Among the many victims of the levees that failed in New Orleans following Hurricane Katrina was Charity Hospital, a historic institution that played a critical role in caring for the city's large uninsured population.
In the wake of the floods, Louisiana State University chose not to reopen the hospital but instead build a more modern one. To compensate for Charity's loss, the federal government funded a network of some 90 neighborhood-based health clinics that provide care to the uninsured.
But the federal funding for the clinics could soon dry up — even though Charity's replacement has still not been built. That could spell disaster for a safety-net system that has served about 100,000 people since Katrina. And the loss would come at a time when the region's residents are facing new physical and mental health threats related to the BP oil-spill catastrophe.
A $100 million federal grant to Louisiana has supported the clinics in the four-parish Greater New Orleans area since 2007, but the money will run out on Sept. 30. The Primary Care Access and Stabilization Grant funded 25 public and private nonprofit organizations that provide services including primary health care, mental health counseling and substance abuse treatment in Orleans, Jefferson, Plaquemines and St. Bernard parishes.
A recent report from the federal Government Accountability Office raised the concern that “the primary care gains made in the greater New Orleans area may not be sustainable after PCASG funding ends.”
That would have major implications not only for the people who rely on the clinics, but for the positive changes that have come about in the way health care is delivered in the New Orleans area.
“One of our concerns pre-Katrina was care-seeking behavior, because for generations, people would go to hospital and rely on the emergency room,” Joseph Kimbrell, chief executive of the Louisiana Public Health Institute that administers the grant, recently told the medical journal The Lancet. “That paradigm has forever changed here and the influx of dollars made that possible.”
A survey released earlier this year found that in the New Orleans region more than 100,000 adults between the ages of 19 and 64 do not have health insurance. The region has one of the highest rates of uninsured adults at 22%, compared to 18% nationwide.
Before Katrina, many of the uninsured sought care at Charity's emergency room or its outpatient clinics. But as Kimbrell noted, the neighborhood health clinic network was successful in reducing reliance on costly emergency room care. It is also able to treat patients more holistically, Karen DeSalvo, a professor at Tulane's medical school, told the Lancet:
“The clinics have been thinking about how best to relate to their community,” said DeSalvo. “There's no point just prescribing insulin to a diabetic if that patient's landlord hasn't fixed the electricity because the insulin has to be kept cold. Or, instead of just telling a patient to eat more vegetables, they give them a list of farmers' markets in their neighborhood that also take food stamps.”
Louisiana has requested a federal waiver of Medicaid rules in order to allow Medicaid funds to be used for the clinics. Negotiations are underway for that waiver, which has the support of the New Orleans City Council, the state's congressional delegation and the New Orleans Business Council, among other groups. The state, LPHI and organizations that run the clinic are working to submit a formal request by Aug. 15.
In the meantime, one of the clinics affected — the New Orleans Musicians' Clinic, which has been serving the city's vibrant musical community since 1998 — is turning to the public for support. It's issued an urgent appeal in the form of a website and video asking people to contribute to keep the facility afloat.
“A lot of our musicians fall between a rock and a hard place,” New Orleans rhythm and blues icon Deacon John says in the video. “They're too young for Medicare and Social Security, they're not totally disabled, and they can't afford private health insurance.”
Watch that video here:
Barack Obama’s ambitious health care plan is fairly simple and straightforward. His plan seeks to dramatically and swiftly increase the number of people that have health insurance. He insists that this plan will save the typical American family approximately $2500 in annual costs. Since the average Ohio health insurance premium is less than most other states, savings to Ohio residents may average less than $2500.
The Obama plan is designed to give the federal government more control over health care decisions and dollars, a major difference from the current decentralized system of employer-based insurance and state-based insurance regulation. Here in Ohio, health insurers have been effectively held in check by the Ohio Department of Insurance. This, however, is not the case in many other states.
The Obama Plan
Many parts of the Obama plan resemble initiatives from the Clinton health plan of 1994 and the Kerry Health plan of 2004.
Essentially, Obama’s health care plan is divided into three sections:
1. Modernizing the US health care system to lower costs and improve quality
2. Promoting prevention and strengthening public health
3. Quality, portable and affordable health coverage for every person
The “Savings”
The $2500 in savings will come from health care reform, using some of the following initiatives:
*Making health insurance universal, which may reduce spending on uncompensated care.
*Improving management and prevention of chronic conditions.
*Increasing insurance industry competition and reducing underwriting costs and profits.
*Providing reinsurance for catastrophic coverage, which will reduce insurance premiums.
Shifting Cost Burden
While all of these ideas are feasible, the underlying theme seems to be simply shifting some of the cost burden from the private sector to the government. And of course, much more control of our health dollars and decisions would come from Washington D.C and not Anthem or UnitedHealthCare.
The Obama plan will actually compete directly with Ohio private health insurance companies in a “National Health Insurance Exchange.” The federal government (not health insurance carriers) would determine the quality of health benefits that Americans would receive. And these new rules would apply to both the new national health plan and all participating private health plans.
Preventative Coverage Would Be Emphasized
Obama’s health care plan will encourage “healthy lifestyles” with specific emphasis on wellness. Employer wellness programs will be increased, and cafeterias and vending machines in the workplace may see healthier food.
School-based health screening programs may increase along with increased support for physical education.
For Ohio individuals and families, the Obama plan would require preventative services on many federally-supported health programs such as Medicare, Medicaid and SCHIP. One benefit may be possible discounts to on health insurance premiums for enrollment in wellness and prevention programs.
Currently, some Ohio individual health insurance policies offer a similar discount, such as Anthem’s Lumenos Health Incentive Account (HIA).
Ohio Group Health Insurance
Employer-based health insurance would radically change under the Obama plan. Here in Ohio, both small and large employers are able to choose among many different health plans for their employees. The Obama plan would force employers to offer a specific level of health benefits to their employees or pay a tax to finance a national health program. Currently, the amount of provided health benefits and the size of the tax have not been specifically discussed.
Perhaps the best and most economical health insurance plan for Ohio residents would be a concept already in place…HSAs (Health Savings Accounts). Thus, instead of imposing a top-down change on the health care system, it would seem to be prudent to transfer direct control of health care dollars to individuals and families. This would allow Americans to choose their own health plans and benefits, while making health insurance companies compete directly for consumer’s dollars by providing a real value to patients.
All of this could be accomplished by specific tax and regulatory changes designed to utilize the power of free-market competition. Health care spending could be reduced, preventative treatment could be emphasized and portability could be promoted. Reforming the tax treatment of health insurance and aiding employers that help their employees buy health insurance would help quite a bit.
For now, Ohio health insurance rates are remarkably low compared to many other states. There are many reputable health insurance companies that offer a wide array of policies, including Health Savings Accounts. That shouldn’t change much for the next two years. In 2011, things might change…hopefully, for the better.
For additional information on Ohio health insurance plans, or an instant Ohio health insurance quote, please visit http://www.ohioquotes.com
