Health Care: For College Students and Young Adults

If you are a student or a recent graduate and do not have insurance either from parents or school or employer; be innovative. When Medicaid fails you, when other state health care programs fail you; search for other options. You are young and healthy but accidents happen having some access to preventative medical care is a plus and does not hurt you in any way.

Free Clinics

This website is a search engine that will populate directories of all the free clinics in a city or state that you choose. This is the website I populated for Pittsburgh, Pennsylvania. This is the website for the free clinic closest to Pitt Students. The website lists several locations.

Planned Parenthood provides well-women care services such as free contraceptives, physicals, STD testing, etc.

EMERGENCIES

Go to the Emergency Room if you are injured or are severely ill. The prevailing ideal in medicine is still patients first and money later. Doctors have a moral and ethical duty to save lives.

Charity Care from UPMC

I spoke with Dr. Elizabeth Wettick from University of Pittsburgh Student Health. She is the director of Student Health and I happened to see her at a meeting and talked about my project. She sent me an application for a charity care program through UPMC. I am attaching the application at the end of this post. Please copy and paste the link (don’t click on it; it won’t work).

It is called UPMC Financial Assistance and seems to imply that the program will help you pay off your medical expenses and bills if you qualify. I am unsure of the eligibility requirements and the standards that the hospital uses. This program is not well known to many people but a lot of hospitals have some kind of financial assistance programs for the low-income individuals and families.

The point is that these programs are hard to find because hospitals don’t want everyone applying for help. It would put a significant dent in the profits and a significant work load on administration. You need to dig for this kind of information.

file:///C:/Documents%20and%20Settings/Catherine/Desktop/Writing%20for%20Public/Blog%20Entries/UPMC%20Financial%20Assistance%20Application%20070105.htm

Increase federal funding

Instead of relying too heavily on States already strained by budgets. The federal government has a broad tax base tax base that can support more expansion. The change will only shift the burden from states to the federal government.

Constrain State Options on Spending

Federal government intervention on State use of revenue has traditionally been hated. To return the Medicaid program to fiscal integrity is more oversight of payment levels to providers that follow new upper payment limitations (UPL). The Boren Amendment for example regulated nursing home payment rates. Even though Medicaid costs are rising, this reform will clarify the reason for rising costs. The funds are being used to pay a reasonable price for a covered service for an eligible client of Medicaid.

Revised Waiver System

Waivers are issued to states by the federal government to let states experiment with modifications to the Medicaid program in that state. State’s waivers should become permanent after five years if the state meets the waiver’s terms and/or is free to adopt another state’s waiver without review.

The waiver system should be revised. Instead of just reforming and revising the Medicaid program, states should aim in their experiments to answer several questions. What are the effects on lowest income populations on enrollment, utilization, and health status? Can individuals choose and manage their providers that result in positive effects on health, lifestyle, and finances?

For some state reforms, waivers should be eliminated. For example, simplifying eligibility standards; eliminating boundaries to include more adults in the program; or adopting managed care.

I am and always have been a supporter of universal health care. I admit that universal health care is a dream: a change that will only come about despite all the odds. Universal health care will only come about when everyone in America is willing is give a little and make some sacrifices and bear some of the costs. The reality is that universal health care will be expensive; it will be costly to get it off the ground and it will be costly to sustain. So I realized that I cannot truly argue for universal health care despite all the benefits to people. Since the election has abandoned universal health care as the ultimate policy goal, I feel that it is more important to look at what we have in front of us.

I don’t propose to support either candidate: Barack Obama and John McCain. I want to present here what they have proposed so that you, my reader, may compare and decide.

John McCain

-Eliminate current tax exclusion for employers offering health insurance.
-Every family will receive tax credits. $2,500 for individuals and $5,000 for families: to offset the costs of private insurance.
-Health savings accounts. The tax credits you don’t use you can deposit into this account.
-Guaranteed Access Plan: Working with states to establish a non-profit organization that would work with insurers.
-Work to increase competition.
-Work to re-import drugs and generic drugs.
-Reform Medicaid and Medicare: payment systems will be reformed so that Medicaid or Medicare does not have to pay for preventable medical errors. New payment system will compensate providers for diagnosis, prevention, and care coordination.
-Reform laws governing medical malpractice.

For more on McCain’s plans visit this website.
For CRITISISMS of McCain’s plan

Barack Obama

-“Play or pay” employer mandate: all employers must either offer workers health insurance or pay taxes (some small businesses exempt)
-Create a new National Health Plan like Medicare specifically for the uninsured
-Establish new national health insurance exchange that offers choice of private insurance options for uninsured and small businesses
-Mandate all children to have coverage
-Subsidies for lower-income Americans to buy private insurance
-Plan will be financed through payroll tax: tax cuts for families earning over $250,000 will expire
-Regulate private insurance plans to end risk ratings
-Establish federal re-insurance program to insure businesses against costs of workers’ most expensive medical illnesses

For more on Obama’s plans visit this website.
For CRITICISMS of Obama’s plan

Every election cycle we hear one word; reform. Every candidate, every politician, talks about reforming the status quo: some even speak of chucking the old completely to replace it with something new. Every candidate has a proposal that is different and same in various areas. Dissent is the real prevailing theme, not reform. In truth, as I mentioned in my previous blog entry “Historical Perspective,” dissent is the reason health care reform has been stifled. True reform will require that everyone make compromises. These include legislators, policy officials, employers, pharmaceuticals, interest groups lobbying with corporations, hospitals, doctors, and other health care officials.

John McCain is proposing less government and more free market. Barack Obama is promoting more government and competition through establishing a National Health Insurance Exchange. Sticking to their respective party ideals, each candidate is proposing plans that play to the tune of party politics. McCain, despite being the self-proclaimed “maverick” has bowed to the whims of Republicans unwilling to compromise with Democrats. We all know that McCain has historically angered his party on many occasions to cross party lines and draft or support legislation with the other side. But now in a time when Americans most need legislators to compromise, McCain fails to be a true maverick. A free market system will spawn monopolies. As we have already seen in the past 10 years, large insurance companies have been buying up smaller groups. As a result, the people suffer. Premiums on private insurance have increase over 87% over the last six years. The premiums are so expensive now that the refundable tax credit ($2,500 for individuals and $5,000) will not be enough to buy private insurance.

Change requires that we learn from past mistakes. Barack Obama despite his calls for true change that we have been waiting for, has not learned from the mistakes that struck down health care reform in 1993 when Hillary Clinton first proposed universal health care. His plan is flawed in that he does not take into account the number of interest groups that will rear up in revolt of his reforms. Pharmaceuticals alone will send an army of lobbyists to Washington to make sure that no legislation will be passed to let Americans buy prescription drugs outside of America.

One thing that all politicians can agree on is that reform is necessary and imperative. But political dissent and struggle for power is an ugly monster that has no care for real people suffering from illness and injury. So alas the electorate must make a choice.

Although I wanted to address the comments that I have getting; I felt that this particular topic should be presented first as the election is coming up. The person I interviewed, Diana Fisher told me about all the problems with the Medicaid program that she has encountered; not personally but to people that she knows. One particular story that stood out involved a friend who needed surgery to remove an ovarian cyst. Diana’s friend applied for Medicaid and when she went into surgery, the doctor available through Medicaid performed a cheaper procedure that would leave more scarring and would take more time to heal completely. Diana’s friend had her “navel to pubic bone (skin and tissue) slashed open” and did not recover fully until 2 months after the procedure when the staples were taken out.

From what I can gather from my research, Medicaid is supposed to be available to anyone ages 19-64. The eligibility requirements are quite broad and can be found on its website. The website will not help you pre-determine your individual eligibility. You just have to take the chance and apply and hope you will be accepted. So how many people are actually eligible for Medicaid? In 1995, Medicaid reform came into discussion as a result of the burden it put on the federal budget. The problem then was lack of money to fund the rapid expansion of the program. Enrollment in Medicaid has grown from four million in 1966 to forty-seven million in 2002. The expenditures have grown to $257 billion. Three problems with Medicaid that we need to deal with today are; growing enrollment, high medical inflation, and plummeting state revenues. The purpose of Medicaid was to solve all health system problems back in the 1960s: it covered new populations, supported critical health care providers, and compensated for limitations in other public and private insurance programs.

According to The Urban Institute, uninsured adults eligible for Medicaid are very unlikely to see any physician in a 12-month period; they are also unlikely to have surgery or any overnight hospital stays because of out-of-pocket costs (some report spending more than $2,000 out-of-pocket). “Efforts to increase enrollment in Medicaid, when private insurance alternatives are not available, are essential to maintaining and improving the health of those (uninsured) adults (The Urban Institute).” Results of the study show that covering the uninsured but eligible for Medicaid adults would actually be less expensive because they are healthier than those already enrolled in Medicaid. During my interview with Diana, she mentioned that from her experience, people who get Medicaid are generally very, very sick. This seems to correlate with what the study has found. Young adults who are not insured should be covered by Medicaid because they are generally healthier than adults already enrolled and therefore would be less expensive than expected. But the problem is this.

The Medicaid program is already stretched thin. Enrollment has shot-up even with strict guidelines for enrollment. Funds are limited which lead to cases like that of Diana’s friend. So to talk about expanding enrollment further is preposterous to our legislators. Medicaid enrollment has steadily declined since 2000 and this decline is noticeably affecting persons with the lowest income. So how can we begin to reform Medicaid? States have taken it upon themselves to form programs working alongside Medicaid such as State Children’s Health Insurance Program (SCHIP) to increase children enrollment. What can Congress do? What can our candidates in this year’s election do? What are our local politicians proposing to address these problems? What are the candidates proposing in their health care reform plans?