No Insurance Leads to Health Problems

Findings from an extensive survey of the region's health show that the uninsured use health services very differently than persons with insurance, often failing to seek necessary health care because they cannot afford the out-of-pocket costs. 

As a result, uninsured residents are more at risk for having fair or poor health, receiving inconsistent care, and failing to get critical preventive screenings that could present serious health problems.

The survey, which was conducted in the summer of 2000 by the nonprofit Philadelphia Health Management Corporation (PHMC), takes an in-depth look at the health and health care experiences of residents in southeastern Pennsylvania, including Bucks, Chester, Delaware, Montgomery, and Philadelphia counties. More than 10,000 households were randomly selected for the telephone survey and asked questions about health screenings, use of health services, health insurance, and personal health behaviors, among other topics.

In Southeastern Pennsylvania, adults (ages 18-64) are more likely to be uninsured than either children, who often qualify for free or low-cost insurance through a variety of special programs, or older adults (65+), who qualify for health insurance under Medicare. Young adults between the ages of 18 and 30 are the largest single group of uninsured adults in Southeastern Pennsylvania. Three out of four uninsured adults live above the federal poverty level and more than half are employed full-time.

Uninsured adults are more likely to be in fair or poor health compared to their insured counterparts, yet they are less likely to have seen a doctor in the past year. Furthermore, not having health insurance impacts on the use of preventive health services. Uninsured adults are less likely to have received a blood pressure screening in the past year. Likewise, uninsured women ages 40-64 are much less likely to have received a mammogram and uninsured men ages 50-64, are half as likely to have received a test for prostate cancer in the past year compared to insured men.

In addition to the utilization of health services, lacking health insurance impacts on the quality and consistency of care received. Nearly one-third of uninsured adults in Southeastern Pennsylvania have no regular source of health care; this is nearly four times greater than for adults with health insurance. One-half of uninsured adults, representing 14,900 persons, reported that they sought care in a hospital emergency department during the past year because they did not have health insurance coverage.

Persons without health insurance coverage are eight times more likely than are those with Insurance to have reported that they did not seek medical care at least once during the past year because of cost. Similarly, the percentage of uninsured adults who did not fill a prescription during the past year because of cost is four times that of adults with insurance. Cost was also an impediment to receiving dental care for more than one-half of uninsured adults compared to persons with insurance.

The 2000 Southeastern Pennsylvania Household Health Survey was conducted as part of PHMC's ongoing Community Health Data Base project. The Community Health Data Base is supported by the Pew Charitable Trusts, the William Penn Foundation, the United Way of Southeastern Pennsylvania, and local governments, health care providers, and human service agencies. Survey information is used to plan and improve health services and public safety programs for the residents of Southeastern Pennsylvania.

PHMC is a non-profit, public health organization that is committed to improving the health of the community through outreach, education, research, planning, technical assistance, and direct services. A preliminary report showing data and findings from the 2000 Household Health Survey is available online at www.phmc.org/hdrc

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GOP Shoots Down Senior Prescription Plan 

A proposal offered by State Senator Jay Costa Jr. that would have transferred $100 million from the state's bloated $1.2 billion Rainy Day Fund to help pay for low-cost prescription drugs under the PACE program for senior citizens was rejected by the Senate Republican majority. The vote was along party lines, with all 29 Republicans voting against the amendment. Twenty Democrats voted in favor of Costa's plan.
Costa said he made the proposal in order to provide the PACE program with a short-term infusion of cash while legislators continue to craft a long-term solution to the prescription drug crisis facing seniors.
The Allegheny County lawmaker said his amendment was an intermediate step that would provide breathing room until the full Senate considered his FAIRx legislation. In his floor speech, Costa's said the FAIRx program "cuts drug costs, increases access, lessens bureaucracy and retains drug choice options for all seniors."
Costa said that without a lasting legislative remedy like FAIRx, rising drug costs and stagnant Lottery sales will result in the PACE program going broke in the next several years. 
Costa said transferring $100 million from the Rainy Day Fund would bolster the PACE program while still enabling the Rainy Day Fund to retain an ample surplus of over $1 billion.
"It is raining hard on our seniors and it is time that we use the funds that have been put away for a rainy day to good use," Costa said in Senate Floor remarks. "My amendment would do that and much more. If we did our job diligently and followed up on my proposed $100 million Rainy Day Fund contribution with a long-term solution like FAIRx, this stopgap influx of dollars would have served as a bridge to that solution," he said. 
The FAIRx plan would make nearly 80,000 additional older Pennsylvanians eligible for PACE. The proposal would also cuts costs for those who are not eligible for the enhanced prescription drug benefit by providing for an at-the-counter discount for seniors who have a Medicare card.
Costa along with Mike Stack and other senate Democrats are committed to continuing the fight for low-cost prescription drugs and the retention of drug choice options for seniors. 

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Workers' Comp Watch: Don't Lose Control Over Your Medical Care

by James DeMarco, Esq. 

An injured worker is not only required to utilize physicians named by his employers for the first ninety days of treatment, he must also submit to periodical independent medical examinations. Although the insurance company labels the examination "independent," the physician is chosen and paid by the employer, and is more accurately a "defense" medical witness. The fee paid is considerably more than that paid by Medicare, HMO's, or the regular patients of the physician. If the physician is required to testify in workers' compensation litigation, he is usually paid $3,000 or more for a deposition, which rarely takes longer than one hour. The total time spent by the physician is rarely more than two hours.

It is not surprising that insurance companies frequently choose physicians whose opinions are most likely to be favorable to the employer and provide evidence for terminating a workers' ongoing wage loss benefits. One insurance company physician admitted that ninety percent of his "independent" medical evaluations resulted in an opinion of full recovery from the injury.

In many cases, the worker is told to return to work initially by the physicians chosen to treat him during the first 90 days following the accident irrespective of his medical condition. The worker is unable to perform the normal duties of his job, but none of the employer's physicians will support his position. He reluctantly returns to work and is eventually fired for inability to perform his duties, or laid off and told that he is terminated for a different reason. 

That is why it is so important to consult with an attorney shortly after sustaining a work-related injury and before any medical examination specifically scheduled by the insurance company. Proper preparation and awareness of the insurance company's methods can protect a worker from unscrupulous physicians whose allegiances are with the employer and against the patient.

It is especially important to do this before the transfer of control of medical treatment from the physician chosen by the injured worker to the insurance company representatives and the physicians chosen by them. Some injured workers begin treatment with their own physicians because they received emergency treatment at the nearest hospital and were quickly referred to a specialist with offices at the hospitals.

Most insurance companies will not interfere with the worker's treating physician if there has been no apparent prior personal relationship with the worker. A problem may arise however when the worker transfers to his personal physician (after the 90 days that he is required to utilize insurance company physicians) and the physician requests expensive diagnostic tests.

From the time when insurance companies were first permitted to request review of medical treatment, many of the worker's medical bills went unpaid, most in violation of the Worker's Compensation Act. As a result, many medical providers of diagnostic studies, physical therapy, surgery, or other expensive procedures required pre-approval for the treatment. To reduce the costs for each claim, insurance companies refuse to provide such pre-authorization, and it is not necessary for them to do so. Insurance company's tactics of aggressively challenging legitimate medical bills have caused physicians to become demoralized and avoid treatment of patients with work related injuries to avoid constant bickering for payment of their legitimate bills. The Pennsylvania Worker's Compensation Act lacks an efficient procedure for enforcement, so insurance companies often ignore administrative regulations regarding payment of medical bills.

Insurance companies are more hesitant to violate regulations and wrongfully deny reasonable treatment when the worker is represented by an attorney who is familiar with the provisions of the Worker's Compensation Act. The threat of a Penalty Petition and being dragged before an Administrative Law Judge is a sufficient deterrent to ensure that the worker will receive the treatment to which he/she is entitled.

(Editor’s Note: Jim DeMarco wrote this series before he died)

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Phillies up to bat against breast cancer

Everyone's favorite Philadelphia Phillies and the visiting Atlanta Braves will play one for a great cause, Breast Cancer Research, Tuesday, June 26, at the Vet.

The Phillies will make a generous contribution from the sale of special tickets to the Breast Health Institute. The hometown team will also donate merchandise fans can win-a bat, ball, or maybe a Phillies jacket!

This is the third year the Phillies are reaching out to the community by donating to BHI. Last year $2,250 was donated from the sale of special tickets. The donated funds go to the BHI Breast Cancer Research Fund.

The Breast Health Institute, a nonprofit organization, was founded in 1990 and raises money for education, clinical research and offers free breast cancer screening programs such as mammograms for uninsured individuals. In addition, BHI serves also provides information about breast disease, which kills approximately 44,000 women and 400 men each year. 

Tickets prices are $24, order yours today to get the best seats! You can call Sandy Richman, the director of sports projects, at 215-482-9367 for more information. Come on down, get some peanuts, and be a part of Breast Health Awareness Night with the Phillies!

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