Justice (ification) for Public Health

Yesterday’s Supreme Court decision was a victory for public health. In the past few years it has been challenging to sift beyond the political rhetoric, grandstanding and nonsense to see this issue for what it really is, a vital public health crisis. The Supreme Court’s decision yesterday has allowed us to finally be able to move on and deal with the complex and multi-layered problems that lie in American public health

Since the 1960‘s, the United States has fallen from being the 12th in infant mortality to 29th (with #1 being the best).  Infant mortality is always a key indicator for a nation’s overall public health. At the heart of this problem has been lack of access to quality healthcare.  In that time we have seen an incremental increase in the numbers of the uninsured, individuals which have a 25% higher chance of dying than those with health insurance. As a result, 46,000 people die each year because of their inability to access health care, as we saw in the story of Billy Koehler from Pittsburgh.

It is in the interest of public health to see that everyone is insured. According to the center for American Progress, it costs Pennsylvania families $900 a year more in insurance premiums to cover the uncompensated care of the uninsured, therefore leading more individuals and businesses to forgo insurance or cutback benefits and as a result, jeopardizing personal health. With the highest population of uninsured being those under age 26, as we saw in the story of Eric from Radnor and Teddi from Lebanon County, insuring these young people not only protects them, it protects all of us.

While being able to access healthcare is key to overall public health, ensuring quality is equally as important. As we move forward to open up the state-based exchanges in Pennsylvania, access will be enhanced for currently uninsured individuals and small businesses, therefore alleviating the likelihood of premature death. However, within the exchanges, all policies will be subject to adhering to certain essential benefits in order to ensure a higher quality plan that many in the small group markets are currently unable to access. For example, an essential benefit that consumers on the exchanges will now be able to access is preventive care. As we saw in the story of Micheal and Laura, small business owners from Lebanon County, their small group plan had limited access to cancer preventing procedures such as a colonoscopy. With colon cancer being one of the most preventable forms of cancer, being able to catch it early is a public health victory.

The story of Barbara, a senior from Westmoreland County, illustrates that closing the “donut hole” is in the interest of public health. The Department of Health and Human Services shows that 25% of seniors that fall in the “donut hole” forgo taking their prescription drugs and therefore get sicker and more costly. With 70% of Pennsylvania seniors falling in the “donut hole”, continuing to be able to cover them is a milestone in public health.

With the validation of the high court , it’s time to lower the volume on the cable TV networks and stay focused on ensuring that the tools we have to improve the health of the public are utilized to their highest potential.

Looking for a GUEST SPEAKER on healthcare and The New Healthcare Law?  Contact Holly Dolan.  Through the art of storytelling, Holly takes you on her year-long tour around Pennsylvania with an interactive and informative presentation.  CLICK HERE for more information.  

The Graduate: Teddi's Story

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May 2012
Teddi with her parents at Lebanon Valley College Graduation

When Teddi graduated from Lebanon Valley College in May of 2012, she became a member of the second graduating class to benefit from the provision in the PPACA that allows young adults to stay on their parent’s health insurance until age 26.  The provision went into place September 1, 2010 and in Pennsylvania we have seen 89,000 young adults benefit and 3.1 nationwide according to the Department of Health and Human Services.  This number is an increase from the 2.5 million American youth that benefited when “Health on the Horizon” presented the story of Eric, a member of the first graduating class to benefit from the provision in the PPACA.

While Eric went into the workforce and was covered by his parents plan while he searched for a job and during the 3 month “lapse of coverage” before his employer provided plan became active, Teddi’s situation is different.  In the fall 2012, Teddi will be going to graduate school at Villanova where she will work on a Master’s degree in English.  Her ultimate goal is to earn a PhD in English and become a college professor.  

In fact, all young people, regardless of student status, marital status and state of residence are now eligible to stay on their parent’s health insurance plan until age 26 as long as they are not offered comparable coverage elsewhere (ie: employer).  However, what people continue to question is why this group of individuals are singled out for this provision.  A valid and very important public health question.

When Teddi is in graduate school at Villanova, she will be making $14,000 a year, enough to cover rent and living expenses.  If this provision in the PPACA was not in place Teddi commented that she would not be able to afford a health insurance plan.  Furthermore, she said she would most likely forgo one of her medications, pay out of pocket for the other and just chose to remain uninsured.  A common scenario for many young adults.  

While this may be one individual story, Teddi’s story represents a much larger demographic.  The United States Department of Labor reports that young adults under 26 have the highest rate of being uninsured (over 30%), more than any other age group.  According to a study done by the Commonwealth Fund, over a 3 year period of time, 62% of young adults age 19-23 reported being uninsured at one time.  This is because this age group is more likely to be working part-time jobs, work in low wage jobs that do not offer health benefits, or be a student.

While some argue that this demographic is not in jeopardy because they are generally young and healthy, data shows that they do pose a reasonable amount of risk that results in leaving many young people with lofty medical debts.  The Commonwealth fund states that visits to emergency rooms are more common among this age group.  This age group also comprises 1/3 of all HIV diagnosis, 3.5 million pregnancies each year and this demographic has the fastest rising rate of obesity.  In other words, this group that isn’t as invincible as the critics assume.  

While the personal toll of access to healthcare is evident on these young people both physically and financially, there is also a larger societal cost.  According to Families USA, the hidden “tax” to each taxpayer is roughly $1000 a year to cover the uncompensated care of the uninsured.  It benefits all of us when the largest cohort of the uninsured is covered.

There are also other larger societal issues related to ensuring this population has access to healthcare.  It is in our national interest the the youth population, our future workforce, such as Teddi, is able to meet their most basic needs.  In 2010 The Georgetown University Center for Education and Workforce estimated that by 2018, 2/3 of all jobs in the US will require post-secondary education.  Whereas in 1978, this number was less than 1/3 (28%).  In order to compete globally, we need to be investing and ensuring the success of this population.  

Healthcare Poker: Barbara's Story

his is the fifth story in a 5-part series called "Faces from the Frontline".  Join "Health on the Horizon" on Facebook and Twitter.

Barbara:  Berks County, PA

I like games just as much as anyone else.  However, in the past 9 months of my journey across the state of Pennsylvania, there is one game I have come to realize I no longer want to play.  That’s the game of healthcare poker.  Let’s face it, to insurance companies, it’s a game. If you get dealt a bad hand or play your cards wrong, you lose.  I won mine with beginner’s luck, I missed the lapse of coverage by 48 hours.  However, so many people loose in the worst kinds of ways, as we know with the story of Billy Koehler.

Let’s take Barbara Stakes as an  example.  Barbara is a 64 year old Buck’s County resident.  At the age of 42, Barbara discovered she has a seizure disorder called Venous Angioma.  However, to the insurance industry her disorder has another name.  It’s called a “Pre-existing Condition”.  

So what has this meant to Barbara?  Since her condition appeared in the late 1980‘s when she worked as an administrative assistant for a biotech research company, she was covered under a large group employer plan and she had full coverage.  However, when the company closed it’s doors in September of 2002, she lost her health insurance.  Fortunately, she still had a hand in this “game”.   Her 60 year old husband who worked for Amtrak was able to take her on his policy.  

As with all games though, sometimes you loose.  In 2007, Barbara’s husband turned 65 and he was therefore automatically enrolled into Capital Medicare.  She was now uninsured at the age of 59 and had to play a new hand in this sick and twisted game of healthcare poker.  Let’s explore her possible moves:  (1) an unaffordable COBRA plan for $650 a month, (2) gamble with being uninsured and pay $400 a month for prescriptions or (3) call the private insurance companies and try and get a comprehensive policy.

Barbara went with #3.  When she called two large national health insurance companies, a customer service agent leveled with her and said, “go ahead and apply, but you’ll probably get rejected”.  Barbara played the hand anyway, but lost.  One immediately rejected her and in the letter it stated it was due to a “health history that exceeds the allowable limits”.  However, the other accepted her for $835 mo. with a $5000 deductible (Barbara’s pension was $1230 month).  Go ahead and do the math.  Yes, that’s more than her yearly income!  Let’s face it, that was a denial for a “pre-existing condition” too.  

In the end, Barbara had no choice but to choose option #2 and gambled for 3 1/2 years without insurance until the PPACA was passed in 2010.  At that time, PA Faircare began, the high risk pool to assist the uninsured until the state based exchanges open up in 2014.  For now, Barbara is able to manage the $283.20 a month premium with at $1000 deductible.  

This October, Barbara will be eligible for Medicare.  However, according to a recent (April 2012) Government Accountability Report to Congress, on average, 32% of the US population has a pre-existing condition, with this number drastically higher among older populations.  After 2014, the “house” will no longer always win.  Under the PPACA, insurance companies will no longer be able to deny customers due to pre-existing conditions and for those that can not get insurance through an employer, there will be state based exchanges where individuals can go to purchase insurance at a reasonable rate.  All policies are subject to basic patient protections, must provide essential benefits and based on one’s income, individuals may qualify for a premium tax credit.  

Right now we sit at the crossroads of uncertainty while we wait for the Supreme Court to decide the fate of the PPACA.  To those who oppose the PPACA, I ask you this question:  should we continue to play this game of healthcare poker?  As for me, I’ll pass.

Source:  Department of Health and Human Services

My Brother's Keeper-part II: Billy Koehler's Story

This is the forth story in a 5-part series called "Faces from the Frontline".  Join "Health on the Horizon" on Facebook and Twitter.

Billy Koehler
March 18, 1951-March 7, 2009

Georgeanne Koehler still holds a scrapbook that she made for her brother, Billy, as a birthday present.  She was planning on giving it to him at a family birthday celebration on March 18, 2009.  Billy never made it to his 58th birthday.  Instead, the scrapbook was displayed at his funeral.    

Last week, “Health on the Horizon” presented the story of Billy Koehler, an electronics technician from Pittsburgh that died at the age of 57 because he was uninsured and could not afford to replace a battery in his AICD (defibrillator).  The device was necessary to live with his diagnosed heart condition of Torsades de pointes.  He passed away on March 7, 2009, when he was found slumped over the steering wheel of his car.  

Billy’s heart condition began in April of 1990 when he experienced a heart attack while in triage at the emergency room.  At the time, he had insurance, received a AICD and managed his condition with relative ease.  Over the next 10-13 years he was able to receive the needed battery replacement procedure necessary to maintain an AICD.  This procedure was done roughly every 5 years and usually cost the insurance company about $6000.  However, when Billy was uninsured, he was told to be prepared to pay between $60,000-$100,000, a reality that the uninsured back the burden of cost.   

A 2008 study published in the journal Health Affairs found this to be a common practice.  In their study they found that 49% of the uninsured treated in a California hospital in 2005 paid a higher price for services than those with private insurance, medicaid and medicare.  In Billy’s case, his sister, Georgeanne, tried to negotiate paying the price charged to insurance companies for the procedure, but was denied.  Instead, the hospital sent him a Christmas bouquet.  

Billy’s story is also telling of another reality in the challenges of the uninsured as they try to access healthcare.  In Billy’s story, when he was admitted to the hospital he was told by a resident that he would not get the “same care as those with insurance”.  According to the Institutes of Medicine, the uninsured do receive fewer services when they are hospitalized.  Furthermore, the uninsured have a 25% greater chance of dying than those with health insurance.  As a result, according to a Harvard University study, 45,000 people die prematurely each year in the US do to lack of access to healthcare.  

Billy is more than just an example of the uninsured that have fallen through the cracks in the system.  He is a human testament to the statistical realities that have been featured over the course of the past 10 months on this blog.  When Billy’s employer suddenly closed shop in the Spring of 2003, he was not offered a COBRA plan because the employer had (unbeknownst to the employees) cancelled the health insurance plans for all the employees months prior.  While unethical, this is not an illegal practice.  

In the United States, a vast majority of people rely on employers for access to healthcare- a reality that is beginning to take its toll on both the employer and employee/patient.  As we saw earlier this year in the story of Shontell, employer provided care has drastically declined in the past decade due to exponentially increasing costs.  In 2014, the PPACA calls states to set up state based exchanges/marketplaces (for individuals and small businesses) where people like Billy will be able to go when they no longer are able to get health insurance through their employer.  

Finally, following the loss of his job, Billy did try to apply for private insurance, but was denied due to his “pre-existing condition”, a situation common among 32% of the general public

 and drastically increases with age.  In January 2014, insurance companies can no longer deny coverage to people with a preexisting condition as part of basic patient protections that are written into the law.  

As Georganne Koehler turns the pages of the scrapbook that was never gifted to her brother for his 58th birthday, she sometimes wonders if Billy was a martyr in the fight for healthcare.  Georgeanne’s work as a healthcare advocate has taken her around the state of Pennsylvania and her message has hit the ears of thousands of people.  Above all however, Georgeanne’s mission is to ensure that Billy’s death will not be in vain.   

In 2010, The Pennsylvania Health Access Network, a consumer health advocacy group, named Georgeanne the “Pennsylvania Health Advocate of the year”.  Each year, PHAN awards someone in the state with the award that is now named after Georgeanne.  On April 29, 2012, I was honored to be given the “2012 Georgeanne Koehler Pennsylvania Health Activist of the Year” award for "Health on the Horizon".

I am My Brother's Keeper: Billy Koehler's Story

This is the third piece in a five part series entitled "Faces from the Frontline".  
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Billy Koehler
March 18, 1951-March 7, 2009

While walking down the street one spring in the late 1980’s, Billy found a senior citizen crying on her porch.  When he approached her to find out why she was so upset, she explained, “my television is broken and it will cost $25 to fix.”  To many people this may not be a cause of such great sadness, but to a senior living alone on a fixed income, her only source of companionship was now gone.  

However, today was her lucky day.  Billy, an electronics technician, had found her.  He hurried home, got his tools and repaired the television.  After he finished the repair, the woman sifted through her purse and offered him $5 for his service.  Billy responded, “why would you give me $5 for 1 cent worth of work?”  With gratitude, the woman handed Billy a penny.  When asked by a friend later why he took the penny, Billy replied, “Even a poor senior needs to know that they can contribute.” 

A religious man, Billy’s life echoed the teachings of Luke 20:45- the story of the poor widow that enters the temple amongst the wealthy elite to give her last 2 coins.  

After the electronics company he worked for suddenly closed in the Spring of 2003, he was left uninsured with a heart condition that required him to have an Automatic Internal Cardiac Defibrillator (AICD).  While looking for another job that had insurance, Billy spent the rest of his days building a ramp for a man in a wheelchair and refused any payment for his services.  

Billy believed that he was was brother’s keeper.

By 2005, Billy began delivering pizza’s 31 hours a week for minimum wage with no health insurance.  Due to his pre-existing condition, health insurance companies deemed him a bad investment and society stigmatized him the same.  This stigma crystalized on December 14, 2007 after he collapsed while closing the pizza shop.  Upon his arrival at the Emergency Room, a resident opened his chart and replied, “oh, you’re uninsured.  I need to tell you that you won’t get the same tests as people that have insurance.”  

Are we our brother’s keeper?

Hours later, the cardiologist on staff informed him of his dire condition.  The battery that delivers the life-sustaining electronic charge to his heart was dangerously low and needed to be replaced immediately.  The procedure would cost between $60-100,000.  Unable to produce the money, Billy was discharged immediately and told by the cardiologist, “if you get your priorities straightened out, you’ll come up with the money.”

Are we our brother’s keeper?

Unable to find $60,000, Billy and his family lived the next 446 days wondering if this was going to be his last.  On Sunday March 6, 2009 Billy knelt before the alter of his church and asked his almighty healer to answer the will of his heart.  

The answer came at 5:00pm the next day.  On March 7, 2009 Billy left work, got behind the wheel of his car and headed home.  Without the battery, the defibrillator was still capable of giving him the “warning signal” that an electronic jolt was needed.  The signal came.  Billy pulled over to the side of the road, knowing that the life-sustaining jolt would not be delivered, he sat and waited to meet his creator.  At 5:07pm Billy was found dead over the steering wheel of his car. 

This story was written with the help of Georgeann Koehler, Billy’s sister.  Georgeanne has become an outspoken activist about the issue of access to healthcare.  In December of 2011, Georgeanne facilitated a postcard campaign entitled “No more empty chairs at the table” which produced 1200 cards in 12 days to every PA Congressman and Senator.  Georgeanne has dedicated herself to being her brother’s keeper.

Please return next week to learn more about the details of Billy’s experience and see how the PPACA help to prevent that there are no longer any more “Billy’s”.