A 21st Century Journalism Project

Health Care Woes

In Defining The Problem on March 1, 2012 at 12:47 pm

By: Josh Petruska

Unforeseen medical expenses can have long-term consequences.  Zach Petruska, a 2008 college grad, took a job in Stowe, VT as a seasonal worker when he couldn’t find work in Pittsburgh.  In December of 2009 Petruska landed on his wrist while attempting to land a trick on his snowboard.  After a few days of excruciating pain he saw a doctor who told him he needed surgery for a broken bone in his wrist.  He could not afford the high cost of surgery on top of his recurring living expenses.  He was barely getting by as it was.

Instead of surgery, he decided to let the injury heal on its own.  A year later the bone healed, but incorrectly.  He still feels uncomfortable pains as a result.  Doctors tell him there is a good chance of him developing painful arthritis later in life.

Petruska’s situation is not uncommon.  A 2010 study conducted by the U.S. Census Bureau found approximately 16% of Americans are uninsured and lack the availability to proper health care coverage.  Nearly 50 million Americans go each day with out health care.

Many people with jobs still can’t afford health care.  Nearly one-third of the working poor work in the service industry, 16 percent in the farming industry, 11 percent in construction, and 11 percent in the sales industry.  Ten percent of all working Americans earn on average $8.50 an hour.  Of the working poor only about 12 percent receive health care from their employers.  So why is it that employers are not offering the same employer-based coverage they used to?

The rising cost of health care keeps businesses from providing health care to their employees.  A study conducted by HealthReform.gov shows that small businesses of 25 people or less, which employs nearly 11 million people, pay up to 18 percent more for the same coverage as a big business.  Smaller businesses pay higher broker fees and health plan administrative costs, which are three to four times higher than those in a bigger market according to HealthReform.gov.  This results in employers charging their employees more in deductibles and co-pays before their plan kicks in.  Premiums for employer-based health coverage have more than doubled since 2000, three times faster than the increase in wages in the same period.

Many factors prevent individuals from purchasing a personal plan.  Studies have shown in 33 states insurance companies can deny health care to individuals because of preexisting conditions, age, and gender.  Some have no choice but to desert the idea of an individual plan because of the high cost of premiums.  A study found that of the 75 percent people who went out looking for an individual plan, cited the high costs of premiums as the single biggest factor when deciding against purchasing a personal plan.  A survey conducted by the Kaiser Family Foundation and the Health Research & Educational Trust found the average premium for a family of four rose to $13,770 in 2010.

Government programs that serve the under insured and uninsured are also being cut.  Pennsylvania Governor, Tom Corbett, cut adultBasic, the states subsidized health plan for low-income individuals who earn too much to qualify for Medicaid, but not enough to afford health insurance.  Corbett’s decision to cut the program reflects the stark reality that there is not enough money in the states budget to continue funding it.  In 2010 the program cost the state $166 million to fund, which came from a big tobacco settlement and donations from Pennsylvania’s four Blue Cross and Blue Shield insurance companies.  AdultBasic served nearly 42,000 low-income Pennsylvanians who now have to find coverage elsewhere.  The plan costs consumers just $36 per month.  Another reason the plan was attractive to people is it covered more medical areas and allowed consumers unlimited doctor’s visits.  Low deductibles and co-pays also made the plan a viable choice for individuals.

Corbett’s administration replaced adultBasic with Special Care, which is still covered under the policies of Blue Cross and Blue Shield.  The states new coverage plan, requires higher premiums and limited coverage.  Special Care costs individuals premiums between $138 and $162 per month, about a 400 percent increase from adultBasic.  Special Care also limits the coverage individuals receive.  Recipients of Special Care are only allowed four doctor visits a year.  Many of the adultBasic subscribers who woke with no health insurance in early May of 2011 are now forced to either pay the higher costs and receive less coverage for Special Care or go uninsured.

Jennifer Davis, a media relation’s specialist for West Penn Allegheny Health Systems, which includes five regional hospitals in the Pittsburgh area, says no patient who comes to one of these five hospitals is ever turned away.  “As a non-profit health system we do provide care to every patient who comes to us, regardless of their ability to pay,” Davis said.

The West Penn Allegheny Health Systems provide a number of assistance programs and payment plans to individuals who cannot afford the high financial burdens of medical costs.  The WPAHS Charity Care Program allows individuals to be recommended for full or partial coverage depending on the number of individuals in the house and income.  To receive full coverage a households income cannot exceed 200% of the Federal Poverty Guidelines.  In order for a household of four to be accepted for the full coverage, household income cannot exceed $46,100.  For an individual seeking full coverage income can not exceed $22,300.

Today approximately 46.2 million Americans live at or below the poverty line.  Many of these people live day-by-day hoping to find work that will sustain them or their families basic needs.  The United States is one of the few industrialized countries that does not offer universal health care to its citizens. Nearly one-sixth of the American population, about the size of South Korea is without health insurance.  Health care in this country has become more of a luxury than a necessity, and continues to affect millions of Americans every day.


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