Health in Recession

As the unemployment rate climbs, many of the newly unemployed are losing insurance coverage. Candice Choi of the Associated Press summarizes the options for replacing employer-sponsored health insurance: extending benefits for up to 18 months through COBRA; getting an individual policy; and, for those who qualify, getting coverage under a government program like Medicaid. 

As weâve noted here before, securing an insurance policy on the individual market can be difficult and expensive â especially if youâre a woman. Medicaid eligibility varies from state to state. Childless adults generally donât qualify for this program, but parents and children do; the cutoff is generally the poverty level or some multiple of it, and it tends to be higher for covering children. As the economy continues to worsen, more and more people meet Medicaid eligibility requirements.

Medicaid is run by the states, which face their own problems with declining revenues. As Amy Goldstein of the Washington Post reports, that means Medicaid cuts:

Already, 19 states -- including Maryland and Virginia -- and the District of Columbia have lowered payments to hospitals and nursing homes, eliminated coverage for some treatments, and forced some recipients out of the insurance program completely.

Many are halting payments for health-care services not required by the federal government, such as physical therapy, eyeglasses, hearing aids and hospice care. A few states are requiring poor patients to chip in more toward their care.

Goldstein writes that Congressional Democrats are considering spending nearly $100 billion to increase the federal governmentâs contribution to Medicaid. (Generally, the federal government matches state Medicaid payments at rates that range from 50% to around 75%, with poorer states receiving higher match rates.)

As the recession continues, weâll see more and more people having difficulties accessing the healthcare they need, either because theyâre uninsured or because their insurance still isnât enough. Some insurance plans require deductibles and co-payments that are out of reach for those on limited budgets, and Medicaid recipients can have a hard time finding providers willing to accept Medicaid patients.

This means that more pressure will fall on the healthcare safety net â providers who will serve patients regardless of their ability to pay. Emergency departments are a crucial component of the safety net, but as weâve pointed out before, many of them are already badly overstretched. Federally qualified health centers, which receive federal grant funding to provide basic health service to low-income and otherwise disenfranchised patients, are also a crucial part of the safety net. And here, notes the New York Timesâ Kevin Sack, we have to give some credit to the Bush administration, which expanded FQHC capacity dramatically.

In Mr. Bushâs first year in office, he proposed to open or expand 1,200 clinics over five years (mission accomplished) and to double the number of patients served (the increase has ended up closer to 60 percent). With the health centers now serving more than 16 million patients at 7,354 sites, the expansion has been the largest since the programâs origins in President Lyndon B. Johnsonâs war on poverty, federal officials said. â¦

With federal encouragement, the centers have made a major push this decade to expand dental and mental health services, open on-site pharmacies, extend hours to nights and weekends and accommodate recent immigrants â legal and otherwise â by employing bilingual staff. More than a third of patients are now Hispanic, according to the National Association of Community Health Centers.

The centers now serve one of every three people who live in poverty and one of every eight without insurance.

Thereâs still a long way to go â Sacks cites a Government Accountability Office study that found 43% of medically underserved areas lack a health center site â but the new and expanded health centers will be even more necessary than before as the economic downturn continues.

Meanwhile, a new study published in the Annals of Internal Medicine emphasizes the importance of having continuing health coverage. Kaisernetwork.org explains the findings:

California Medicaid beneficiaries who faced gaps in coverage were more than three times as likely as those with continuous coverage to be hospitalized for chronic illnesses, according to a five-year retrospective study published in the Annals of Internal Medicine, the New York Times reports (Rabin, New York Times, 12/17). For the study, funded by the Commonwealth Fund, researchers examined use of health services by Medicaid beneficiaries from 1998 to 2002. During that period, beneficiaries were required to verify their eligibility every three months. The policy was changed in 2001, and the state now requires proof every six months (Wallbank, CQ HealthBeat, 12/16).

The study found that about 62% of Medicaid beneficiaries had a gap in coverage during the study period, and those beneficiaries were 3.6 times more likely to be hospitalized for chronic conditions such as diabetes, asthma and high blood pressure. According to the Times, heart failure, diabetes and chronic obstructive pulmonary disease were the leading causes of hospitalizations among the beneficiaries. The study found that most beneficiaries were admitted to the hospital within three months of losing coverage and that most qualified again for Medicaid once they were in the hospital.

Steps like expanding childrenâs access to health insurance and increasing health center capacity are helpful, but they donât change the underlying problem: Under our current system, an economic downturn leads to reduced healthcare coverage and worsening health problems.