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A long wait for care


For a Hillsboro family, health care overhaul will be godsend, when it arrives

by: CHASE ALLGOOD - Osvaldo Martinez, his wife Alejandra Galicia and their daughter Alexa, 8, are patients at the Virginia Garcia Memorial Health Center in Forest Grove. They look forward to a day when, under the Obama administration's Affordable Care Act, they'll have full health insurance coverage. Times have been tough in recent years for the Martinez-Galicia family, but with a new job in the picture and the promise of health care insurance on the horizon, things are looking up.

Osvaldo Martinez, 39, had been out of work since October 2010 until recently, when he landed a job as a truck driver for S & M Steel Fab, Inc. of Beaverton. Now, he drives about 100 miles a day for his new company, returning home to Hillsboro most evenings.

His wife, Alejandra Galicia, 37, used to work at a preschool but now is a stay-at-home mother to their daughter, Alexa, 8, a bright but shy girl who’ll start second grade at Brookwood Elementary School next week, where she takes English as a second language classes.

by: CHRISTOPHER ONSTOTT - Linda Monroy's $350-per-month prescription for Advair saves her costly trips to the emergency room. But without help from the Oregon Health Plan, she wouldn't be able to afford the medicine.“We want to establish ourselves here,” said Martinez, who is originally from Michoacan, Mexico, but made sure he, his wife and daughter became legal U.S. citizens. “We want to raise our daughter in the states, away from all the corruption.”

Galicia agreed. “We think Alexa will go to high school, and maybe college, if there’s money,” she said. “Here, she can have a career.”

The family, which at least at this point is unable to afford the $400 a month Martinez’s company charges for health insurance, visits the Virginia Garcia Memorial Health Center clinic in Hillsboro for routine exams and when one of them comes down with an infection or other malady.

They’re among the approximately 40 percent of Virginia Garcia patients who are uninsured or underinsured.

Expensive surgery

While Martinez said he was unaware of a recent project that has health care researchers showing renewed interest in Oregon — an experiment called the Oregon Health Study — he’s looking forward to the day when he can schedule an expensive surgery doctors say he needs in order to regain his full measure of health.

“My husband was going to get a surgery, but he hasn’t yet,” Galicia said, noting that Martinez suffers daily pain from an anal fissure that can only be fixed by an operation he anticipates would cost between $5,000 and $9,000 out-of-pocket.

“Hopefully that happens soon,” he said. “But I can’t pay for it now.”

Enter the Affordable Care Act, the Obama administration’s landmark health care bill, upheld by the U.S. Supreme Court June 28. The most significant element of the act will extend health care insurance to an estimated 30 million Americans — including the Martinez-Galicia family.

For years, researchers have wondered what that might mean. Health care providers could be stretched thin as uninsured people who received little health care take advantage of their new status. But economists and hospitals have long made the case that the uninsured cost the health care system vast amounts of money by putting off health care until their conditions became severe and more costly to treat, and by repeatedly visiting emergency departments.

Over the last four years, the Oregon Health Study provided an opportunity to examine those possibilities. Top researchers from across the country began comparing the lives and health care costs of Oregon Health Plan lottery winners with those who remained uninsured. An initial report was released a year ago, and the analysis continues.

Bill Wright, a Providence Health & Services researcher participating in the study, said two primary lessons so far are clear.

“A lot of folks have said Medicaid doesn’t do anything, and we found that it does,” Wright said. “And a lot of folks say (that if) you insure people, it’s going to immediately pay for itself. We found that it costs, at least initially.”

The newly insured low-income lottery winners used more health care than their still-uninsured counterparts — about 25 percent or $777 per year more. They received much more preventive care, including mammograms and cholesterol screenings. They entered hospitals 30 percent more frequently. Surprisingly, they did not go to emergency departments any less frequently than those who were uninsured.

At death’s door

Linda Monroy’s experience is a bit like the Oregon Health Study in miniature. While she enrolled in the Oregon Health Plan four years ago, many of her friends remain uninsured, and she can see how the difference has played out in their lives.

Monroy, of Beaverton, works as a self-employed courier, driving around town delivering medical equipment, blood samples and documents for medical companies. She has five children, but Valentino is the youngest and the only one still living at home.

In 1995, she lost her health insurance, and she remained uninsured until winning the health plan lottery in 2008.

Monroy said that during the 12 years she carried no health insurance, her asthma became far worse. For starters, she could not afford the prescription drug Advair, which costs about $350 per month. Occasionally she would find a friend who had some extra, a few times safety net clinics gave her some, and once the drug’s manufacturer gave her a free one-year supply after she wrote them.

But without regular medication, Monroy noted, even colds were likely to blossom into respiratory crises. She estimates she would visit a hospital emergency department six to eight times a year.

“I would wait until I was at death’s doorstep and I couldn’t breathe,” she said. “The doctor would say, ‘Why did you wait so long?’ And I would say, ‘How do you expect me to pay for the medication and my appointment?’ “

Now insured, Monroy has visited an emergency department only once in the past year, when she couldn’t get in to see a physician during an asthma episode.

Happier people

But one of the mysteries of the initial Oregon Health Study data is that Monroy is not typical. Emergency department visits stayed about the same for those who enrolled in the Oregon Health Plan and those who remained uninsured.

The Oregon study found those who gained Oregon Health Plan insurance improved their financial status considerably, compared to those who remained uninsured. They had a 25 percent decline in unpaid medical bills sent to collection agents, for instance, and a 40 percent decline in borrowing money or not being able to pay bills on time.

In addition to asthma, Monroy suffers from depression and occasional anxiety attacks. Uninsured, she couldn’t afford the medication that had been prescribed for these conditions. Now she takes it regularly.

Monroy says she is certain her enrollment has saved money, despite the study’s finding that those who enrolled used 25 percent more in health care dollars than the uninsured. Her asthma and psychiatric medications combined cost about $250 a month. She says she visits a primary care physician about twice a year. Add to that about one emergency department visit per year.

Prior to gaining insurance, Monroy says her six to eight emergency department visits each year often cost $2,000 or more apiece. At one point while uninsured, she had accrued $50,000 in unpaid hospital and physician bills, most from her asthma-related emergency department visits, which led to her filing for bankruptcy.

Too embarrassed

Not everyone who was lucky enough to win the Oregon Health Plan lottery in 2008 jumped at the chance to become insured. Researchers say less than one in three lottery winners enrolled in the health plan.

According to Massachusetts Institute of Technology economist Amy Finkelstein, a member of the Oregon study's research team, only about six of 10 who received letters notifying them that they could enroll returned the plan’s applications. Some found the lengthy forms too hard, she theorizes, and others either had moved out of state or knew the income they would have to report would make them ineligible. And some might have been reluctant to reveal they were not U.S. citizens.

Heidi Allen, another of the project's researchers, recalls interviewing a lottery winner who cleaned houses for a living. She had eight clients, and the enrollment form required her to have her clients report how much they each paid her. The woman didn’t like the idea all her clients would know she was applying for Medicaid. In the end, the housecleaner did not enroll.

“She said, ‘I was so embarrassed, I couldn’t even ask them,’ and she just let it go,” Allen said.

Real insurance

For Osvaldo Martinez, learning about the Oregon study was a mere blip on his radar compared to the prospect of having “real, full” health insurance for his wife and child by 2014.

“Alejandra needs contact lenses, but she has been using the same pair of glasses she had last year,” he said. “She’s been getting eye infections. Having insurance will be very good for us.”

Well child check-ups are also important to Galicia and Martinez with Alexa growing solidly into her grade school years. And, the family has another baby on the way.”

“I am one month pregnant,” Galicia said with a smile.

Anticipating a March 2013 birth, she figures the family can hold out for another year by continuing to receive services at Virginia Garcia, which will open a new, two-story, 34-room clinic in the heart of Cornelius in October.

“The health care act will help us a lot,” said Galicia. “I feel very grateful.”

Martinez, too, is looking forward to the safety net insurance will afford her family.

“I believe in what President Obama said, that it’s great for many people in America,” he said. “Especially for the Hispanic community, it’s a real good thing.”