Missing Out on Health Care
Last month, California lost an opportunity to receive tens of millions of dollars in federal funding to provide healthcare to uninsured kids. Why? It didn't enroll enough eligible children into its government health plans.
In response to a federal incentive program that awarded extra money to states that met certain enrollment numbers, California set a goal of signing up 352,000 new kids in its Medi‐Cal or Healthy Families programs. It fell short by about 24,000 kids, which left the state ineligible for the federal funds.
It wasn't that there weren't enough eligible kids in the state. This happened, let's remember, during a year when unemployment in California peaked at 12%. Researchers at the Urban Institute estimated in October that the state was home to nearly 700,000 uninsured children who qualified for state or federal programs but hadn't been enrolled. So why couldn't the state meet its enrollment goals? Because California has a cumbersome system that acts as a roadblock to enrolling eligible children.
One problem is that in 2009, to save money, Gov. Arnold Schwarzenegger cut funding to pay certified application assistants, who help enroll those qualifying for Medicaid.
A second problem is that it has become increasingly difficult to find physicians willing to accept the artificially low payments — as low as 9 cents on the dollar for some kinds of care — that have been set by the Medi‐Cal program.
A third reason involves the hoops hospitals must jump through to get reimbursed for treating uninsured children who qualify for state or federal programs. If a family without insurance brings a child with a serious medical problem to the hospital, for example, the emergency room staff provides care with the expectation of being reimbursed by the state under a process called retroactive enrollment. But submitting such claims has become increasingly difficult. Delays and denials are commonplace. Some hospitals have grown so wary of participating in this hard‐to‐win system that they have opted to absorb the loss and chalk up the cost of treating such children to unreimbursed care.
In an effort to get more people signed up for coverage, our nonprofit organization, the San Jose‐ based Foundation for Health Coverage Education, launched a 24‐ hour help line for the uninsured in 2005. Through our live call‐in center and our coverageforall.org website, we have been able to help more than 2 million uninsured Americans who seek help.
The process is simple. First, we ask five eligibility questions. Then we identify public programs for which the inquirer might be eligible and provide applications for the programs and a list of documentation that will be required. It doesn't have to be an obstacle course.
California needs to simplify its process. One step in that direction would be to allow people eligible for Medi‐Cal to sign up for it at the "point of service" — when they receive medical care. California employs 26,500 state workers who are responsible for enrolling people in public programs, including welfare, Medi‐Cal and food stamps. This number could be reduced if Medi‐Cal enrollment could be done online at a clinic, doctor's office or hospital where care is delivered.
California lost out this year, and that should never happen again. By revamping its antiquated and inefficient enrollment system, the state need never again leave federal grant money on the table while children go without healthcare.
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Oct '10
Re: Missing Out on Health Care
I'm not sure I understand this issue:
Does CA need to advertise to find people to participate?
Did CA signup 328,000 just in an attempt to garner federal aid?
Does CA not have enough money to hire clerks to process applications?
Should CA doctors work for 9 cents on the dollar?
Who pays for the coverageforall.org web site and call-in center?
Do the people who work for the web site and call-in center get paid?
If point-of-service enrollment is enacted, doesn't that simply transfer costs to the point-of-service? I see no savings here.
I'm confused, which children go without healthcare if the hospitals absorb the costs of the unenrolled?
Jan '11
Re: Missing Out on Health Care
Phil, if you are seriously going to say things like, "One problem is that in 2009, to save money, Gov. Arnold Schwarzenegger cut funding to pay certified application assistants, who help enroll those qualifying for Medicaid" and "California employs 26,500 state workers who are responsible for enrolling people in public programs, including welfare, Medi‐Cal and food stamps" and can't see something VERY wrong going on - then you are living in a parallel universe, and I don't think you can be helped.
Is this a leg-pull? Am I on Candid Camera here?
Oct '10
Re: Missing Out on Health Care
Nov '10
Re: Missing Out on Health Care
What on earth is wrong with providers choosing to give free care and thus avoid the costs of complicated billing and other regulatory tangles that accompany the government checks?
Oct '10
Re: Missing Out on Health Care
What a monster we have created. My father stopped working in1968. To that point, he had never earned more than $16,000 a year. He never did. During my childhood, myself and my three siblings never had any form of insurance, and any and all medical payments came from dad's paycheck. Thankfully, none of us ever encountered a life threatening medical moment. If we had, mom and dad knew that friends, co-workers and the church could be counted on. They were our insurance.
We live in different times, no doubt about that. Do we prefer these times? Would mom and dad have preferred the forms and paperwork, the uncertainty of government? Mom is 96 now, and we have these kinds of conversations. She is 100% here, even though her body shows the age. She wants nothing to do with the new and improved (?) America. Nor do I. Happily, with my wife and two kids, uninsured at 68, with a Medicare card which has been lost or thrown away, I have no desire to participate. My taxes are simply dollars burned in a trash can. Don't play, and, for the most part, you can be left alone.
Aug '10
Re: Missing Out on Health Care
You say that like it's a bad thing...
Oct '10
Re: Missing Out on Health Care
raycon:
My taxes are simply dollars burned in a trash can. Don't play, and, for the most part, you can be left alone. · Feb 21 at 8:35am
Our lives mirror each other. I'm 64, a father, a grandfather and within a month I'll be a great grandfather. I'm retired and uninsured, see a doctor only if I'm nearly dead, pay more taxes than I have to just to keep the _force_ out of my life.
If I've failed, it's only because I wasn't able to keep my descendents as free as I've been.
Oct '10
Re: Missing Out on Health Care
Matthew Osborn
raycon:
My taxes are simply dollars burned in a trash can. Don't play, and, for the most part, you can be left alone. · Feb 21 at 8:35am
Our lives mirror each other. I'm 64, a father, a grandfather and within a month I'll be a great grandfather. I'm retired and uninsured, see a doctor only if I'm nearly dead, pay more taxes than I have to just to keep the _force_ out of my life.
If I've failed, it's only because I wasn't able to keep my descendents as free as I've been. · Feb 21 at 10:51am
In the progressive universe you and everyone else who does not buy in to the health insurance system are freeloaders. How does that make you feel? You say you are free (and I am in agreement with you, that you are), but they say you are not free to not contribute to the risk pool and expect someone else to pick up your tab in the event of a catastrophic illness.
So much for liberty.
Re: Missing Out on Health Care
Hi Folks, Thank you for your responses. It seems this opinion piece struck some nerves. I have been out of town on business and will reply to your comments over the next day or so. Keep your eyes, ears and minds open. It seems some of you think the piece is too liberal and others think I am for government run programs. Hopefully we can learn from each other. Phil....
Jan '11
Re: Missing Out on Health Care
Look forward to it, Phil - I learn something on Ricochet every day.
Oct '10
Re: Missing Out on Health Care
Good Berean
Matthew Osborn
raycon:
My taxes are simply dollars burned in a trash can. Don't play, and, for the most part, you can be left alone. · Feb 21 at 8:35am
Our lives mirror each other. I'm 64, a father, a grandfather and within a month I'll be a great grandfather. I'm retired and uninsured, see a doctor only if I'm nearly dead, pay more taxes than I have to just to keep the _force_ out of my life.
If I've failed, it's only because I wasn't able to keep my descendents as free as I've been. · Feb 21 at 10:51am
In the progressive universe you and everyone else who does not buy in to the health insurance system are freeloaders. How does that make you feel? So much for liberty. ...· Feb 21 at 2:05pm
Liberty is worth it. I could continue on weighing 'suffering the slings and arrows...', but really, it makes no difference to me.
Re: Missing Out on Health Care
Hi Mathew,
I appreciate your questions. Before I answer them, let me give you some background. I am in the health insurance business. Our company serves 16,000 small businesses in California. Early on in the health care debate, we recognized that the government health care takeover position was driven by one contention: “There are 50,000,000 uninsured in the U.S. with California having 8 million uninsured.” I decided if I could figure out what they were saying and where it was coming from I could create a good argument. We discovered that of the uninsured they are claiming in the U.S. about 1/3 are immigrants awaiting legal status, 1/3 are the Young and Invincibles, and 1/3 are eligible for public programs and not signed up. In order to prove my point, since 2004, we, at the non-profit, Foundation For Health Coverage Education, have put the entire U.S. public health insurance system online. This includes all 50 States and the District of Columbia. We have a simple 5 question Health Coverage Eligibility Quiz, which takes the anonymous respondents to a personalized list of public health coverage options for which they are eligible, including sign-up checklists, applications, and program contact information. There is more to it than that, but this gives you a general understanding of how we got started.
Edited on Feb 23, 2011 at 8:57amRe: Missing Out on Health Care
I feel that it is nonsense to actually put the responsibility on people to sign-up for public health insurance plans because, first of all, more likely than not, the people you are asking to enroll do not know for what exactly they’re signing up. In many cases, they are the indigent and uneducated. It is hard to get these folks to go through the enrollment process. Secondly, California’s reimbursement program is not insurance anyway. It is prepaid health care, which is hugely different than insurance. The State takes everyone with no emphasis on risk evaluation. I ask, why does the State of California have 27,300 employees whose job it is to screen those who are eligible for public assistance? And why is the average cost of each one of these employees $110,000 per year? California could easily streamline the eligibility screening process online, replacing these employees with a point-of-service reimbursement system that pays the doctors and hospitals for services rendered. This would save the State about $3,000,000,000 per year and implement a system that would be transparent, have automated check points for eligibility, and immediate fraud controls in the payment system. It would also make it simpler to budget the process.
Edited on Feb 23, 2011 at 8:59amRe: Missing Out on Health Care
Matthew Osborn:
Did CA signup 328,000 just in an attempt to garner federal aid?
We did not make up the rules, but the federal aid was there. When Governor Schwarzenegger eliminated all of the application assistants he was saving a small amount of money from non-government employees who were only compensated when they actually enrolled someone in the program. He kept the fixed cost of the government union contract employees. In a time of fiscal constraint, he eliminated his variable cost and kept his fixed cost. Eliminating the variable cost saved him a nominal amount of money, but cost the State $10’s of millions in Federal Aid. No one is ever held liable for these types of obvious blunders.
No.
The FHCE is a public 501c3 non-profit. See our 2010 Annual Report for a list of funders and other information about the organization.
Re: Missing Out on Health Care
The call center is outsourced to a company in Fresno that answers the phones for doctors and hospitals. The FHCE bought up some of their excess capacity. We have 32 operators who are managed and trained by one call center employee dedicated to our efforts. It costs the FHCE about $14,000 per month to answer calls from all over the United States. We have answered over 110,000 phone calls. The WellPoint Foundation donates the money necessary to run the call center to the FHCE. We only have one employee who keeps the information on the website up-to-date for the whole United States. She is paid by the FHCE. We have two other volunteers that help out the FHCE and a terrific board. We get over 100,000 people per month visiting CoverageForAll.org and have had over 2,000,000 total visitors since 2007.
Point-of-service eliminates 27,300 public sector jobs in California and saves about $3,000,000,000 per year not counting better fraud control and budgeting process.
Edited on Feb 23, 2011 at 9:09amRe: Missing Out on Health Care
In California Emergency Rooms, all children, as well as all patients, are cared for regardless of coverage. It is the financing of care we are addressing. All premium payers and tax payers absorb the cost of uncompensated care.
Oct '10
Re: Missing Out on Health Care
Thanks for the detailed answers to the questions raised by your original post. Over the years, it has become obvious to me that much of the federal largess is not consumed by the bureaucracy itself but by an outside industry, the welfare industry, for lack of a better term, that actually plans and implements various federal programs.
What I see is the federal government has setup and funded a program to help not actual supplicants, but an estimated, but unidentified, population. We, all of us, regularly encounter situations amongst our families and neighbors where ready cash can avert long term damage. A neighbor, for instance, who has a job but whose paycheck is two weeks too late to pay the rent. Or there is a sick child that needs an expensive medicine for a short period of time. Or repairs needed to a broken water pipe that has flooded a closet and ruined a wardrobe that must now be replaced.
Oct '10
Re: Missing Out on Health Care
continued:
Churches, schools, families and individuals face these sorts of demands in the face of financial constraints. These people are known to us; they are decent, hardworking folks who have stumbled upon a bad spot in the road. These are not alcoholics, drug dealers, petty criminals, nor are they lazy wastrels taking the easy road. Most are not eligible for government assistance even if they could be persuaded to apply.
Local, state and federal governments extract so much in taxes from these communities that we cannot meet our community’s needs. A bad starter on the winter beater might cost a couple hundred dollars to repair but when that money isn’t available, it can lead to lost time at work or even the loss of a job. That same person almost had it made; he had an apartment, he had a car, he had a job, he had pride in himself and he had hope for the future. Now he is facing no car, no job, no rent and a very depressing outlook.
Oct '10
Re: Missing Out on Health Care
continued:
Too often, those who cannot find the help they need in their community do end up living in section 8 housing, no job and a very poor outlook on life. Your program is searching for these people. You know they exist, but you don’t know who they are, you don’t know where they are and you don’t know how they got where they are. Yes, they need your help; but your help won’t repair his starter, restore his job, his car or his apartment to say nothing of his pride or his future.
To replace that $200 dollar repair bill in California alone requires for 350,000 / 2 kids per family or ~175,000 families, requires ~20,000 certified application clerks (whether employed by the state or the hospitals), organizations such as yours, the state administration bureaucracy and the federal bureaucracy.
Wouldn’t it be much cheaper and more effective to simply leave those resources in the community in first place? Isn’t it better to offer up the ‘stitch in time’ to keep the family together? To keep the job? To keep the hope? To share the companionship of a functioning community?
Oct '10
Re: Missing Out on Health Care
continued:
These comments are not directed at you or your organization. I understand that your contribution is to make this program work as efficiently and effectively as you can. It is good to see that you’re reaching out for ideas and to motivate others to become involved by contacting their elected officials.
Somehow, though, we need to return to a place where charity prompts the giver’s thanks for his good fortune and emphasizes the importance of commitment to community.