79.7% of uninsured patients seeking emergency care in four San Diego hospital ERs could have had some form of government insurance, but did not, according to research cited at health policy journal Health Affairs by the Foundation for Health Coverage Education (FHCE) (www.CoverageForAll.org). The analysis shows that a significant issue facing the uninsured is not the availability of free and low-cost programs, but the poor communication and faulty application processes that need to be streamlined. The American Hospital Association estimated hospitals lost $36.5 billion in uncompensated care due to underpayments for service by Medicaid in 2009.
The data was uncovered through an analysis of the FHCE’s Eligibility Survey results, which also found that 61.7% of national online respondents seeking to obtain coverage were likewise unaware that they were eligible for government coverage. .
· 79.7% of patients were eligible for state and federal health coverage programs,
· 16.9 % were eligible for private coverage – this includes group coverage of 2 or more employees, individual coverage with medical underwriting, COBRA and Cal-COBRA,
· 3.3 % were eligible for high risk pool coverage – this includes California’s state-run high risk pool, Major Risk Medical Insurance Program, and the newly implemented Pre-Existing Condition Insurance Plan (PCIP).
Key findings of the Online Survey, which was given to web visitors from all 50 states and Washington D.C., include:
· 61.7 % of respondents were eligible for state or federal health coverage programs, most of which require individuals to have income of $44,700 or below for a family of 4 to qualify,
· 21.1 % were eligible for private coverage – this includes individual, group, or COBRA and MiniCOBRA,
· 15.4 % were eligible for high risk pool coverage – this includes state-run high risk pools, as well as the newly implemented Pre-Existing Condition Insurance Plan (PCIP).
The blog posting was written by four health care leaders, Leonard D. Schaeffer, Alain Enthoven, Ph.D., David S. Helwig, and Phil Lebherz, executive director of FHCE.
Based on the Eligibility Survey findings and analysis of the current application system, the authors suggest the best strategy for solving the dilemma is to use point-of-service enrollment. When a person without insurance seeks treatment, a trained staff member in any qualified health care setting could simply go to an online address, input basic patient data, check for available options, and promptly enroll the person in the relevant government health coverage program. Point-of-service enrollment would have automated check-points for eligibility and implement a transparent system with fraud controls. Through point-of-service enrollment, the government could significantly reduce a costly administrative system that drains resources.
The Foundation for Health Coverage Education is a non-profit organization with a mission to help simplify public and private health insurance eligibility information in order to help more people access coverage. The CoverageForAll.org website and U.S. Uninsured Help Line (800-234-1317) receive over 100,000 visitors or callers each month. For more information, visit www.CoverageForAll.org , friend us on Facebook or follow us on Twitter (@CoverageForAll).