By John Trumbo, Tri-City Herald, Kennewick, Wash. Knight Ridder/Tribune Business News
Sep. 27--It's not that Aaron Warburton of Pasco doesn't believe in health insurance. He just can't afford it.
The 36-year-old husband and father of a 6-year-old son is among the estimated 33,000 people in Benton and Franklin counties who are bare when it comes to health insurance.
Warburton supports his family as a barber at the Ganzel's Barber Shop in Richland, but the job doesn't include health benefits.
He's not alone. One in four people in Franklin County has no health insurance. And nearly one in six in Benton County is uninsured, according to statistics released last week by the Benton Franklin Community Health Alliance.
According to the U.S. Census Bureau, 14.8 percent of Washington's 6 million residents had no health insurance for a full calendar year in 2002-03.
The three Tri-City hospitals can't handle the growing number of uninsured people, says Brooke DuBois, executive director of Benton Franklin Community Health Alliance.
Most of them go to Community Health Center La Clinica in Pasco. 'It's the backbone of our system' for the uninsured, DuBois said. But the agency is having its own financial struggles.
The burgeoning medical insurance problem has Tri-City health care officials wondering whether the existing medical system can handle the growing demands.
'How strong is the safety net and will it hold under stress? What is a community to do?' wonders DeBois.
Health care organizations from the Tri-Cities hope to answer those questions during a news conference Tuesday at Columbia Basin College. The event expects to draw representatives from La Clinica, Grace Clinic, Kadlec Medical Center, Kennewick General Hospital, Lourdes Health Network, the Community Health Alliance, the state Department of Social and Human Services and the Benton Franklin Health District.
It is impossible to know exactly how many people in the Tri-Cities are without insurance. No one has counted them and not all of them want to be counted.
They include the working poor, people on public assistance, migrant workers and their families, as well as people who have solid jobs but, like Warburton, do not have health insurance through their employer.
La Clinica's administration recently announced that in the past two years the clinic saw its number of uninsured patients double.
In 2001, about 15 percent of La Clinica patients had no insurance. Last year that figure climbed to 30 percent.
With 25,000 to 29,000 patients in those two years, that means the number of uninsured rose from about 3,750 to 8,700.
Meanwhile, enrollments in Washington's program for the uninsured, the Basic Health Plan, have been cut to help balance the state budget.
In August 2003, there were 2,317 Benton County residents and 1,867 Franklin County residents signed up for the Basic Health Plan, said Dave Wasser, spokesman for the Washington Health Care Authority.
Today, those numbers are down 23 percent to 1,872 in Benton County and 1,333 in Franklin County.
Part of the problem is fewer Tri-City doctors accept Basic Health Plan patients.
Dave Wright, who until recently cut hair with Warburton at Ganzel's, said he takes his family to La Clinica because he can't find a doctor anywhere else who will accept his family with state-sponsored health insurance.
'At one time, Basic Health had a list of four or five doctors to choose from,' Wright said.
Not any longer. Now, 'La Clinica is the only (provider) listed in the book,' Wright said.
'I've called at least 10 to 15 doctors to see if they take Basic Health, and they just aren't accepting Basic Health patients anymore.'
Warburton pays $160 a month for his wife to have coverage through Premera, and his son is on state insurance, which costs $10 a month.
Warburton said he doesn't have insurance for himself because his take-home pay for a family of three is too high to qualify for the Basic Health Plan.
The situation is worsening with rising health premiums, which are prompting more employers to drop health insurance for employees.
Also, Tri-City doctors are shying away from Medicare and other public insurance patients because of shrinking reimbursement rates and rising costs for medical liability insurance.
Almost half of the doctors surveyed by the Benton Franklin Medical Society in August said they were considering closing or moving to other states where it doesn't cost as much to run a medical practice.
'We knew it was bad, but the survey gave us hard numbers to show just how bad the professional climate is for our doctors,' Dr. Mark Mulholland, the association president, said in a statement announcing the survey results.
The survey, which drew 113 respondents from about 200 members, found:
--Nearly half of the doctors reported 30 percent or higher increases in liability insurance premiums in the past four years.
--13 percent surveyed reported 100 percent increases in premiums in that period.
--53 percent said they were limiting the scope of their practices to exclude high-risk services, such as obstetrics.
'There is no health care without doctors,' said Dr. Fred Foss, a urologic surgeon in a statement issued by the society, which represents more than 200 doctors.
The result has been costlier health care, fewer doctors, more people uninsured and fewer options for care.
'Everyone needs to share a portion of the blame,' said Dr. H. Matt Smith of Kennewick. Doctors, insurance companies, attorneys, hospital administrators and even patients all need to stop trying to take advantage of the health care system, he said.
Smith serves about 20 uninsured families in his practice. About 25 percent of his patient load is on Medicare.
Statistics released recently by the Community Health Alliance show 32,305 people in Benton and Franklin counties -- about 17 percent -- were uninsured in 2000. In Benton County, there were 20,351 uninsured, while Franklin County had 11,954.
The statistics show the Tri-Cities has 17 percent uninsured, 10 percent on Medicare,16 percent with other public insurance, such as the Basic Health Plan, and 57 percent with private insurance coverage.
Dr. Larry Jecha, who heads the bi-county health district, said the Tri-Cities is facing a crisis.
'It's a spiral. This is mainly a community thing about access,' he said. 'If people aren't able to get access to the health care they need, then it comes back on the community when we are trying to prevent illness.'
The Legislature was hard on health care in 2002-03, said Cassie Sauer, executive director of the Washington State Hospital Association.
There were major cuts to state-managed health insurance programs, forcing an estimated 40,000 children off Medicaid, about 35,000 adults off the Basic Health Plan of Washington and about 20,000 immigrants off Medicaid, Sauer said.
Health care in Washington makes up 15 percent of the state budget, but 29 percent of $2.6 billion in state budget cuts in 2003 came out of health care programs, she noted.
At the same time, says Sauer, the Legislature imposed more regulations for people seeking state health program benefits. More paperwork, required to be filed more often, and restrictions on how fees can be paid add up to 'major bureaucratic hassles,' Sauer said.
Warburton, the Richland barber, knows he's taking a big risk going uninsured.
'Right now I'm going on God's grace,' he said, explaining that if he paid the additional money to get coverage, the household budget would be too tight.
'I'm just believing that at age 36 nothing catastrophic will happen to me, but I know my time is limited,' Warburton said.
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