Hurricane health crisis unaddressed by govt. plans

Two months after vicious winds and surging waters crushed communities on the Gulf Coast, the health institutions impacted by the storm are at the center of a different calamity, fraught with waiting lists, empty prescription bottles and unpaid medical bills. The Bush administration's plan for addressing the health needs of hurricane survivors is to adjust the Medicaid system, the federal healthcare program for the poor. But healthcare advocacy groups say such stopgap measures fail to remedy the short-term crisis or the longstanding problems amplified by the plight of Katrina's poorest victims. Through a special waiver program, the Department of Health and Human Services has authorized states to provide Medicaid to Katrina survivors based on existing eligibility guidelines that cover families, the elderly and the disabled. But these provisions leave out many poor adults, including those who have lost jobs and employer-sponsored healthcare plans due to the hurricane. A state-led outreach effort in shelters, which ended last month, found that nearly one in every five survivors who requested Medicaid was rejected during initial eligibility screenings because they did not fit Medicaid requirements. Tara Lachney, a spokesperson for the Louisiana Department of Health and Hospitals, reported that of about 6,900 remaining households that progressed to the application process, nearly 60 percent were denied coverage or had their applications shelved "in hopes that we would be able to cover them under a future program." Those hopes are riding on legislation to expand Medicaid in Katrina's wake. A bill introduced by Senators Charles Grassley (R-IA) and Max Baucus (D-MT) would essentially grant full coverage to all affected individuals who met basic income requirements and would waive state matching fund rules, thus committing the federal government to absorbing the full cost. But conservative lawmakers have stalled the proposal, instead pushing through a narrower plan that would relieve impacted states of matching payments but would not broaden eligibility categories. As talk of reform dies down in Washington, service providers resign themselves to desperate but familiar shortages. Anthony Iton, public-health officer for Alameda County, CA–which has absorbed about 1,200 Katrina evacuees, most from New Orleans–sees the daily struggle to care for survivors as part of a more troubling syndrome. Most of the survivors who have accessed Alameda's medical system lack private insurance, and many have chronic conditions like hypertension and diabetes. Iton said that as service providers connect survivors with local care networks, "the Katrina impact is noticeable, but it's not necessarily something that's going to break the system, because the system is already pretty much operating on fumes, anyways." The Kaiser Family Foundation conducted a survey of 680 refugees in Houston, TX–nearly all from the New Orleans area–and found that of surveyed childless adults under 65 who would probably not qualify for Medicaid, about half lacked any insurance, and nearly one-quarter reported a time since the hurricane when they needed medical attention but did not receive it. There is also fear that the public-health infrastructure will not be rebuilt fast enough to keep pace with the repopulation of the area. Several hospitals, including Big Charity Hospital, the city's primary indigent-care facility, are now shut down indefinitely. Thousands of the city's healthcare employees have been temporarily laid off. "We're still worried about the future, in terms of having enough healthcare facilities available to take care of patients," said Joseph Guarisco, an emergency-medicine specialist at one of the city's only fully operational facilities, Ochsner Clinic Foundation Hospital. The reopening of the city, he said, has increased intakes of injuries and acute illnesses, but "there's certainly no trauma system in place" to absorb an influx of patients. But one unique initiative in the city's Algiers district is trying to sow an alternative public health system that cares for underserved populations without compromising quality–or principles. The Common Ground Collective Clinic, established by activists shortly after the hurricane, hopes to raise the bar for the city's healthcare. "We treat people with respect," said Scott Weinstein, a volunteer nurse from Montreal who helped establish the operation. "… as neighbors. Not as clients." Operating out of a converted mosque–with technical and material support drawn from donations around the country, local health authorities and federal relief agencies–the volunteer staff provides free health care to about 100 patients of all ages in a typical day. The clinic offers routine services like prescription refills and vaccinations, along with less conventional treatments like acupuncture and massage therapy. Their next move will be to transition to a standard nonprofit structure with a full-time staff and, eventually, to pass control of the free clinic on to its main stakeholders: the local people it serves.