1. The Uninsured, Do We Have A Moral Obligation To Treat… Renee’ Rainey, RRT, RN, BSN

2. Who Are The Uninsured? Medically Uninsured Definition: Individuals or groups with no or inadequate health insurance coverage. Usually comprised of three primary groups: 1.The medically indigent 2.A person whose clinical condition makes them medically uninsurable 3.The working uninsured Ascensionhealth.org

3. Who Are The Uninsured? The medically uninsured are not THEM, it’s all of us Most are working but do not qualify for government insurance programs A great percentage are young adults ages 18-35 Many are interested in coverage but do not understand the value of health insurance Struggling families barely meeting basic needs Previously covered by a spouse who is now unemployed CDC.org

4. Who Are The Uninsured? Moneyusnews.com

5. Facts

6. In addition to the 47 million w/o insurance, another 38 million have inadequate coverage This means nearly 1/3 of Americans are w/o coverage Having no coverage means people will forgo preventive care Most uninsured wait to seek care which usually results in an ER visit Delaying care for fear of medical bills leads to overall higher health care costs Public Broadcasting Service, 2012

7. Facts

8. Hhs.gov Facts

9. Faces of Our Uninsured Patients

10. Although the uninsured look like any other patients, it’s easy to spot them. Their charts have places for their address and emergency contact information. But the empty insurance box is a telltale sign. Some doctors examine the chart before examining the patient a practice referred to as “wallet biopsy” Physicians sometimes say “No other professionals – lawyers, plumbers, accountants provide uncompensated service to 1/5 of their clients” The Washington Post, 2008

11. Facts

12. Pbs.org

13. Facts

14. Communityhealth.org Some refuse insurance because they want more affordable coverage or believe their company plan is inadequate

15. www.forbes.com

16. Facts Kaiserhealthnews.org

17. Facts

18. Rising insurance rates have contributed to fewer employers offering health insurance Many employers are managing costs by requiring higher employee contributions Some people are considered “uninsurable” or have been rejected for insurance Some people choose alternative methods of treatment

19. Healthcare - A Right or a Moral Obligation? Emergency Medical Treatment and Active Labor Act (EMTALA) Guideline to protect those who lack financial resources Not all hospitals have obligations under EMTALA Only hospitals accepting federal funds under CMS are subject to civil liability To comply with EMTALA participating hospital must provide a MSE and stabilize the patient.

20. Healthcare - A Right or a Moral Obligation? Treatment in the Absence of an Emergency What happens now? Obligation to treat patients in non emergent situations is not clear-cut Principle VI of the AMA’s “Principle of Medical Ethics” states: A physician shall, in the provision of appropriate patient care, except in emergencies be free to choose whom to serve… No common law duty or ethical imperative exists outside of EMTALA that requires a physician to treat every patient There is no specific ruling on whether physicians are wrong in refusing to treat patients without specified conditions American Medical Association Journal of Ethics

21. Healthcare - A Right or a Moral Obligation? Some behavior is downright disturbing: A heart surgeon operates on uninsured patients but schedules them for the end of the day; if other cases take longer than expected, the uninsured get bumped. Some gastroenterologists are quick to perform endoscopies or colonoscopies on insured patients; not so for the uninsured. KevinMD.com

22. Healthcare - A Right or a Moral Obligation? Some behavior is downright disturbing: Being uninsured is a stigma when seeking care In 2006, a study of 25 primary care private practices in the Washington area showed that 1:4 instances physicians adjusted care based on insurance status For patients with no insurance, alterations occurred 43% of the time For privately insured; just 19% KevinMD.com

23. Healthcare - A Right or a Moral Obligation? Some behavior is downright disturbing: A TV reporter found himself uninsured and in need of an ER visit. Vomiting blood he went to the ER. After being examined by a resident it was decided he could wait until morning for a specialist. He was left in the ER for 14 hours without seeing an Attending MD. He went on to write a book entitled “One in Forty Million” (ABC Action News, 2012)

24. Healthcare - A Right or a Moral Obligation? Many uninsured patients experience care disparities Uninsured more likely to delay seeking care for heart attacks, strokes and pneumonia due to concern about cost of care Patients let their disease progress to the point where they are sicker by the time they seek care Hospitals avoid doing high-cost procedures on the uninsured even if that is the procedure of choice CNN Health, 2010

25. Healthcare - A Right or a Moral Obligation? With some states adjusting already low Medicaid payment rates, those with this insurance are rapidly joining the uninsured by being treated with preferentially poor care. Many choose to practice in affluent areas with a favorable low proportion of uninsured or Medicaid. Being uninsured may be a stigma when seeking care In some areas doctors adjust their clinical management based on a patient’s insurance status Doctors consciously or not treat those without health insurance differently

26. Healthcare – A National Crisis

28. Houstonchronicle.com

29. How Can We Help? How Can We Advocate?

30. Resources Are Available State Health Programs are available to cover the uninsured By Law, Hospitals have responsibility to give information on financial aid programs and/or charity care Some programs provide a subsidy to private insurance, others cover individuals directly State Pharmaceutical Assistance Programs; provide subsidies and discounts for uninsured

31. Resources New Jersey Medicaid: Covers Pregnant women and infants >1 NJ Family Care: New Program beginning January 1, 2014. Open enrollment begins 10/1/13

32. Resources CHIP – Children’s Health Insurance Program Beginning 1/1/14 will be part of NJ Family Care CHIP provides free or low-cost health insurance to children <19 Ccf.georgetown.edu

33. Resources NJ Family Care Advantage For those who do not qualify for NJ Family Care, Offered through Horizon NJ Health Low Cost plan for children

34. Resources New Jersey Hospital Care Payment Assistance Program “Charity Care” For those who are uninsured or underinsured Listed under State of New Jersey Department of Health Website

35. Summary As Healthcare professionals We have a Moral Obligation To: Treat every person regardless of their ability to pay Provide education on available options Advocate for the uninsured when they can’t or won’t speak for themselves

37. References ABC Action News. (2012, May 5). One in Forty Million. Retrieved from www.abcactionnews.com www.abcactionnews.com American Medical Association. (2006, May). Obligation to Provide Services. Retrieved from www.ama-assn.orgwww.ama-assn.org Ascension Health. (2007). Medically Uninsured. Retrieved from www.ascensionhealth.org www.ascensionhealth.org Centers for Disease Control, & Prevention. (2013). Programs for Uninsured and Underinsured Patients. Retrieved from www.cdc.govwww.cdc.gov CNN Health. (2010, June 10). Uninsured more likely to die during hospital stay, study finds. Retrieved from www.cnn.comwww.cnn.com examiner.com. (2010, July 10). The uninsured and the emergency rooms. Retrieved from www.examiner.comwww.examiner.com

38. References FierceHealthcare. (2008, October 14). Doctors treat uninsured differently. Retrieved from www.fiercehealthcae.comwww.fiercehealthcae.com Public Broadcasting Service. (2012). Healthcare Crisis: Who's At Risk? Retrieved from www.pbs.orgwww.pbs.org U.S. Department of Health, & Human Services. (2012). Overview of the Uninsured in the United States. Retrieved from www.hhs.govwww.hhs.gov The Washington Post. (2008, October 14). Equal Treatment for the Uninsured? Don't Count on It. Retrieved from www.washingtonpost.comwww.washingtonpost.com