NCW sees dramatic increases in uninsured [The Wenatchee World, Wash.]

Dec. 16--WENATCHEE -- Almost one in four Okanogan County residents have no health insurance, and people living in Grant, Douglas and Chelan counties aren't faring much better, according to a new state report on the uninsured.

North Central Washington now has some of the highest uninsured rates in the state. Its four counties rank among the eight highest for uninsured residents per capita, including Okanogan County, which is second highest, followed by Grant at third, Douglas at sixth and Chelan at eighth highest of 39 counties.

Okanogan County's 23.1 percent uninsured rate is behind only Yakima County, where 27.5 percent have no health insurance.

"It pains me to see all these people uninsured. It's a very hard thing for people to go through," said Steve Jacobs, chief financial officer for Central Washington Hospital, where the rise in uninsured residents has corresponded with similar-sized increases in the hospital's charity care and bad debt.

The report from Insurance Commissioner Mike Kreidler found nearly 1 million Washingtonians, or 14.5 percent of the population, are now without insurance, and hospitals and other healthcare providers are kicking in over $1 billion a year to cover them.

That's up significantly from 2004, when 12 percent of residents were living without insurance, and charity care and bad debt totaled about $500 million.

It's up even more in North Central Washington, where more than 13,400 people joined the ranks of the uninsured between 2008 and 2010. An estimated 51,220 people are now without health insurance.

These high numbers of people without insurance are taking a toll on the health care facilities that serve them.

At Central Washington Hospital, 100 employees lost their jobs this year through attrition, retirement and direct layoffs. The rise in uncompensated care along with the poor economy contributed to the need for those layoffs, said chief financial officer Steve Jacobs.

This year, the hospital's total uncompensated care costs are expected to hit $21.5 million, out of a net operating budget of about $190 million, he said.

That includes charity care and bad debt of about $13.5 million, plus about $8 million in costs of what Medicaid doesn't reimburse for its patients.

Jacobs said the hospital's bad debt and charity care costs rose only slightly this year, but went up by 32 percent from 2008 to 2010 -- about the same rate as the increase in uninsured residents in North Central Washington.

In Okanogan County, small public hospitals have been relying on borrowed county funds to help cover their costs of operation for the last few years.

Bud Hufnagel, CEO of the Three Rivers Hospital in Brewster -- which recently changed its name from Okanogan Douglas Hospital -- said he wishes three out of four patients who came through his doors were insured, as reflected by the county-wide uninsured rates.

"Approximately 45 percent of the patients who come into this hospital are what you would call self-pay patients, meaning they have no insurance," he said. They don't qualify for Medicaid, yet most cannot pay their bills, he said.

And, he said, "There's no way to collect any meaningful dollars from those folks, even if they are well-intentioned. They are not in a place where they can pay for much of that care, so it ends up being uncompensated care for the hospitals."

Along with the large number of patients who can't pay, the hospital was also hit hard by state budget cuts, and Hufnagel said he's even more worried about those proposed in Gov. Chris Gregoire's new budget.

"We're kind of between a rock and a hard place. We can't just raise our prices, or make more widgets," he said. "It's going to be a significant and very difficult time for us."

He attributes the large number of uninsured to the large number of migrant workers in the area.

Stephanie Marquis, a spokeswoman for the Office of the Insurance Commissioner, said that's a reasonable assumption. She said people who work in agriculture are among the state's most uninsured. Combined with people who work in forestry, mining, fishing and hunting, about 46 percent have no insurance.

That's followed by people who work in recreation and accommodation, arts and entertainment and food services industries, of whom 33 percent are uninsured. She said lower incomes in North Central Washington also contribute the higher rates.

It's not just hospitals that are noticing more uninsured patients.

Mike Hassing, CEO at Family Health Centers, a nonprofit clinic that charges patients on a sliding scale based on income, said he doesn't have this year's figures yet. But from 2009 to 20010, the number of patients with no insurance seen at his clinic jumped from 36 percent to 46 percent. "It did not decline in 2011, and when the final numbers are in, it's likely to be even higher than that," he said.

Hassing said the health center gets much of its revenue from federal grants, which are not tied to the number of uninsured patients served.

"We get that set grant amount, and if our uninsured users go up, we have more users to share that grant dollar with," he said. "So, we have to try to supplement it from other places." To make up the difference, the health center is now scheduling shorter visits, so a practitioner can see more patients in a day.

"In private practice, patients are primarily commercially insured, so there's a cost shifting that can happen from insured patients to cover the uninsured or under-insured. We don't have that," Hassing said.

Wenatchee Valley Medical Center, the region's largest private clinic, has long offset the cost of providing care to uninsured patients.

Dr. Peter Rutherford, the medical center's president and chairman, said they've always had a goal of providing services to everyone, regardless of their ability to pay. This year, the medical center will spend between $5.5 million and $6 million on its compassionate care program.

"There is obviously a cost to doing that, and as long as your other incomes allow you to continue to do that, we certainly want to do that," he said, but added, "Who knows where the tipping point is?"

As for hope on the horizon, health care officials hope to see some relief when the Affordable Care Act's main provisions take effect in 2014, although some are in a wait-and-see mode, partly due to uncertainty over changes that could be made in the next two years.

Assuming the bill isn't changed, the Insurance Commissioner predicts that the number of uninsured residents will continue to climb until 2014, when the state will experience a large and sudden drop in those rates.

"It will be the single biggest improvement in decades to the state's uninsured rate and uncompensated care levels," the report said.

Expanded Medicaid eligibility alone is expected to provide health coverage for nearly 355,000 Washington residents, or 38 percent of those now uninsured, it said.

K.C. Mehaffey: 997-2512

[email protected]

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