‘I might have to die’ without Medicare, says St. John's patient

Apr 21, 2011 Issues: Health Care, Social Security

GOP changes would be devastating, St. John’s staff tells Rep. Levin

Sylvia Harper lies in a bed at St. John’s Providence Hospital in Warren, “scared to death” as she awaits surgery to repair a complicated shoulder injury but grateful that she has Medicare insurance coverage.

Retired from a steel company where she performed heavy industrial work, Harper survives on a pension and Social Security checks, but she said she couldn’t afford Medicare if the out-of-pocket costs rose dramatically.

“Without coverage, I don’t know. I might have to die,” she said. “They might throw me out of here. I can’t afford it (the surgery).”

Harper was among the patients whom U.S. Rep. Sander Levin met on Wednesday as he toured portions of the hospital and questioned doctors and administrators about the potential impact of a Republican proposal to convert Medicare insurance into a voucher system.

Levin and other critics point to a government estimate that forcing seniors to shop for insurance on the private market, armed with a federal allocation that annually shrinks in size, could mean future retirees will pay $6,000 more per year in out-of-pocket costs than under the current system.

Diane Radloff, an executive vice president with the St. John’s Providence health care system, said the Warren site (formerly South Macomb Hospital) already struggles with its finances for two reasons related to the nation’s health care system:

Some 57 percent of all patients are covered by the Medicare program, which already presents reimbursement difficulties.

And a staggering 65 percent of hospital admissions consist of people who show up at the emergency room.

In some cases, those seeking ER care are seniors who tried to avoid co-pays at their primary care physician’s office and grew increasingly ill, according to Radloff. Some others are chronically ill elderly who fail to purchase their full complement of prescription drugs for financial reasons.

As a result, the Warren hospital’s “uncompensated care” has jumped by 46 percent in three years, to $52 million annually. And administrators predict that the Republican transformation of Medicare would double or triple the unpaid costs that the hospital will swallow.

“We care for everybody, but we do it with no compensation,” Radloff said.

The House GOP budget plan approved earlier this month would eventually move toward a voucher system for any Medicare recipient, including the disabled, who is currently under 55 years of age.

Democrats say the proposed changes would provide a federal subsidy to seniors that is set below Medicare’s coverage value and fails to keep pace with rising health costs. Those who turn 65 in 2020 would be required to purchase private insurance in a health care “exchange,” a marketplace similar to the shopping process for the uninsured established by the 2010 health care reform law.

Critics say the annual cost to seniors — premiums, co-pays and deductibles — could double by the time the program is fully effective in 2022, growing from roughly $6,200 to more than $12,500.

In addition, the Republican approach would abandon efforts in the 2010 health care reform law to gradually close the “donut hole” in yearly Medicare prescription drug benefits. Those benefits dry up after $2,500 of coverage and then are revived at when a senior’s expenses reach the $5,000 mark.

Levin, a Royal Oak Democrat who represents most of Macomb County, said he also worries that other long-term health care reforms will fade if the GOP austerity program prevails.

One initiative that is very valuable, according to doctors and administrators, is the federally backed move toward a fully integrated information technology network for the nation’s health care providers, with no more paper records, files or charts.

The congressman said the goal of increasing efficiency by “bundling” hospital bills for Medicare patients could also be shelved if the senior population receives coverage from dozens of different insurers.

“We’ve got to get away from fee-for-service,” Levin said. “We have to rationalize our reimbursement system.”