Number of local residents without health insurance rose in 2010

Hospitals spent more on charity care; fewer patients paid debts

By Paris Achen, Columbian courts reporter

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To see Clark County health insurance rates by year, age, sex and income or to compare different counties, try the Census Bureau’s interactive database

Dr. J. Michael Albrich, medical director of Legacy Salmon Creek Medical Center, has seen lives ruined from lack of health insurance. One patient without health insurance lived with neck pain for a year and a half, which turned out to be cervical stenosis - nerve compression in the neck, Albrich said. The man waited until he had lost motor strength in his arms to seek help in Legacy Salmon Creek's emergency room.

"Had the patient responded to the neck pain, even after six months, it is likely he would not have suffered the permanent weakness in both arms," Albrich said.

The share of people with health insurance continued to decline in 2010 among low-income and lower middle class Americans, including Clark County residents, according to recent statistics from the U.S. Census Bureau. About 15.2 percent of county residents were uninsured in 2010, up from 14.6 percent in 2009.

Much of that increase was due to unemployment and other effects from the recession.

As a result, hospitals spent more on charity care and saw fewer debts paid by patients who didn't qualify for charity care. At Legacy Salmon Creek, charity care costs went up by 70 percent, from $5.6 million to $9.4 million, between the beginning of the recession and the 2011-12 fiscal year, said Jonathan Avery, chief administrative officer. Unpaid debt went up 60 percent during the same period, from $10 million to $15.9 million, Avery said.

Income differences

The census statistics focus on residents who earn

138 percent to 400 percent of the federal poverty level in 2010. That equates to an annual income range of $30,440 to $88,232 for a family of four.

Residents at 138 percent of poverty -- the equivalent of $30,440 per year for a family of four -- were more likely to be uninsured. However, uninsured rates went up between 2009 and 2010 for all income levels up to 400 percent of poverty -- about $88,232 per year for a family of four in 2010.

About 28.2 percent of Clark County residents at 138 percent of poverty were uninsured, up from 27.1 percent in 2009. As income levels rose, the percent of those uninsured fell. About 23.1 percent of county residents at 400 percent of poverty were uninsured. But the higher income group's uninsured rate has been increasing at a greater rate than the lower income group's. Only 20.5 percent of county residents at 400 percent of poverty lacked health insurance in 2009.

Age differences

Clark County residents between 50 and 64 were the least likely to have health insurance in 2010. People in that age group may have been laid off or opted for early retirement during the recession. That group also rarely qualifies for Medicaid coverage, Avery said.

The county's children, younger than 19, were the most likely to be insured. That's due largely to the state-subsidized Apple Health for Kids program, said Long Vue, health educator at Clark County Public Health. Just 1.3 percent of the county's children lacked health insurance, according to the census report.

Some 36,981 children in the county had health insurance through Apple Health in 2012, according to state Health Care Authority statistics. That represents about 34 percent of insured children in the county.

Sex differences

Men were more likely to lack health coverage than women in Clark County. About 16.7 percent of men in 2010 didn't have health insurance, compared with 13.8 percent of women.

Health care reform

Barring repeal, the Affordable Care Act is expected to help improve access to health coverage for up to 79 percent of uninsured county residents -- about 51,900 people -- by 2014, according to a report from the Washington State Office of the Insurance Commissioner. That would come from both voluntary state expansion of Medicaid eligibility and subsidies to help people pay for health insurance, according to the report.

Hospitals such as Legacy Salmon Creek are unsure how the increase in coverage will play out. People with Medicaid may continue to face challenges accessing primary health care, given that only about 50 percent of physicians accept the subsidized program for payment due to low reimbursement rates, Avery noted.

Legacy Salmon Creek, for example, estimates that more than $20 million in health care costs at the hospital were not reimbursed due to the low rates in 2011-2012, Avery said.

Avery said improving access to health care involves more than insuring Americans; the cost of health care also must go down. The federal government is beginning to reward hospitals with higher reimbursements rates for positive health outcomes, in order to encourage efficiency.

The United States pays the most per capita in health care costs -- about $8,233 each in 2010 -- out of 22 industrial nations, according to the Paris-based Organisation for Economic Co-operation & Development. The second highest in 2010 was Norway at $5,388 per person, according to the OECD statistics.

Paris Achen: 360-735-4551; http://twitter.com/Col_Trends; http://facebook.com/ColTrends; paris.achen@columbian.com.