Case Managers and the Uninsured Population

Emergency Room Case Management

Whether you are the Emergency Department case manager or a case manager on a unit within the hospital, you have encountered the uninsured patient. Unfunded patients come in all shapes, sizes, colors, cultures, ages, and genders. Some use the Emergency Department as their only source of healthcare for services from immunizations to broken bones to life threatening conditions. Others avoid all healthcare services since they do not have insurance only to present to the Emergency Department in critical conditions. In an emergency, hospitals are required to provide care to individuals presenting regardless of their ability to pay. Triage for an individual’s medical needs come before staff can do a financial triage. Many of these critical conditions could have possibly been prevented or at least minimized with regular primary care services.

Situations such as these are the reasons why hospitals employ specialized staff to assist patients with applying for any and all financial aid. The short term goal for the hospital is to receive payment for services provided. Long term goals include payment for ongoing care, individuals receiving insurance enabling them to obtain healthcare in less expensive outpatient healthcare settings and take advantage of preventative services for a healthier and better quality of life.

The numbers do not lie when looking at the non-elderly uninsured. The Affordable Care Act (ACA) led to historic gains in providing individuals with healthcare insurance coverage. This coverage includes Medicaid Benefits to those below 400% of the poverty level.

Opportunities for additional insurance options are available through the Health Insurance Market Place. In 2013, 44 million were without any healthcare insurance. This data is reflective of a year before the ACA went into effect. In 2016, the number of non-elderly uninsured individuals decreased to 28 million. (Henry J Kaiser Family Foundations, Key Facts About the Uninsured Population, November 29, 2017, Updated, Analysis of The March 2017 Current Population Survey Annual Social and Economic Supplement)

The individuals still without healthcare insurance include those who are not eligible for Medicaid Benefits but unable to afford the cost of coverage through other options. Out of pocket medical expenses are a leading cause personal bankruptcy. (2017’s State Uninsured Rates, 9/15/17, John S. Kiernam, Senior Writer Editor, Wallethub). They do not have insurance through their employers and or they do not know about healthcare insurance options available to them. Finally, undocumented immigrants are included among the non-elderly uninsured.

Those without insurance often do not receive preventative care or services for major health conditions or chronic diseases. Lack of healthcare insurance is associated with increased mortality in the range of 30-90 thousand death per year. (Health Insurance Coverage in the United States, Wikipedia.) This group of uninsured individuals has less access to recommended care, they receive poorer quality of care and have worse health outcomes than insured adults. (The Milbank Quarterly, A Multidisciplinary Journal of Population Health and Health Policy, Health Consequences of Uninsured Among Adults in the US Recent Evidence and Implications, J. Michael McWilliams)

All this data can make for interesting reading, if you had time to read it. You and all the other Case Managers working in the trenches know the faces of these numbers. Their lives become known to us and we see them as the people they are, not a number. We see the fear in their eyes, the tremble in their voices and their hesitancy in their answers for fear of the unknown. Their situations become our situations to solve and improve. This is the role of Case Managers in the Healthcare setting especially involving the non-elderly uninsured population. We willingly accept this challenge and commit to doing the best with declining government benefits, limited community resources and fragmented family support.

Cathy Massaro MSW, CCM

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