Jeff Edwards has had high cholesterol for years.But when the Mount Cobb man was laid off from his job as a salesman in March 2009, he found himself without health insurance to help him keep it under control.
Eventually, he found out about Lackawanna County’s only free health clinic, run by the University of Scranton. On a recent hot summer day, Mr. Edwards was one of dozens waiting to see a member of the clinic’s volunteer medical staff.
“If this wasn’t here, then I guess I’d run the risk of maybe dying from high cholesterol complications,” he said. “I don’t really know what I’d do if I hadn’t found this place.”
Mr. Edwards, 47, joins more than 1.2 million Pennsylvanians without health insurance, according to estimates from the U.S. Census Bureau. And Mr. Edwards is exactly the kind of person that health care reform could help as early as 2011.
The first stage of health care reform – passed by Congress and signed into law by President Barack Obama in March – is expected to provide coverage to about 1 million Americans who do not have insurance. Eventually, the measures will provide coverage to more than 30 million uninsured Americans and lay out a complex set of mandates, deadlines, tax breaks and formulas to do so.
In a March letter to House Speaker Nancy Pelosi, the Congressional Budget Office and the Joint Committee on Taxation estimated that the health care reform bill would reduce the federal deficit by about $124 billion between 2010 and 2019. The reduction is accomplished in a number of ways, including enacting an excise tax on high-premium insurance plans, expanding the rate and scope of a tax for higher-income households, increasing the penalties for employers that do not offer health insurance and modifying penalties for individuals who do not obtain insurance.
Like many Americans, Mr. Edwards said he is not sure how effective health care reform will be.
“If I could afford insurance, I’d have it,” he said. “I worry that it will put poor people over a barrel.”
Despite the skepticism many Americans have toward health care reform, experts locally and around the nation say the cost will be far less than what Americans are shelling out now.
The Leahy Clinic, which opened in November 2007, treats between 40 and 60 people from 2 to 6 p.m. every Thursday, said clinic director and certified registered nurse practitioner Andrea Mantione.
Thanks to local doctors and nurses who volunteer to staff the clinic’s four examination rooms, Leahy Clinic operates on an annual budget somewhere between $175,000 and $190,000, Ms. Mantione said. All of that money is generated through donations and grants.
If the Leahy Clinic did not exist, many more Lackawanna County residents without health insurance would be showing up in hospital emergency rooms for nonemergency medical treatment. Many local experts say that ends up costing everyone more money in the long run.
“A lot of people without insurance go to the ER for primary care,” said Brenda Hage, Ph.D., a certified nurse practitioner and the director of graduate nursing programs at Misericordia University. “They’re going there for minor complaints that could be managed very easily at a doctor’s office, if they had access to one.”
And in Pennsylvania, that issue is compounded by the ever-increasing number of people suffering from chronic conditions like asthma, diabetes, chronic obstructive pulmonary disease or heart failure. A report released in June by the Pennsylvania Health Care Cost Containment Council found that more than 60 percent of Pennsylvanians suffer from a chronic condition. The report also found that chronic conditions account for 80 percent of all health care costs and hospitalizations in the state, and that the state’s hospitalization rates for diabetes, asthma, chronic obstructive pulmonary disease and heart failure were all worse than the national rates in 2007. Finally, the report predicted that by 2023, the annual economic impact of chronic diseases on the state due to productivity loss and treatments is estimated to hit $170.2 billion.
Ms. Mantione said many of the patients who come to the Leahy Clinic are battling a chronic condition that requires follow-up care with a primary physician. Especially for those without health insurance, regular doctor visits are too expensive and they miss out on medical advice that could prevent complications that will land them in the emergency room.
Relying on this model of treatment raises health care costs for everyone, said Satyajit Ghosh, Ph.D., a professor of economics at the University of Scranton.
“Hospital provides the care for people without insurance and there’s a cost to that,” Dr. Ghosh said. “That cost trickles down to (people with insurance) indirectly.”
In addition to extending health insurance to millions of uninsured Americans, the health care reform bill also places emphasis on follow-up and coordinated care by encouraging providers to work together to treat patients suffering from chronic conditions like diabetes and heart disease.
“Right now, we’re seeing a lot of fragmentation of care and duplication of services,” Dr. Hage said, adding that portions of the health care reform bill offer incentives for primary care providers to network with other services, from labs to education classes, to offer follow-up care to patients with chronic conditions.
“Philosophically, it is the right approach,” said Moses Taylor CEO Karen Murphy, Ph.D. “The bill really focuses on improving the quality of care … and forces hospitals to improve the way we deliver care by being more efficient and effective.”
What that looks like remains to be seen. In July 2009 and again in September, Mr. Obama mentioned Geisinger Health Systems as a model for such ideas as electronic medical records. Dr. Murphy said the health care reform bill will also offer funding to health care providers with unique ideas on how to improve quality and efficiency.
For Dr. Ghosh, the health care reform bill that was signed into law in March is a first step toward lowering the cost of health care for everyone.
“It is going to lower the costs that most people can’t see and don’t think about,” he said. “Much of the cost of implementing the measures will be paid for by the implied savings years down the road.”