Healthcare & Insurance

Healthcare & Insurance

Written by Rachel Youens Thursday, 07 February 2008

Alex Cogburn is not indigent, unhealthy or unemployed. In fact, the college-educated 24-year-old shares a house with a roommate, has a car and works almost 40 hours a week at his job using his black belt training to teach karate at a Northwest Austin studio.

Not having insurance wasn’t something Cogburn thought much about since graduating from the University of Texas last year, when he lost coverage under his parents’ insurance plan. But in late December, when an unplanned trip to the emergency room led to Cogburn receiving almost $5,000 in medical bills, he realized that health insurance was something he couldn’t afford not to have.

“I hate having to feel like we have to have insurance, but clearly it really is a necessity or else there’s no way I can ever pay this amount again,” Cogburn said. “If it was something where I had planned to go to the hospital, I would have asked my parents or looked into what I could have done to make it cost less, but since it was unplanned it was like…I didn’t ask for this at all.”

Cogburn is one of 5.7 million Texans who are currently without insurance and make too much to be considered indigent and too little to afford sufficient coverage. Texas has the highest number of uninsured residents in the country according to the 2003 census, and area hospitals, city government and the state legislature are battling a number of factors in an effort to help these residents.

“The fastest growing part of our population is the population that has the highest rate of the uninsured. The more people who become uninsured and the higher the health costs grow, the more employers will bail out of the healthcare system,” said Earl Maxwell, president of the St. David’s Foundation at a recent Central Texas growth summit. “Our hospitals are under great pressure to provide services for the uninsured. The amount of uncompensated care at St. David’s, Seton and Brackenridge is skyrocketing, and it was already huge.”

Maxwell recently observed some of these factors handicapping Austin healthcare when he began visiting St.David’s hospitals trying to figure out where the problems lie. One of the first things he noticed was emergency rooms filled with patients, and many of those patients were seeking treatment considered primary care.

“I asked ‘why don’t these people go to one of the many safety net clinics in the region?’ and I was told the safety net clinics are beyond capacity, and at least going to the emergency room you only have to wait a matter of hours, not a matter of weeks,” Maxwell said.

Of those Texans who are uninsured, of working age and able to work, only about 8.3 percent are unemployed, according to the Texas Health Care Primer. Like Cogburn, many of them work for small businesses that cannot afford to provide insurance to employees or do not work enough hours to be eligible. Two years ago a non-profit organization comprised of Central Texas counties, The Indigent Care Collaboration, The Travis County Healthcare District and the Seton and St.David’s systems formed with a goal of helping small businesses provide insurance to employees. This non-profit, The Central Texas Regional Health Coverage Project, received a major boost in the last legislative session when Former Austin Mayor and current State Representative Kirk Watson authored a bill allowing counties to join together to form what Watson calls a “three-share” funding program.

“The goal is to bring affordable health coverage to 10,000 small businesses (in Texas) in the coming years,” Watson said. “The idea is to lump (the businesses) together so they have the bargaining power of a large corporation. In the last legislative session, Rep. Naishtat and I worked on legislation for a three-share program that would allow employers to put up a third (of the cost), employees a third and the rest would come from grants or matches or things of that nature.”

One of the places the state found funding for this three-share program was through the recently introduced $5 per person tax at strip clubs.

In the mean time, still without insurance, Cogburn is grappling with his medical bills and looking at how he can avoid this situation in the future. He is looking at insurance policies through his bank and is talking with financial counselors in the St.David’s system trying to figure out how much of his bill he will pay and how much the hospital will lump into their annual amount of “charity care.”

Local resources for the uninsured or underinsured

Hospitals

North Austin Medical Center, 12221 N. MoPac, 901-1000, stdavids.com/sdnamc.aspx

Financial counselors at the hospital will evaluate eligibility for local, state, county and national benefits. The hospital also offers a Charity Discount Policy that gives free hospital care on non-elective procedures to those who do not receive Medicaid and whose income is less than 200 percent of the federal poverty level. There is also an Uninsured Discount Policy for patients who don’t meet charity requirements. These patients can receive a managed care-like discount.

Seton Northwest Hospital, 11113 Research Blvd., 324-6000, www.seton.net/locations/northwest

Financial counselors can help patients find their eligibility for assistance programs or agencies or for internal assistance from the Seton system. The hospital has a service for the uninsured called the Initial Payment Program which helps patients determine any possible source of funds. For more information on these resources, prospective patients can speak with a hospital financial counselor at 324-6006.

Clinics for low income individuals

Lone Star Circle of Care

Round Rock Health Clinic, 2120 North Mays, Ste. 430, Round Rock, 255-5120

Round Rock Community Clinic, 1099 East Main St., Ste. 200, Round Rock, 342-0500

Lone Star Circle of Care OB/GYN, 2300 Round Rock Ave., Ste. 106, Round Rock, 828-3300

Although Lone Star Circle of Care’s clinics are based in Granger, Georgetown and Round Rock, it opens its doors to patients from all over Central Texas. The clinic offers primary care for both adults and children, women’s health, maintenance of chronic illness, discounted medication and dental care.

People’s Community Clinic, 2909 N. IH 35, 478-4939, peoples@austinpcc.org, www.pcclinic.org

This non-profit clinic, founded in 1970, partners with local medical education institutions, hospitals and even school districts to offer primary healthcare at a reasonable cost. In 2007, the clinic won “Best Public Healthcare” in The Austin Chronicle’s reader’s poll.

Who is eligible: Currently, the clinic is only accepting new patients ages 11-19.

Austin Community Health Centers, www.cityofaustin.org/communitycare

AK Black Community Health Center, 928 Blackson Road, 972-4170

Pflugerville, North Rural Community Health Center, 15822 Foothill Farms Loop, 251-6094

Austin offers 19 of these clinics around the city and surrounding areas featuring primary care, dental and behavioral health services.

Who is eligible: People at 200 percent of the federal poverty level. Everyone must be screened before receiving services. The clinic accepts Medicaid, Medicare and medical assistance programs, but if there is no other payment help, patient fees will be based on a sliding scale.

Austin Women’s Hospital, 601 E. 15th St., 322-2100

This hospital, located within Brackenridge, was created by the Austin City Council in 2002 and offers obstetrics, maternity and family planning services. The hospital is run by the University of Texas Medical Branch.

Who is eligible: Patients must be registered with one of Austin’s Community Health Centers.

Volunteer Healthcare Clinic, 4215 Medical Parkway, 459-6002, www.volclinic.org, jhopkins@volclinic.org

This clinic is privately run and offers non-emergency treatment. The clinic does not offer primary healthcare, immunization or physicals. Rather than scheduling appointments, the clinic runs on a first-come-first-serve basis, asking patients to line up at 5:30 p.m. on Tuedays and Thursdays. Thirty five adults and 15 children will be given a waiting number and will be seen by the doctors for a $5 donation. Patients are asked to bring a photo ID and a pay stub or tax form to prove income.

Who is eligible: Very low income patients with no insurance, Medicaid, Medicare or medical assistance program.

Seton Topfer Community Health Center, 8913 Collinfield Road, 324-6850, www.seton.net/locations/topfer

Seton opened this general health clinic in 2000 to specifically target the underinsured and uninsured in north Austin. All fees for medical and counseling services are based on a sliding scale of family size and income.

Who is eligible: All patients.

Planned Parenthood North Austin Clinic, 9041 Research Blvd., Ste. 250, www.plannedparenthood.org/ppaustin, 331-1288

The north Austin location of Planned Parenthood offers a range of women’s health services from breast exams to treatment of infections. The clinic charges on a sliding scale based on income and accepts Medicaid.

Who is eligible: All patients. Walk-ins are allowed for some testing and prescription refills, but the clinic requires appointments for many of its services.