Who covers the medical expenses of victims of mass shooting, street conflicts and natural disasters in the USA

The epidemic of mass executions and unrest in the United States forces the system of medical institutions to develop new skills to help patients with large medical expenses, writes Modern healthcare.

Photo: Shutterstock

Does insurance help

What is happening in the country exposes serious problems in coverage for the medical and long-term care that people may need. Hospitals in Fort Worth (Texas), Las Vegas (Nevada) San Bernardino (California), Aurora (Colorado), Orlando (Florida), Newtown (Connecticut) and other places where the mass shootings took place helped victims to cope with large uninsured expenses. Such expenses include inpatient care, follow-up operations and other types of treatment, psychiatric care, rehabilitation and skilled medical care, durable medical equipment, personal care and living expenses until patients can work.

Needs are exacerbated by the proliferation of health care plans with high deductibles and cost-sharing requirements for the patient and the insurance company, resulting in huge bills for patients. Severely wounded patients requiring repeated operations can go beyond their personal expenses several times in a row, which can lead to bankruptcy. In addition, even insured patients may encounter large surprise bills if they go to providers outside the network.

“Living with a gun injury comes with enormous costs,” says Dania Palanker, an insurance expert at Georgetown University's Health Policy Institute. “For many people, expenses such as personal care are not included in their insurance.”

Hospital help

A number of hospitals serving victims of mass shootings, such as Sunrise Hospital & Medical Center and Dignity Health's St. Rose Dominican in Las Vegas have announced a policy of reducing or canceling payments for these patients. But this is only part of the financial question.

Orlando Health wrote off a balance sheet totaling about $ 5 million for 135 patients treated after being shot at Pulse Nightclub in June 2016, which killed 49 people and injured 58. In addition, its staff worked closely with patients and their families to find ways to fund their ongoing health and long-term care needs, said Michelle Napier, Director of Revenue.

“Orlando Health considered this a tragedy and a crime against humanity, so we decided to remove financial responsibility from these patients,” she said. Many of the patients faced $3500-plus deductibles on coinsurance plans that they had not budgeted for, so the system worked with the patients' insurers to resolve those issues.

But the company and employees knew that this would not solve the long-term needs of patients. They acknowledged that they would need to help patients find sources of funding to meet their needs, and so that they could restore their lives.

Patients with gunshot injuries may require extensive rehabilitation, physiotherapy, speech therapy, high-quality wheelchairs, home modifications, and long-term psychiatric therapy. According to Napier, even patients with insurance may have limited coverage or no coverage for such services. According to Palanker, for victims of the shooting and their families who do not receive assistance, as suggested by Orlando Health, this is a separate hard work to manage accounts and organize all services, especially if a person needs highly specialized assistance outside his hometown.

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Nevada senators Catherine Cortez Masto and Dean Heller once called on leaders of US health insurance plans and the Blue Cross and Blue Shield Association to review their plans to provide more generous coverage for hundreds of people injured in a Las Vegas mass shooting in October 2017 of the year. They asked for cancellation of deductibles, surcharges and off-net payments.

Non-medical expenses

The victims of the shootings face many expenses that were never covered and will not be covered by insurance, for example, hiring assistants to clean their homes and cooking and living expenses until they worked (or if they couldn’t work). Relatives and friends of many victims of mass executions, even those who had good medical care, were forced to create crowdsourcing pages on the GoFundMe portal to help pay bills.

Garen Wintemute, MD and firearms researcher at the University of California, Davis, told Kaiser Health News (KHN) that the total cost of medical care for victims of mass shooting in Las Vegas three years ago could reach tens of millions dollars, writes Becker's hospital review.

Ted Miller, MD, a student of violence at the Pacific Institute for Research, has estimated at least $ 600 million worth of healthcare costs for survivors for the rest of his life.

How much are these services

KHN cited a health care study that showed the average emergency room bill for an individual shooting victim was $5 and the average hospital cost was nearly $254. The study found that these costs add up to the U.S. total at approximately $96 billion per year, and that's just emergency care and inpatient care.

19-year-old Riley Golgart was one of the victims of the shooting in Las Vegas on October 1, 2017. She received a bullet wound in the spine. The expected total cost of treating her daughter will cost her mother Janice $ 1 million over several years. Just staying in the hospital at the first stage of treatment cost her insurance company $ 400, not including therapeutic expenses. She is not alone: ​​the survivors of this shooting for years face large medical expenses, depending on their injuries, says Las Vegas Review Journal.

Nadine Lusmeller, 40, was shot in the left thigh and broke her left arm at the same fatal festival in Las Vegas. The bullet and shrapnel in her leg left her with permanent nerve damage and severe pain. The woman cheers up and tries to carefully pay bill after bill on her own. Lusmeller and Golgarth are getting used to the “new normal” of life. Both families don't let medical bills get in the way of their happiness and the quality of life they strive for, Janice says.

All this raises the broader question of how to enable people with partial disabilities to continue to work, instead of giving them no alternative but to apply for disability benefits under the Social Security Program and Medicaid.

Who pays the bills of hurricane victims

In 2005, Hurricane Katrina struck southeast Louisiana, leaving behind unprecedented destruction and a dire need for medical care. The storm and levee failures killed 1 people in Louisiana and another 577 in Mississippi. Thousands more people suffered immediate health problems as a result of the storm, with many unable to access medical care or prescription medications for pre-existing conditions. Countless people have experienced serious mental health problems, including depression and post-traumatic stress disorder, that last for years, writes Center for American Progress.

Although the Bush administration approved the temporary expansion of Medicaid after the September 11 attacks to provide coverage for low-income survivors, it abandoned a similar approach after Katrina and supported restrictive eligibility rules. As a result, thousands of uninsured evacuated people trying to sign up for insurance were rejected at times of emergency.

The expansion of Medicaid through the Affordable Care Act, or ACA, has reversed these restrictive eligibility rules in most states and created a more reliable health insurance scheme. However, despite the possibility of significantly improving access to health services during and after future natural disasters, the Gulf Coast states have so far refused to expand Medicaid.

At a time when Hurricane Katrina hit the United States, the level of uninsured in the states along the way was one of the highest in the country. The annual public health study ranked Mississippi and Louisiana among the two least healthy states in the country in 2004. Consequently, public health in these states was particularly vulnerable to disasters.

A survey of New Orleans evacuated at a Houston shelter in September 2005 confirmed the direct health effects of the storm. Interviewees interviewed were predominantly low-income African Americans, and 52% did not have insurance. A third of the respondents reported having health problems or injuries due to a hurricane and flooding, while 41% of the respondents called these medical problems “serious”. One in five respondents with health problems associated with a hurricane did not receive medical care at the time of the survey. In addition to their new health problems, many of those evacuated had pre-existing medical needs, such as antenatal care for pregnant women or chronic illnesses for the elderly. It was estimated that over 40% were taking prescription drugs, and a third of all respondents were left without the drugs they needed at some point after the storm.

An October 2005 survey of returning residents in New Orleans and neighboring Jefferson Parish found that more than half of all families surveyed had a person who was sick or injured within two months of the storm, and a quarter of families experienced difficulties with access to medical care or prescription drugs during this time. Two years after the Federal Emergency Management Agency (FEMA) survey, trailer parks in Mississippi found continued deterioration in the physical and mental health of people. Adults surveyed were twice as likely to report “fair or poor” health compared to pre-storm surveys, and children were four times more likely than before.

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While in the affected states, the high level of uninsured was long before Katrina, many previously insured people were without insurance when enterprises closed and jobs disappeared after the storm. In Louisiana, it is estimated that up to 200 people lost health insurance from employers due to hurricanes Katrina or Rita, the last of which hit the region shortly after Katrina in September 000. Katrina also sharply reduced the access of residents to medical care.

In addition to the impact on physical health, Hurricane Katrina left behind devastating levels of mental illness—especially depression and post-traumatic stress disorder, or PTSD. Surveys in October 2005 found that a third of respondents experienced PTSD and were likely to need mental health services. Despite this, less than 2% of families included someone who actually sought counseling or other mental health treatment within two months of Katrina.

Among people who remained displaced for many years after the storm, mental illness rates were even higher and longer. Over 70% of people reported symptoms of depression, with nearly 60% showing signs of severe depression. In addition, according to researchers, “24% of respondents reported suicidal thoughts, and 5% reported personal suicide attempts.” Few residents of the trailer park had access to mental health services; Of those struggling with mental health problems, two-thirds have not received any treatment or counseling since their evacuation.

Children suffered the most severe and lasting health effects from Hurricane Katrina. In February 2006, researchers from Columbia University surveyed children in FEMA-supported housing throughout Louisiana and found that gaps in access to health care during and after the hurricane exacerbated chronic conditions that affected 40% of the children surveyed. One in five children with prescription drug needs were unable to take all of their medications—a rate that was 12 times higher than among Louisiana children before the storm. In addition to the difficulties associated with parents' loss of income or lack of health insurance, access to such medications was blocked by the loss of medical records or prescription histories, the inability to contact the child's previous doctor, or the closure of local pharmacies. Parents were three times more likely to describe their children's health as "fair or poor," and 43% of parents indicated that their children exhibited behavioral changes or other symptoms of emotional distress.

Evaluation of PTSD among schoolchildren in four districts in southeastern Louisiana showed that in the 2005-06 school year, 49% of students scored high enough to get a referral to a psychiatric service. Students are more likely to suffer from PTSD if they still did not live at home, were separated from their parents or guardians, if they were evacuated to a shelter and not to a relative's house, or if a family member or friend was killed during a storm or floods.

Because a large portion of the affected population was low-income, Medicaid coverage played an important role in providing access to health care after Hurricane Katrina, but only for those who could obtain it. Before Congress passed the ACA, only low-income people who met strict eligibility rules—including some people with disabilities, children, seniors, pregnant women, or very low-income parents—were eligible for Medicaid coverage. All other low-income individuals, especially nondisabled adults without children, were ineligible. In addition, the Medicaid enrollment process was slow and required excessive documentation. These were significant obstacles for the displaced population, who needed urgent assistance and often did not have access to the necessary records.

It quickly became apparent that the need for insurance overshadowed the traditional right to participate in the program. By early October 2005, low-income evacuations had filed nearly 7000 applications for Louisiana Medicaid coverage; however, 58% of these applications were not approved, mainly due to non-revenue-related program restrictions. In addition to the refusals to apply, one fifth of the people said that they clearly did not meet any of the traditional eligibility categories.

To quickly alleviate refugee suffering from natural disasters, many policymakers turned to the Medicaid disaster relief program, which the New York and state governments created in collaboration with the Bush administration after the September 11 attacks. This was a temporary extension of coverage by four months, which allowed all low-income people in the disaster area to enroll in the Medicaid program through an abbreviated one-page application.

Many health policy experts, including those from the Center for American Progress, have called for a similar program for the states of the Gulf of Mexico after Katrina. With significant bipartisan support, Senators Chuck Grassley and Max Baucus introduced legislation similar to the New York program, which suspended additional requirements and offered 5 to 10 months of coverage to all low-income people in areas affected by natural disasters. The proposed program would be fully funded by the federal government to ease the burden on shattered state budgets. However, for ideological and budgetary reasons, the Bush administration rejected this approach, putting pressure on Republican members of Congress to refuse and block the bill.

To date, in most states, ACA has extended Medicaid to all Americans who earn less than 133% of the federal poverty level. This measure removes the main barrier that prevents uninsured low-income people from receiving insurance coverage after Hurricane Katrina. However, the U.S. Supreme Court ruling on supporting the ACA in 2012 made Medicaid unnecessary for states.

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It is important to note that the costs of covering this group of new eligible persons were financed almost exclusively by the federal government until 2016, when the state share appeared in expenses and reached 2020% by 10.

Leads some numbers Vox:

• Before Katrina, there were 4083 hospital beds in New Orleans. A year later, 1 remained.
• About 4500 doctors serving three city congregations were forced to move because of Katrina, and after a year only 1200 returned to practice.
• The number of nursing homes was reduced from 51 to 29, resulting in a decrease of 2200 beds in the city.

But things have improved somewhat over the years.

In August 2015, Kaiser researchers summarized their findings on how the city changed 10 years after the storm:

• In 2006, 85% of people said they were worried that medical services would not be available if they needed them. By 2015, this share fell to 54%.
• In 2006, only 1% believed the city had enough health care services for the uninsured and poor. In 2015, this figure rose to 28%—still low, but a significant improvement.
• 74% of city dwellers said disaster helped them learn how to better cope with stress.

There are still many problems. There were noticeable racial differences: for example, African Americans were more likely to claim that they delayed treatment or struggled to pay medical bills than white residents. A well-known minority of residents, 21%, said they were still having difficulty sleeping many years later due to a storm-related injury.

You can get help from the government if you are affected by a disaster or natural disaster in the United States. You can find out about the available options for such assistance. at this link.

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