Tahlequah Daily Press

November 29, 2013

Doctor: ER care not always available, or cheap

Staff Writer

TAHLEQUAH — Now that the Affordable Care Act is in its first phase of implementation, problems with the enrollment process have some folks concerned about the law’s effectiveness in providing care to the poor.

The Oklahoma Legislature, at Gov. Mary Fallin’s insistence, refused to expand its Medicare program to include 9,000 slated to fall into an insurance “crater” beginning in 2014.

In an earlier Daily Press report, Rep. Mike Brown, D-Tahlequah, said the Oklahoma Legislature has no plan in place to deal with the issue of the many Oklahomans who will lose their insurance at the end of the year.

“Current Republican leadership refused to take up any measure to help all of the Oklahomans who will lose their insurance coverage,” said Brown. “In January 2014, the federal government will stop participating financially in the Insure Oklahoma program because it does not comply with certain regulations in the federal law, the Affordable Care Act.”

Many uninsured and underinsured seek care the only place they can: the local emergency room. Dr. James Lewis, a local physician, is concerned that ER care is not the place to get the continuity of care many people seek.

After reading a report in a metro newspaper about Congressman Markwayne Mullin’s take on health care, Lewis wrote to Mullin, explaining the fallacies in the congressman’s statement in the article, which read: “There are a lot of programs out there that if people need medical help they can get it. There are a lot of hospitals out there that do the work for free.”

“It is true that an ER will not turn anyone away, but the care provided in an ER is not free and there will be a bill,” Lewis wrote to Mullin. “Moreover, as a physician for more than 40 years, I know that an ER in rural Oklahoma is not necessarily the place to either get quality care or continuity of care.”

Attached to the letter was a New England Journal of Medicine article, “Dead Man Walking,” outlining a specific case of a poor man who died of cancer because he could not afford the preventive care he needed before his cancer became terminal.

Brown believes Lewis is upset about the state’s failure to expand Insure Oklahoma.

“If you read between the lines, Lewis wants to expand Medicaid, and he’s mad because we’re not doing that at the state level,” said Brown. “He’s not being vocal about it, though. He’s using that journal article to show the gaps in the system.”

Brown pointed out that while cases similar to the one mentioned in the journal article happen “every day in Oklahoma,” he also believes Tahlequah City Hospital provides a good deal of charitable care to help offset the costs.

“We have those type cases every day in Oklahoma,” said Brown. “These poor people end up dying because they can’t get health care. I don’t know that the ACA is the answer to end all answers. It has holes in it that are gaping wide. Insurance companies wrote it, and stand to gain, but they are going to have to provide more services.”

Late last year, the Daily Press published a 12-part series on the Affordable Care Act. The final in the series revealed that TCH averages 25,000 emergency room visits per year. According to TCH CEO Brian Woodliff, 40 percent of that population are Medicaid or uninsured patients, and 80 percent of the ER visits are for non-emergency conditions.

“TCH has loaned over $1 million through a provider fee to the Oklahoma Health Care Authority [the state’s Medicaid program] to allow for the health care needs of those living below the federal poverty level,” said Woodliff in an earlier interview.

In May, TCH provided nearly $870,000 in charitable care for the month, and the year-to-date figure in May was $3.44 million. If that continues at the current pace, TCH will have provided about $7 million in charitable care for 2013.


To learn more about long term health care costs visit www.tahlequahdailypress.com/onlineexclusives