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LOCAL HEALTH CARE SURVEY  2003-2005

 

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Health Care Forum, "Covering the Uninsured"

Former League member Sally Densmore, President-elect of the Rogue Valley Association of Insurance and Financial Advisors ( RAIFA) and Glenn Miller, a health care insurance specialist, attended the 4/8/04 meeting of the Health Survey Committee and helped with the May 10 town hall meeting for “Cover the Uninsured Week” which the LWVRV helped sponsor.

 

At this event, the panel of experts discussed many aspects of health care and health insurance and the following conclusions were reached:

 

Patients should make an effort to pursue a healthy life style. They should ask, “What can I do to take care of myself and my family?”

 

Even if patients have a low income, they should attempt to set up a long-term relationship with one doctor and see him or her on a regular basis. This could be at one of the Community Health Centers or other clinics or through a private doctor.

 

Patients need to be educated, not only about good health and disease, but about opportunities for insurance that are open to them. Some pregnant women and women with children still qualify for the Oregon Health Plan but may not know it. Good health care is available in the Rogue Valley but it does not come automatically.

 

Other Findings

•     there are gaps in health care service and in the “safety net“, which need to be further identified.

•     patients do not return for follow up care after attending the clinics or emergency rooms,  according to Peg Crowley, who says an average of 2.4 visits a year is needed to maintain health.

•     men in particular are among the least served, perhaps because of their reluctance to seek medical care.

•     emergency rooms are still being misused for minor health problems.

 

 The LWVRV listened to Cherryl Walker, a former State legislator, on Dec. 11, 2003, who explained why facilities are antiquated and medical staff short in rural areas, as opposed to Medford, which has become a medical magnet area.   According to Ms. Walker:

 

•    the primary issue is the cost of medical care plus malpractice insurance,

•    now private companies are cutting back on once-generous medical coverage of employees, so that employees are bearing more of the cost of premiums.

•    she stated that individuals with insurance have been requesting expensive procedures and unnecessarily using the hospital emergency rooms, when an office visit to a doctor would have sufficed, and so the cost of premiums has gone up for  everyone. 

 

      Ms Walker believes there should be a reasonable co-payment charged the patient when the Oregon Health Plan is used.  She further explained that because Oregon was once a very efficient provider of medical care, compared with such states as Texas and Florida, reimbursement for doctors for Medicare and Medicaid patients is very low and does not attract doctors to this region as a result. A gall bladder operation in Oregon nets about $500 in reimbursement, while the same operation in Texas nets $900. She believes the local shortage of doctors has these causes:

 

Since many young doctors graduate after a long training, with student loans of $200,000 or more, it is not economically feasible for them to locate here.  If they do, they find that they have to move to a metropolitan area or to one near a University Hospital such as Oregon Health Science University in Portland.   The difference in pay is relevant for trained nurses also.

 

Oregon is disadvantaged politically because of its small number of Congressmen compared with more populous states

 

Oregon lacks health care company headquarters being situated here.

 

Ms. Walker also believes that the price of medical care is also increased by the use of costly technology, legal actions against doctors and the training of medical staff. Actually 80% of medical suits against doctors in Oregon are won by the doctors and there have only been eight suits in which the plaintiff has been awarded over $1,000,000.

 

Medical Suits:   Doctors in certain medical specialties like surgery and OB/GYN have to carry high malpractice insurance, as well as pay for their long years of training.

 

A recent Oregon Health Science University survey found 125 physicians around the state have stopped delivering babies in the past four years, with others planning to follow suit.

 

A “band-aid“ program by the State offers some help to physicians, with obstetricians getting a reduction up to 80% in their basic insurance premiums and up to 40% for other physicians but only in rural areas. (The Oregonian, 1/27/04).

 

Since there are many retirees in Southern Oregon, doctors in high risk fields are difficult to attract and retain, because of the Medicare/Medicaid reimbursement issue. It is estimated that a physician must have fewer than 40% of patients in this age group to survive financially.

 

 

The failure of Measure 30, rejected by the voters in February 3, 2004, has cut back on the number of low-income who qualify for the Oregon Health Plan, as well as many aspects of medical care (see also the Oregonian, 1/17/04).

 

 Dr. Allen Douma, a retired physician, spoke with the whole Health committee on 1/19/04 about the work he is doing with Oregon AARP. His object is to provide information about alternative prescription drugs that are equally efficient and safe and are of lower cost. This information will go to both doctors and the general public. Two years ago, the Oregon Legislature authorized the funding for this work, leading the country in this field, and he has been working on it for over a  year. Other organizations, including the Oregon Health Science University, have been evaluating the effectiveness of drugs and also their side effects.

 

 Dr. Douma mentioned the startling fact that the average person needs $5400 a year for health care, premiums etc. and in 7-8 years, this will double unless it is slowed down by sheer inability to pay for it and unless we improve its delivery. He maintained that medical care is an information business, and if information technology is fully applied, we could cut the costs by 30%. In our local survey, we should push for access to information and access to technology, he said.

 

 Kathleen Weaver, M.D. who is Director of the Health Resource Commission, Oregon Health Policy and Research gave a talk to the League general membership on September 9, 2004. The title was “Maneuvering the Maze of Medicine Costs” and Dr. Weaver explained how her broad-based commission is researching the quality and cost of drugs available in Oregon. Dr. Douma,( see above) who is doing similar research for AARP stated that Oregon leads the nation in this field. The commission is using the EBR approach (Evidence Based Review) and they have already reviewed 12 classes of medications.

 

 The high points of her talk were the dramatic rise in patient pharmaceutical expenditures since 1991 - a shocking 15-18% while other medical costs have remained relatively flat. She explained the benefits and disadvantages of the Dec. 2003 Medicare Prescription Drug  Law HR-1 and the use of the interim drug card which began in June, 2004 . 70,000 seniors were estimated to sign up for this card in Oregon. It is a very complicated process and according to the Health Resource Commission, the only beneficiaries are seniors with very low income and catastrophic drug costs of  more than $5100 a year, the drug companies and the managed care industry. Drug companies succeeded in getting a bill passed that does not moderate drug costs.

 

 The Medicare Part D Drug Benefit begins in January 2006 and is equally complicated, with a premium of $35 a month and other limitations. In many cases social workers will be needed to fill the papers out.

 

 Dr. Weaver suggested some ways to save on prescription drugs:

 

1.  Asking your doctor or pharmacist for generic drugs if they are equally effective.

 

  2.  Splitting scored pills into half when the costs of the larger pills is the same as the smaller ones ( such as Lipitor).

 

 3.  Buying safe Canadian drugs ( not ones solicited on the internet)  Go there physically if you can. Meanwhile, Oregonians are awaiting  the FDA approval of Oregon‘s waiver.

 

  4.  Ordering by mail for a 90 day supply where your condition requires a long term use of the same drug.

 

  5.  Comparing prices and getting information from web sites such as AARP and the Manufacturers’ Aid which covers discounted prices for those on financial assistance..

 

Background on Health Insurance Plans: In the Rogue Valley, as in Oregon, there is a variety of health insurance plans available including those offered by employers with 50 or fewer employees, self-insured plans ( self-funded by employers), Club and Association Group plans, Individual plans and finally Government Programs. These last consist of four major plans:

•     the Oregon Medical Insurance Pool ( OMIP),

•     Family Health Insurance Assistance Program ( FHIAP),

•     the Oregon Health Plan (which is Oregon’s variation of Medicaid) and

•     the best known of all, Medicare, the Federal program for people 65 and over, those on Social Security disability, and those with kidney disease.

 

 Furthermore, there are three options for people losing employer-sponsored group coverage:

 

•     COBRA (Consolidated Omnibus Reconciliation - Federal limited continuation of coverage plan), and in Oregon,

 

•     State Continuation of coverage and portability of coverage, which gives a choice of Prevailing Benefit Plan and

 

•     the Low-Cost Plan version of the above.

 

Recent news reports (see Mail Tribune 1/28/05) told of efforts by the Chamber of Commerce to become a group for purposes of obtaining health or life insurance.  “that could eventually mean lower health insurance premiums for some 40,000 people who work for businesses that are members of the Chamber” said Brad Hicks CEO of the Chamber.  There are still many details to consider before this could happen said several consultants. 

 

Oregon Governor Kulongoski in January, 2005 proposed putting all the school districts in a single pool for health insurance as a way of saving money on premiums.  There are arguments on both sides of the issue.  The Governor also announced (Mail Tribune 2/1/05) a health insurance plan for small business  (2-50 Employees) who haven’t offered health insurance since 7/1/03 to obtain health insurance for children of workers noting that the percentage of children without insurance rose from 10.1 percent in 2002 to 12.3 percent in 2004. An Alternative Group Plan was also announced for adult workers.

 

On 4/8/04 Hank Collins, the Jackson County Health and Human Services Director, spoke to the whole LWVRV about “the Status of County Health Services in Jackson County” and the functions of his department, which has over one thousand employees.

 

The Public Health section is the largest and this provides annual physicals, contraceptives, pre-natal, young mother and child care for all income levels. Visiting nurses are available for at-risk children at home and the state-funded “Healthy Start” for first-time mothers and their babies. About 50% accept this service. Direct Treatment of clients is limited to inmates in the jail, juvenile detention and shelters.

 

The Communicable Disease and Control section offers daily clinics and testing for such diseases as gonorrhea and syphilis, tuberculosis and HIV, all of which are on the increase. It is the only place that offers “shots” for overseas travelers. All types of immunizations are available for $15 a shot, although no one is turned away for lack of money. Immunizations are required for all school children except those with religious exemptions. These exemptions run  about 2% of all children for Jackson County but are 15% in Ashland, even 25% in one Ashland elementary school. He believes Ashland parents need to be educated about the dangers of various diseases such as measles.

 

The director also mentioned the large Federal funds received for anti-terrorism preparations, actually more than they need for training, planning and equipment.

 

Mental Health care has been somewhat limited by the failure of Measure 28, but case workers take care of 1200-1300 people a year with severe and persistent mental illness, finding places for them to live and paying for their state-mandated hospitalization if needed, also personal care and work skills. There are increasing numbers of children in need of mental health services.

 

The county maintains some beds at 2-North at Rogue Valley Medical Center for patients needing treatment. Mr. Collins attributes the use of new effective drugs for keeping people out of State hospitals.

 

Alcohol and Drug cases come under his department. They offer methadone treatment where necessary for those on narcotics. There is an increase in the use of methamphetamines. The county supports residential and out-patient services at OnTrack and ARC. Mr. Collins said 3 out of 4 patients on drugs are using illegally-obtained prescription medications. The Detox center which was in danger of having to close at the time of his talk, has since been refunded and has a  small transitional housing unit for people who complete the program.

 

 

 

 

 

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League of Women Voters of Rogue Valley

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Medford, OR 97501

541-245-6920

 

Last revised: September 19, 2005

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