes effect on Dec. 8, six weeks before Mr. Bush leaves office.

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Business Wire -

Nov. 6: McLean, Va. – With open enrollment season in full force across the country, many Americans are evaluating health care benefits for themselves and their families. But, according to a new survey conducted by BearingPoint, Inc. and Zogby International, a startling percentage of citizens are considering denying themselves and their children health care to save money during this unstable economic environment.

The survey, “Impact of the Economic Crisis on Health Care Consumers,” found that of the roughly 3,500 American adults polled, nearly one in 10 were more likely as a result of the reported economic crisis to either drop their health insurance plan or switch to a plan with lower premiums and less attractive benefits. Considering the number of insured adults in the country according to the most current report from the U.S. Census Bureau, Income, Poverty, and Health Insurance Coverage in the United States: 2007, August 2008, this would translate to almost 21 million American adults that are considering making sweeping changes in their health care behavior to cut expenses.

“The purpose of this survey was to understand how the financial crisis is impacting health care consumers and changing their behaviors,” said John Distefano, vice president of health care payer services for BearingPoint. “While Americans are looking at many ways to curb their expenses, this survey reveals for the first time that they are considering cutting back health care services and benefits as a result of the economic conditions. And, if a portion of those considering these extreme steps actually take action, the issues we face with uninsured and underinsured Americans will only be exacerbated there could be a real negative impact on the overall health of Americans in the year to come.”

Additional key findings of the BearingPoint/Zogby study suggested that, as a result of the reported financial crisis:

Fifteen percent of survey respondents were more likely to take less medication, delay prescription refills, or not fill prescriptions as a result of the state of the economy.

Respondents making less than $25,000 per year reported being more likely to drop their health insurance plan to save money at rates 10 times higher than those making more than $100,000.

Women reported being more likely to put off necessary care for themselves or their children at twice the rate men did.

Young adults, specifically between ages 18-24, were more likely than other age groups to report being inclined to drop or switch to a less expensive health care plan.

Hispanics consistently reported being more likely than Caucasians, African-Americans or Asians to want to take drastic measures on healthcare due to cost.

Nearly 12 percent of respondents making less than $25,000 per year reported being more likely to fail to provide or delay providing vaccinations for their children. Based on the number of children living in poverty reported by Columbia University’s National Center for Children in Poverty, this could affect more than 1.5 million poor children in the U.S. including 600,000 children under the age of six.

Ventura County Star -

Nov. 9: Falling stock prices and fear of unemployment are doing more than making people feel sick. Economic forces are pushing some Ventura County residents away from the medical procedures they want or need.

In diagnoses that vary widely throughout the county, doctors say the recession is driving people to postpone or cancel procedures ranging from breast augmentation to colonoscopies.

The number of patients in at least two hospitals in west Ventura County slumped with the economy, though hospitals in some more affluent communities haven’t had a change. At the same time, a county clinic system designed for people with little or no money has had 44,000 more patients in the past year.

The same trend is emerging everywhere. A survey by the Kaiser Family Foundation in October suggests 36 percent of Americans are putting off care because of the cost. About 27 percent of the people polled said financial concerns have kept them from filling prescriptions.

“People do wild things,” said Lynn Rolston, chief executive officer of the California Pharmacists Association, warning of particularly dangerous abuses. “They go as far as buying antibiotics from pet stores.”

Some Ventura County doctors haven’t seen a dramatic change. They said people are more cost conscious and aware of what may not be covered by insurance but are not putting off needed surgery or treatment.

“In my opinion, it is normal to see things wax and wane,” said Simi Valley orthopedic surgeon Gregg Hartman, describing his practice one week as a little slow and the next as “so busy, I don’t know what to do.”

Outpatient procedures down

The number of patients at the 240-bed Community Memorial Hospital in Ventura has been up and down as low as 124 over the past few months. The hospital’s patient count or census was about 3 percent down from last year through September, said CEO Gary Wilde.

Outpatient procedures like MRI and CT scans, laboratory tests and cyst removals are down about 9 percent over last year, said Dave Glyer, the hospital’s chief financial officer.

Glyer blamed not only the soft economy but also high-deductible insurance policies that mean people pay more out of their own pockets.

However, Wilde said, insurance concerns are also bringing people back into the hospital. Over the past two weeks, the patient count has surged and so has the demand for elective surgery. People want to get procedures done because they’ve already met their deductibles for the current year.

Proffett is medical director of the SeaView Independent Physician Association, a managed care network of some 300 doctors.

He said case managers at all three hospitals have reported that admissions have been unusually low at times during the economic downturn. Overflow areas used for patient care during busy times have been closed at both St. John’s hospitals, Proffett said.

Community Memorial officials said general care beds in their overflow unit have also been closed more than usual. “When people don’t have money or lose their jobs, they don’t seek healthcare,” Proffett said.

Murray said admissions haven’t been down in Camarillo. He said overflow units at the Oxnard hospital are opened and closed depending on the patient census.
Chris Slane, union representative for nurses at St. John’s in Oxnard and Camarillo, said the reduction in admissions has affected staffing at both hospitals, though it’s been worse in Oxnard.

Filling up the safety net

As some hospitals report fluctuating declines in patient numbers, the county-run clinics designed to operate as a healthcare safety net are catching more patients. Over the past year, the volume has increased about 17 percent, said Mike Powers, director of the county Health Care Agency. Many of the patients are poor and uninsured. Some have just lost their jobs.

“They’re telling us that before they came here they might not have had a doctor and were unable to get medication,” said Powers, attributing the surge at least in part to the economy.