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Patients get the Oregon Health Plan runaround

Oregon Health Plan payments to doctors are too low, so a lot of doctors won't treat OHP patients. Politicians get to say they've "covered" people without actually doing it. Also, premiums and copays have driven a lot of people off OHP.
News-Register, McMinnville, Oregon
September 6, 2003
 http://www.newsregister.com/news/results.cfm?story_no=170417

Patients get the Oregon Health Plan runaround
By MATTHEW D. LaPLANTE

It's the same story here as it was at the last clinic. And the one before that. And the one before that one.

"Sorry sir," says the rosy-cheeked girl behind the counter. "We aren't taking Oregon Health Plan patients right now."

A shiny heart-shaped sticker is stuck to her plastic name badge. It reads: "Got Love?"

She smiles apologetically. Ron Bortles smiles back.

He lifts his OHP card from the counter and raises it to his brow, bending it against his sweaty forehead in a moment of reflection.

"I understand," he says, beginning his query in the same manner he did at the last two locations. "But can you tell me who does?"

The girl reaches around the corner of her desk and retrieves a slip of paper with a hand-written phone number. "I have this number for a referral service," she says. "Four-seven-two"

With that, the 56-year-old Lafayette man has come full circle. It's the same number he started with, three clinics ago.

The Oregon Health Plan was conceived to increase the accessibility of heath care for low-income Oregonians.

Many experts consider Oregon's approach toward broadening health care coverage a model for other states.

But statistics compiled by the Oregon Population Survey suggest fewer Oregonians had health insurance in 2002 than any time since the plan was enacted. It concluded that in a region including Yamhill, Marion and Polk counties, 14.6 percent of citizens don't have any health care coverage.
Bortles said he's always been wary of numbers, especially those tossed about by "bleeding-heart types." He noted, "A glass that's 14 percent empty is mostly full."

But Bortles said the days he spent seeking treatment for the cancerous mass growing on his ear made him realize that while his OHP card placed him in the mostly full glass of insured Oregonians, it didn't mean he was eligible to take a drink.

"I realize now that I'm in a different group," Bortles said. "I'm one of the uninsured-insured, the uncovered-covered."

Bortles said the only thing that kept him looking for help was the fact that he was unemployed.

"If I had a job, I wouldn't have time for these games," he said. "I wouldn't have the time and I so wouldn't do it."

Even though he had the time, he quickly tired of being turned away. Calling - for a second time - the number given to him by the rosy-cheeked girl, he made a gentle plea:

"Could you please, before telling me to go somewhere where they are going to turn me down, check your list and call around and make sure they'll take me?" he asked. "I'm getting a little old for this."

It took the young man on the other end of the line an hour, but eventually he located a physician at Willamette Valley Medical Center's Med First clinic who was accepting OHP coverage. And by mid-August, Bortles was finally rid of the ugly mass of basal cells that had burgeoned on his right ear.

Med First is one of two clinics sponsored by Willamette Valley Medical Center dedicated to taking all patients, regardless of insurance type.

But that doesn't mean everyone gets in. The doctors' schedules quickly fill up, so the clinic often must turn away new patients.

Even still, the hospital loses about $250,000 a year on the clinics, but CEO Rosemari Davis said the need for care is too pronounced to ignore and the alternative is even more costly.

That alternative - one used by thousands of Oregonians every day - is the emergency room.

There, doctors are legally obligated to treat all patients, regardless of their ability to pay. But it is terribly costly.

Bortles said he thought about going to the emergency room, knowing he would at least be able to get a doctor's opinion on what, exactly, was causing the deep-red blob to grow on his ear.

"But emergency rooms are for gunshot wounds and trauma patients," he said, "not for ugly ears."

Not even, the way he saw it, for ugly ears infested with cancer.

homepage: homepage: http://www.oregoniansforhealthsecurity.org

Bush just struck down COBRA law 10.Sep.2003 00:23

af

which required emergency rooms to treat people regardless of their ability to pay.

A poem 10.Sep.2003 05:20

for profiteers

Money makes the world go around
the world go around
the world go around

Don't have cash? You get the runaround
you get the runaround
you get the runaround

Money makes the world go around
the world go around
the world go around

Don't have cash? Might as well be in the ground
Might as well be in the ground
Might as well be in the ground

If you die, you won't cost us anything.
If you have money, we want it
NOW.

Need Resource Info 10.Sep.2003 09:53

jb

I am going through this right now with an unemployed friend. Because he was 8 days late with a 6 dollar payment to OHP, they dropped coverage and banned him for 6 months. The problem is this amounts to a death sentence. He requires an expensive infusion every month to stay alive. No one at OHP seems to be able to offer any solutions.

If anyone knows of ANY resources or helpful attorneys or agencies that might help, PLEASE reply.

Thank you

Facts AF 10.Sep.2003 10:14

^^

First of all, COBRA is not a federally funded emergency room health program for the poor, it's a program that allows employees the ability to keep their employer-funded insurance for a period of time prior to being laid off.
You are thinking of the Emergency Medical Treatment and Labor Act, which Bush did not "strike down" or veto or overrule. He changed parts of it to favor hospitals. I do not agree with some of those changes, but at least I am not spreading misinformation.

Sorry 10.Sep.2003 10:57

af

I get the acronyms mixed up too frequently(there are so many). And you are correct, EMTLA changes would reduce liability of hospitals when they chose not to treat indigent patients. How do you see this impacting emergency room service provision for the poor?

Oregon Health Plan 10.Sep.2003 17:40

tom

There is no way to run an office and pay employees on OHP reimbursement rates. Dividing overhead (rent, lights, help, insurance, heat, etc.) by a reasonable number of patient visits per day comes out to more than OHP pays for a visit. That's without paying the doctor.

That is just a fact, that someone is going to have to deal with.

Oddly enough, emergency rooms are allowed to charge (and collect) about 3-4 times as much as a private office for the same problem, so guess what-- private offices allow the OHP patients to go to emergency rooms.

In some places there are Community Health Clinics. These are somehow Federally qualified and partially Federally funded, and they are also eligible for various grants-- they can take OHP patients because they get about 4 times a much for a visit as a private office, and they are allowed to capitalize with tax-exempt grant money.

The whole thing is miserably complicated.

But the bottom line is that "Old Europe" spends about half as much as USA on health care-- and you don't see Germans or Italians or Spaniards dying in the streets.

Answer: single payor health plan.

Problem: it will be corrupted, too. Look at the problems Canada is having.

Single payer, Canada 10.Sep.2003 23:53

Lynn

As I understand it, the main problem Canada is having with its single-payer plan is underfunding by its federal government. The U.S. is having the same problem with Medicare and Medicaid (which in Oregon is the Oregon Health Plan). In both countries conservatives have gotten enough power to starve "socialized" government-run safety net programs. So then the programs have big problems and the conservatives say, see, it doesn't work. By the way, the Clinton administration cut funding for the safety net programs, so it's not just the Republicans.

Even with the problems Canada is having with its single-payer system, I've read that they still strongly prefer it. There may be waits for some surgery, but at least they get treatment. In this country we ration health care by ability to pay.

Check out the Health Care For All - Oregon website. Subscribe to our email list.


Underfunding Health Care 11.Sep.2003 09:52

Tom

I can't see how health care will ever be properly funded by a democratic form of government-- with the exception of a relatively small minority who want to make things work out to the benefit of all, the majority just want theirs, they want it now, and someone else should pay for it.

Even our free-market bretheren are perfectly happy to use the government to collect money to pay for their own projects (Star Wars, or whatever)

Maybe the best thing is to go for a strict libertarian program for a while.

It is possible 13.Oct.2003 09:46

SR

It is possible to maintain a current list of participating physicians. The state health plan in Hawaii is excellent; insurance is provided by a private company and funded by the state, so patients receiving assistance cannot be discriminated against, thier insurance cards look just like anyone else's and come with the same benefits. Maybe Oregon should follow suit, I've been paying for insurance for two months and still cannot find a doctor.