Washington Blade - October 17, 2003
Laurel Faust

Michael Cover, deputy executive director of public affairs at the Whitman-Walker Clinic, said 34 percent of this year's clients have no health insurance. The clinic, which experienced a $3.5 million decline in private donations in the past two years, instituted a major restructuring in September, including establishing a sliding scale payment system.

Cover said that before the sliding scale system was initiated, clients were asked to contribute whatever amount they could manage. Cover said clients paid anywhere from $5 to the full cost of services rendered. He said he couldn't estimate the amount of uncompensated care because the contributions were voluntary and were made anonymously.

Jackie Adams, spokesperson for Chase Brexton Health Services in Baltimore, said preliminary figures show that 39.7 percent of the organization's clientele have no private, Medicaid, Medicare or other insurance. She said Chase Brexton had $1.9 million in uncompensated care in 2002.

The Washington Post reported Sept. 30 that 43.6 million Americans -15.2 percent of the population - had no health insurance in 2002.

A 2002 Harris Interactive/Witeck-Combs Communications poll showed that 70 percent of gay, lesbian, bisexual, transgendered people have health insurance, as compared to 86 percent of non-gay adults. Fourteen percent of heterosexuals receive insurance through their partner, as compared to three percent of gays.

A May 2002 report from the Kaiser Commission on Medicaid and the Uninsured noted that the uninsured receive less preventive care; they're diagnosed at more advanced stages of illness; they receive less therapeutic care; and their mortality rates are 10 to 15 percent higher.

No insurance means no preventive care

Adams said providers haven't yet begun to feel the full impact of the increased number of uninsured people.

"There's a time lag between people losing their insurance and starting to inundate the safety net system, because people who lose their insurance stop going to the physician until something happens and they absolutely must go," Adams said.

She said when people finally do get sick, they'll go to the emergency rooms and to the low-cost service providers.

"Private practice can't handle it. Emergency rooms can't handle it. People go there but they can't handle that kind of influx. The upshot will be that organizations like us that serve that population are going to see an increase," Adams said. "What that exact percentage is - I don't know."

"We're stretching the best we can and as far as we can," said Pat Hawkins, Whitman-Walker associate executive director for policy and external affairs. "I think everyone else is doing the same. So you're not seeing a collapse because people are coping. But if anything unusual hits us, we have no reserve. There's just no reserve here."

Hawkins said an act of bio-terrorism or even an outbreak of the flu would be enough to overload the system.

"There's a point beyond which you can't go any further and we have to get into the waiting list phenomena. And these are life and death issues. You can't afford to give marginal care. You've got to give high quality care all the time because somebody's life can depend on it," Hawkins said.

Adams said that for now Chase Brexton is able to manage the demand for services.

Ron Simmons, executive director of Us Helping Us, said he can afford to provide health insurance for his employees, but can't afford to extend those benefits to their immediate families.

"Right now it's a manageable trend, but in six months - who knows," Adams said.

Carren Kirkland, coordinator of Outreach Services of the D.C. Comprehensive AIDS Resource & Education Consortium, which provides services to more than 65 HIV/AIDS agencies, said clients are being turned away by hospitals and primary care providers because they don't have insurance. Increasingly people are turning up at the community based providers, she said.

"It makes the job harder because you almost have to select who you're going to help," Kirkland said.

Kathleen DeBold, executive director of the Mautner Project, said many of the women her organization serves really should take time off from work because their health would benefit from the reduced stress. But she said women often don't take off because they're afraid to lose their insurance.

"They're afraid it would make them vulnerable to layoffs," DeBold said.

Kirkland said D.C. CARE Consortium can't afford to pay for health insurance for its part-time outreach employees.

Ron Simmons, executive director of Us Helping Us, a community-based AIDS service organization committed to reducing HIV infection in the African-American community, said the organization can't afford to pay the insurance premiums for his employees' families.

"We know we can insure our employees, but we may not be able to insure their dependents," he said.

Hawkins said that people who were laid off a year ago are scheduled to run out their insurance privileges through COBRA soon. COBRA is a federal program that extends insurance for people who lose their jobs and can afford to pay the full premiums themselves for an additional 18 months.

"There's very much a concern," Hawkins said. "There's a concern for the fact that you'll get this peak of needs when we're losing our infrastructure. Our infrastructure is being eroded by this lack of consistent stable funding."

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