A health insurance dilemma
05 05 08 - 15:08
Estimated 1 in 6 S.C. residents live without it
By Jill Coley (Contact)
The Post and Courier
Monday, May 5, 2008
For three years, Minnie Hopkins pushed out of her mind the fact that she could have cancer. She had two lumpectomies to remove surgically what turned out to be benign breast calcifications. Then she lost her job and her health insurance.
The 63-year-old North Charleston resident skipped her mammogram appointments, afraid a diagnosis would plunge her and her five adult children into debt.
"Sometimes we tend to put things in the deep recesses of our mind," Hopkins said. "The more you think about it, the more it drives you crazy."
Lynn Bailey, a Columbia-based health care consultant, said ignoring the problem is a common approach. "They ignore it," she said. "They pretend it's not there."
Then when they have an emotional diagnosis, they are asked to navigate a labyrinthine health care system, Bailey said. "It is really, truly scary."
Last week, several of those uninsured navigators came to talk during a forum sponsored by two nonprofits, Mount Pleasant-based Palmetto Project and the national Partnership to Fight Chronic Disease. Their goal was simple: remind policymakers of the humanity behind the numbers.
Hopkins is one of the 700,000 to 800,000 South Carolinians, or 1 in 6 people statewide, estimated to go without health insurance. Sixty percent of the uninsured are working, said Palmetto Project Executive Director Steve Skardon Jr.
Not all employers offer insurance, and not all employees qualify. About 53 percent of employers in
South Carolina offer insurance, according to Cover the Uninsured, a Robert Wood Johnson Foundation project.
The ranks of the uninsured are expected to swell along with the unemployment rate, which rose in South Carolina to 5.7 percent in March from February's 5.5 percent, one of the highest jobless rates in the nation.
A 1 percent rise in the nation's unemployment rate is projected to increase the number of uninsured by 1.1 million, according to the Kaiser Family Foundation, a California policy group. Nationally, 1 million more people will enroll in Medicaid, increasing state Medicaid spending at a time when state tax revenues are falling.
Compounding the problem further, insurance rates are rising faster than income, pricing more Americans out of coverage. People who get insurance through their jobs have seen premiums increase 10 times faster than their incomes in recent years, according to a study of government data by the Robert Wood Johnson Foundation.
Sue Berkowitz, director of the South Carolina Appleseed Legal Justice Center, a low-income advocacy group, gets phone calls from people seeking help. If you're working and uninsured, Berkowitz said, "There's very few real solutions out there."
Hospitals are feeling the pinch and asking uninsured or underinsured patients to pay upfront for nonemergency and elective procedures, which may include treatment for cancer.
Officials at the Medical University of South Carolina, Trident Health System, Roper St. Francis Healthcare and East Cooper Regional Medical Center confirmed they ask for payments upfront, sometimes at discounted rates if patients do not qualify for charity care.
The move is one of necessity to remain financially solvent, officials said. In October 2007, area hospitals released a report through the South Carolina Hospital Association stating they delivered more than $136 million in care that was uncompensated.
Hopkins was lucky. After the life insurance company where she worked closed shop, she continued to see her primary-care provider, whom she paid out of pocket.
When her doctor found out Hopkins wasn't keeping up with her screening, he and Hopkins' children urged her to get a mammogram. Ultimately, her son paid for the test, and she had cancer.
Although she had a new job, Hopkins had missed the enrollment period for benefits. Hollings Cancer Center helped her navigate the Medicaid application process.
But as that application process was closing, her employer-provided insurance card came in the mail. The two coverage possibilities canceled each other out. Medicaid wouldn't cover treatment because she was insured, Hopkins said. The insurer wouldn't cover the treatment because the cancer was a pre-existing condition.
Hopkins still isn't sure how it worked itself out. She feels borne along the crest of paperwork and medical codes. Ultimately, Medicaid paid for the chemotherapy and radiation, she said. She is now in remission.
"Half times I don't know what is going on," Hopkins said. "You learn how to tune out a whole lot of things."
Beginning in January, she started receiving five or six benefit explanations in the mail weekly. Each one has a form for her doctor to fill out before benefits will be paid.
And the cycle continues.
Reach Jill Coley at 937-5719 or jcoley@postandcourier.com.