When I think of the emergency room, I think of the crowded waiting area, chock full of people who have been waiting a long time to see a doctor.  The Center for Disease Control confirms that image. Studies have shown that the average wait to receive care is around one hour. A 2006 report by Press Ganey Associates found that the average stay in an American emergency room clocks in at around 3.7 hours. Patients filled out satisfaction surveys, and Arizona clocked in with the highest average wait time at 297.3 minutes—close to five hours!  Iowa led the way with a wait time of 138.3 minutes, a little over two hours worth of time spent in the hard plastic waiting room chairs.

Healthcare providers working to reduce Emergency Room waits

Some feel that the health care reforms will put the squeeze on emergency rooms. After Massachusetts implemented universal health care, emergency rooms reported a boost in people. Even though the health insurance would theoretically give them more access to preventative care, the primary care physician shortage may actually make it more difficult to seek preventative services, consequently making ER care ever more critical.

It’s no surprise that hospitals throughout the United States are working to increase patient satisfaction by decreasing hospital wait time. According to the Baltimore Sun, in 2006, 120 million patients went to an emergency room, a sizeable increase from ten years earlier. More and more people are using the ER to receive care. By using innovative, inexpensive new technology, emergency rooms are cutting down unnecessary services.  Hospitals in some states use texts and emails to communicate with patients, marketing their services.

A recent article in the Baltimore Sun details the efforts of area emergency rooms.  At St. Joseph Medical Center in Towson, the hospital advertises its emergency room wait time online. This initiative has raised patient satisfaction, increasing the likelihood that patients will choose St. Joseph’s. St. Joseph’s cuts out unnecessary, bulky procedures to streamline care.  At the University of Maryland Medical Center, staff moves patients in need of urgent care to beds instead of housing them in the ER.  Many other Maryland hospitals have added staff to deal with emergencies.

In Arizona, the state that the third longest wait time in 2009, hospitals are also marketing their wares. Gilbert Hospital in Phoenix ran an ad touting its ER services, highlighting the fact that most patients saw a doctor in 31 minutes or less. Other area hospitals used billboards and other media to promote speedy service. By marketing their superior service, hospitals can increase their business, unless their actions don’t back up their words.

All in all, the fact that emergency rooms are working to become more efficient is promising.  Ultimately, however, I feel that increased ER waiting times are a symptom of the primary care physician shortage. On top of all the slimming and trimming of ER procedures, emphasizing preventative care is crucial to reducing ER wait times.  Building a strong supply of primary care physicians can increase access to preventative care as more and more people are insured.

On Monday, Connecticut announced that it would be the first state to move low income residents to the Medicaid program.  This shift will allow the state to save over 53 million dollars over the next year.  Because the government made changes in the Medicaid program to allow low-income singles without kids to enroll in Medicaid for the first time Connecticut was able to move these people from the State Administered General Assistance (SAGA) program.

Low-Income Single Adults Eligible for Medicaid in CT

Medicaid provides a wider range of health services than SAGA, and by enrolling low-income singles in Medicaid, Connecticut will save money and provide the approximately 45,000 qualifying individuals with more medical care.  Before the Affordable Care Act, adults without kids did not qualify unless the state allowed exceptions. On top of the savings, Connecticut will get some cash from the federal government for this endeavor. Kathleen Sebelius, Secretary of Health and Human Services Department, lauded Connecticut for early enrollment because it

The District of Columbia also followed Connecticut’s lead, and requested the government to expand its own Medicaid program, slashing over 56 million dollars from the city’s budget.  Both Connecticut and Washington, DC took advantage of the Affordable Care Act.  By 2014, every state will need to expand its Medicare coverage with federal funding, so successes in Connecticut and DC could indicate overall success for the Affordable Care Act.

Are states finally accepting the Affordable Health Care Act? Hopefully Connecticut and Washington, DC’s Medicaid expansion will truly prove successful in reducing expenses and providing citizens with quality health care.

Today is the deadline for states to submit details to the Department of Health and Human Services on how they intend to operate the high-risk health insurance pools mandated by healthcare reform. The high-risk pool program is intended to provide coverage to those who have been denied health insurance because of a pre-existing condition and who have been without coverage for more than six months. These pools are meant to bridge the gap for such individuals until subsidies and new health insurance exchanges are instituted in 2014. Other crucial reforms included in the package which brought on these pools are provisions that allow individuals to stay on their families’ insurance plans up to age twenty-six, prevent insurers from excluding children because of preexisting conditions, and eliminate lifetime limits on health costs imposed on policyholders. Twenty-nine state and the District of Columbia have elected to run their own pools and will be entitled to a portion of the $5 billion allocated by the federal government to fund them. Nineteen states said they would leave operation of pools in their states to the federal government. Some think tank analysts and state officials worry that federal funding may run out, leaving states liable to cover these high-risk patients out of their own budgets. Federal officials at the Department of Health and Human Services have assured these doubters that the funds will last for until 2014 in states where it will administer the pools. They further say the federal government will cover the costs of developing or modifying accounting or enrollment systems and any other start-up costs states may incur. The contracts due to Health and Human Services today must include strategies for operation of the pools, estimations of total cost, and other provisions. Enrollment in the pools begins July 1 and coverage for policyholders will begin August 1. For more information on the high-risk pools in your state, contact your state’s Department of Insurance.

Obama administration officials and some Senate Democrats are optimistic that the federal subsidy of COBRA benefits passed by the economic stimulus bill will be extended by inserting  a provision to this effect into the “extenders” package of jobless benefits working its way through the Senate this week. This bill is co-sponsored by Senators Bob Casey Jr. (D-PA) and Sherrod Brown (D-OH). As discussed in my last post here, it is estimated that over 2 million families who would have lost their employer-sponsored health insurance as the result of a lay-off took advantage of the COBRA subsidy. Instead of losing their coverage, COBRA has allowed them to keep their previous employer’s health insurance and the federal government’s subsidy has paid for 65% of the total cost of maintaining that coverage. This subsidy was a huge help for families who otherwise would have had to assume 100% of the total cost of premiums (including the portion their employer used to pay) to maintain their coverage under COBRA.

COBRA Subsidy Running Out for the Unemployed

As of June 1, 2010, the 15-month COBRA subsidy has expired for those who took advantage of it when it first became available in February 2009. The National Employment Law Project estimates that more than 144,000 households each month will be dropped from the subsidy as these families hit their 15-month mark. Many families whose COBRA subsidy has not yet expired hope the Senate will pass this extension of the COBRA subsidy beyond the 15 month mark so that they can continue paying just 35% of the total cost of their previous employer’s insurance premiums and keep their old coverage. Here are five reasons why I don’t think an extension of this subsidy will make it into the final jobless benefits package which should come to a vote this week:

1)      Centrist House Democrats rejected a similar proposal to extend COBRA subsidies in May 2010 because of concerns about continuing to run-up the national deficit.

2)      Last week, the non-partisan Congressional Budget Office evaluated the Senate’s trimmed down version of the proposal which is in currently in the works. Extending the COBRA subsidy again is estimated at $4.1 billion, which is much higher than supporters had anticipated.

3)      Congress already extended the subsidy once in November 2009, allowing COBRA beneficiaries to continue receiving the 65% subsidy of their total premium cost for a maximum of 15 months. The original subsidy as passed in the American Recovery and Reinvestment Act of 2009 was set to expire after 9 months.

4)      There are few other areas of the bill from which co-sponsors Sens. Bob Casey Jr. (D-PA) and Sherrod Brown (D-OH) can pull funds for the subsidy. The subsidy extension is only part of a package of provisions the Senators are trying to attach to the must-pass legislation. Their whole package has a total cost estimated at nearly $7 billion. Other parts of their provisions would extend unemployment benefits and make changes in dozens of federal programs, and these are not areas from which the senators could easily justify cutting funding in order to make room for another COBRA subsidy extension.

5)      A similar proposal to extend the COBRA subsidy was dropped from the House-passed bill. Additionally, Senate Democratic leaders omitted it from their version when the bill was originally drawn up.

Unfortunately, it seems that given the strained economy and need for budget-consciousness in Washington families who have relied on the federal subsidy to keep their coverage under COBRA will have to reevaluate their options.

According to Hartford Business online, the Connecticut State Government is debating on passing a bill which will mandate expanded coverage for more than six medical conditions. Such mandates would add approximately 3% to total premiums, according to insurance experts.

The six medical condition mandates for the new proposal include: ostomy-related supplies, prosthetic devices, hearing aids for children and wigs for patients who experience hair loss due to medical conditions. These mandates would cover what is typically paid for out of pocket, therefore increasing premium costs.

The state of Washington is nearing the 1 million mark for uninsured residents. Approximately 1 in 5 Washington residents above the age of 19 are uninsured. The record of 876,000 people for this year jumped more than 150,000 since last year. According to Insurance Commissioner Mike Kreidler, the jump is due to the 95,000 state residents who lost their jobs in 2009 and the 15,000 depends who lost coverage when those people lost their jobs.

“As staggering as 876,000 uninsured sounds, this number does not include people with jobs, but whose employer no longer offers employer based health insurance, or those who drop coverage because they can no longer afford their employer’s health plan. The rising number of uninsured has always been a moral issue, but today it’s clearly an economic issue,” said Kreidler.

The 150,000 jump amounts to a 21 percent increase from 2008. Kreidler also states that the number of uninsured will continue to increase even if the economy improves. The 876,000 uninsured includes 40,000 people who have been scheduled to be cut from the state’s Basic Health plan this year. The state doesn’t want to have to cut people from the plan so they will be raising rates instead. Monthly rates will increase by about $25. Deductibles will also increase from $150 to $250.

Beginning July 1, a new law in South Dakota will expand the South Dakota High Risk Pool to children with preexisting conditions that may not be able to get coverage any other way.

The law will help to cover approximately 455 children that are under the age of 19 who are considered medically uninsurable.  Governor Mike Rounds explains that “Every child in South Dakota should have health insurance, and now every child can. The South Dakota High Risk Pool will begin taking applications today for children who have been without health care coverage.”

The open enrollment period is from July 1 through August 29 and allows any child who has been without health insurance coverage for 12 months or longer can enroll without a pre-existing condition waiting period. Other requirements include:

Younger than 19
U.S. citizens
South Dakota residents

Monthly premiums range from $125 to $240 a month for children who qualify for the South Dakota Risk Pool. Deductibles range from $1,000 to $10,000 a year.

Though 455 children does not seem like a lot, especially compared to the 200,000 uninsured children in the state of South Dakota, but it’s a start and South Dakota is definitely making a positive stand for uninsured children.

Yesterday, the House passed a bill to expand the children’s health insurance program. The State Children’s Health Insurance Program (or SCHIP) is a federal program that gives funds to the states to provide health insurance to families with children. The program was designed for low income families that do not qualify for Medicaid. The House vote was 289 to 139.

Similar legislation has been vetoed before by the Bush Administration but the bill that was passed yesterday would extend to cover more than 4 million uninsured children.  The bill includes an additional $33 billion to be spent to insure children over the next 4 ½ years.

President-elect Barack Obama stated after the legislation was passed:

In this moment of crisis, ensuring that every child in America has access to affordable health care is not just good economic policy, but a moral obligation we hold as parents and citizens. That is why I’m so pleased that Democrats and Republicans in the House of Representatives came together to provide health insurance to over ten million children whose families have been hurt most by this downturn. This coverage is critical, it is fully paid for, and I hope that the Senate acts with the same sense of urgency so that it can be one of the first measures I sign into law when I am President.

The bill would be financed by an increase in tobacco taxes, including a 61-cent increase in the tax on cigarettes, to $1 pack.

Democrats believe that the current economic state of the country calls for the expansion of children’s health insurance. Many people have lost their jobs this year, and the number of unemployed has increased by 50% since last year. When people lose their jobs, they lose their health insurance which therefore means their children don’t have health insurance.

“At a time of rising unemployment, this legislation is more important than ever,” said Representative Mike McMahon, a Democrat from New York.