Gila County Residents Lack Medical Insurance

Medical debt, delayed care, uninsured residents, deaths all rise as lawyers debate health care reform

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As the U.S. Supreme Court debates whether to gut recent federal health care reforms, new studies have documented the breakdown of the current system — even for people with insurance.

That’s especially true in Arizona — with one of the highest shares of the uninsured in the nation — and in Gila County, where 30 percent of the residents rely on the Medicaid-based Arizona Health Care Cost Containment System (AHCCCS) for coverage.

Unfortunately, even Arizona residents with health insurance have been sinking into debt, according to a study by University of Arizona researchers reported in the American Journal of Public Health.

Medical bills trigger 60 percent of the 1.5 million bankruptcies annually according to a Harvard Medical School study. By contrast, medical bills rarely trigger bankruptcy in the rest of the industrialized world with national health care plans.

The U of A study of 4,200 Arizona households with adults between the ages of 18 and 64 found a high level of medical debt regardless of medical insurance status.

However, those who had gaps in their coverage were

twice as likely to report problems paying bills and six times as likely to report delaying care.

Another study found that the number of underinsured adults rose 80 percent between 2003 and 2010, from 16 million to 29 million. All told, 44 percent of adults are either uninsured or underinsured, according to a Commonwealth Fund study published in the Journal Health Affairs. The number of adults without adequate coverage has risen from 61 million in 2003 to 81 million in 2010, the study concluded.

If the Supreme Court doesn’t strike down the reforms on the grounds that the requirement to buy health insurance violates the Constitution, those reforms could reduce the number of uninsured and underinsured by an estimated 70 percent, the study concluded.

The study found that 63 percent of adults with high deductible health plans skipped needed care and 58 percent of the uninsured and 52 percent of the underinsured had trouble paying their medical bills.

An estimated 45,000 Americans die each year for lack of medical insurance, according to another study by researchers from the Harvard School of Medicine published in the American Journal of Public Health.

The study estimated the premature deaths that resulted from lack of care for treatable conditions among a sample of the roughly 50 million Americans without medical insurance.

An estimated 20 percent of Arizona residents lack medical insurance at present, compared to 16 percent nationally, according to the U.S. Census Bureau. That’s a total of 1.3 million Arizonans without insurance. Another 3.3 million residents get their insurance through their jobs and 2.2 million get coverage through a government program like Medicare or Medicaid.

Gila County has among the worst rates in the state when it comes to poverty, medical coverage and the share of the population that relies on AHCCCS.

The share of people insured through their workplace has declined steadily since 2000, dropping from 64 percent to 55 percent last year.

Along with one of the highest rates of medical insurance, Arizona now has one of the highest poverty rates in the nation — a whopping 18.3 percent. Only Louisiana (21.6 percent) and Mississippi (22.7 percent) had higher rates, according to the U.S. Census Bureau.

Most of those figures don’t take into account recent deep reductions in the number of people covered by programs like AHCCCS, which hit especially hard in Gila County.

In fact, just last month the Arizona Supreme Court rejected an appeal of the Legislature’s decision to cut roughly 280,000 from the AHCCCS rolls, in an effort to save an estimated $540 million. Most of those cut were children, but it also included 100,000 childless adults living below the poverty line.

The state’s voters in 2000 approved a ballot measure that extended eligibility for AHCCCS beyond the federal minimums. The Legislature essentially discarded that ballot measure.

An earlier appeals court ruling determined the Legislature violated the provisions of the voter-approved Proposition 204, but also concluded that the court had no legal authority to force the lawmakers to come up with the extra money needed to fully implement the voter initiative. The Arizona Hospital Association said that the elimination of the extended coverage under the terms of Proposition 204 has cost the state 30,000 jobs — including 194 in Gila County.

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