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Treating the uninsured takes more than money



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Published January 20, 2006

Poor folks without health insurance tend to go to the emergency room when they get sick.

Instead of the $20 copay that insured people pay for a doctor's visit, the uninsured rack up big medical bills. That bill often goes unpaid.

In Pasco County, about 18 percent of the population - about 70,000 residents younger than 65 - are uninsured.

In Citrus County, there are 16,724 uninsured. In Hernando County, care for the 26,000 uninsured cost taxpayers about $2.9-million a year.

Seniors 65 and older are covered by Medicare. State programs cover some low-income families. When we are talking about the uninsured, we are mostly talking about the working poor, mostly parents with children.

In Pasco County, hospitals were left holding the bag for $26-million in charity care in 2003 - a 205 percent increase in three years, according to the Florida Agency for Health Care Administration.

That kind of price tag prompted a group of elected officials, county staff members and health care providers to begin looking for a sensible way to pay the rising bill generated by the uninsured and find practical alternatives to folks showing up at the ER for illnesses such as strep throats.

One proposal calls for voters to approve a sales tax increase. Officials have discussed putting the question of a quarter-cent or half-cent sales tax hike on the November ballot. If voters approve, that increase could generate $11-million to $22-million a year, depending on the rate. The money would support a network of clinics, a laudable goal given the county's geography.

However, persuading taxpayers to raise their sales tax two years after a penny sales tax hike for schools, roads and other capital projects will be tough. But if antitax die-hards such as state Sen. Mike Fasano are on board with a half penny for indigent care, then there's hope.

Unfortunately, voter skepticism would be just one obstacle. Since the county is at 7 percent sales tax, the initiative would need legislative approval in Tallahassee. County commissioners would also need to back the move.

But first, proponents of this plan must fashion a vision taxpayers can support.

As part of their discussions, today county and local hospital officials will hear from representatives of Orange County, who in 2001 established the Primary Care Access Network, or PCAN, program for indigent care. The program combines the resources of government, social service agencies, faith-based organizations, private medical providers and physicians to treat poor people at places other than the emergency room.

Orange County officials sidestepped the politically perilous route of asking voters for a tax increase. Instead, they opted to contribute money from the county's budget - about $11-million - to support the network. That money is supplemented by grants. They also use state and federal matching grants to stretch the money even further, says PCAN administrator Margaret Brennan.

The Orange County network is grounded on more than dollars and cents. Physicians and other specialists participating in secondary care programs donated $1.3-million in services last year, Brennan said.

For any Pasco program to work, more area doctors and specialists are going to have to be persuaded to donate their services.

In four years, PCAN has demonstrated the kind of fiscal performance not usually associated with government-sponsored programs.

PCAN started in 2001 with two sites or "medical homes." That has grown to nine sites, and two more will be added by year's end. Now the network is caring for 56,000 patients, Brennan said.

They're seeing more patients for just about the same amount of money.

"We have been able to expand care without increasing our costs," Brennan said.

In the health care industry that's virtually unheard of.

The Orange County network was created on a community consensus that people ought to care about the uninsured, be willing to provide good care and be willing to pay for it.

It's much too early to tell whether that consensus exists in Pasco County.

Andrew Skerritt can be reached at 813 909-4602 or toll-free at 1-800-333-7505, ext. 4602. His e-mail address is

[Last modified January 20, 2006, 11:54:14]

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