Who covers the medical expenses of victims of mass shooting, street conflicts and natural disasters in the United States

The epidemic of mass shootings and riots in the United States is forcing the medical providers to develop new skills to assist patients with large medical expenses, writes Modern Healthcare.

Кто покрывает медицинские расходы жертв массовой стрельбы, уличных конфликтов и стихийных бедствий в США

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What is happening in the country reveals serious problems in insurance coverage for medical and long-term care, which may require people. Hospitals in Fort worth, Texas, Las Vegas and San Bernardino, California, Aurora, Colorado, Orlando, Florida, Newtown, Connecticut and other places helped the victims of the shooting to cope with large uncovered costs. These costs include hospital treatment, subsequent surgery and other treatment, psychiatric care, rehabilitation and skilled nursing care durable medical equipment use, personal care and accommodation costs, while patients are unable to work.

Needs are compounded by the proliferation of health plans with high deductibles and requirements for cost-sharing regarding patient and insurance companies, with the result that patients are faced with huge bills. Seriously injured patients that require repeated operations can repeatedly go beyond their personal expenses, which can lead to bankruptcy. Furthermore, even insured patients can face big bills surprises if they turn to providers outside the network.

“Life with an injury because of the weapons associated with huge costs, says Denmark Palanker, insurance expert at the Institute for health policy at Georgetown University. — For many people expenses such as personal care, are not considered by our system of insurance”.

The number of hospitals serving the victims of mass executions, such as hospital, Sunrise Hospital & Medical Center and medical center of Dignity Health”s St. Rose Dominican in Las Vegas, announced a new policy of reducing or eliminating payments for these patients. But this is only part of the financial question.

Orlando Health, the company wrote off the balance totaling approximately $ 5 million for 135 patients that received treatment after the shooting at the nightclub Pulse in June 2016, at which 49 people were killed and 58 were injured. In addition, its staff worked closely with patients and their families to find ways of funding their ongoing needs for medical and long-term care, said Michelle Napier, Director of revenue.

“Orlando Health has considered it a tragedy and a crime against humanity, so we decided to write off the responsibility for these patients,” she said. Many of the patients are faced with a deductible of $3500 plus co-insurance that they didn’t put in funds, so the system worked with insurers patients to address these issues.

But the company and staff knew that it will not solve long-term needs of patients. They acknowledged that will have to help patients find sources of funding to meet their needs, and to enable them to rebuild their lives.

Patients with gunshot injuries may require extensive rehabilitation, physical therapy, speech therapy, high-quality wheelchairs, home modifications and long-term therapy in mental status. According to Napier, even patients with insurance may be limited coverage or no coverage of such services. According to Palanker for shooting victims and their families who do not receive aid, as proposed by Orlando Health, that is a hard work on account management and organization of all services, especially if the person is in need of highly specialized care outside of his hometown.

The senators from Nevada’s Catherine Cortez Masto and Dean Heller in his time called the leaders of American health insurance plans Association and Blue cross and Blue shield to reconsider their plans to provide more generous coverage for hundreds of people, victims of the mass shooting in Las Vegas in October 2017. They asked about the cancellation of deductibles, co-payments and out-of-network payments.

However, the victim of the shooting was faced with many expenses that are never covered and are not covered by insurance, for example, the hiring of assistants for cleaning their homes and cooking, and living expenses until they worked (and if they are unable to work). Relatives and friends of the many victims of mass shootings, even those who had good medical care, had to create a GoFundMe crowdsourcing page to help pay the bills.

Garnier Wintemute, doctor of medicine and researcher of violence with a firearm at the University of California at Davis, told Kaiser Health News (KHN) that the total medical costs of victims related to mass shootings in Las Vegas three years ago, can reach tens of millions of dollars, writes Becker’s Hospital Review.

Ted Miller, PhD, studies the cases of violence in the Pacific research Institute, estimated the health care costs for survivors throughout the remainder of life at least $600 million.

In KHN refer to the study on health, which shows that the average bill from the emergency Department for an individual victim of the shooting amounted to $5254, and the average cost of inpatient treatment is $96 000. The study showed that these expenditures lead to roughly $2.8 billion a year to pay for the services of admissions and fees in a hospital.

19-year-old Riley Golgert was one of the victims of the shooting in Las Vegas October 1, 2017. She received a bullet wound in the spine. The expected total cost of treatment daughter cost her mother Janice in $1 million over several years. Only stay in the hospital for the first stage of treatment cost $400 000 and her insurance company, not including therapeutic costs. She is not alone: a survivor in this shooting years face major medical expenses, depending on their wounds, tells the Las Vegas Review Journal.

40-year-old Nadine of Ludmerer was wounded in the left thigh and broke his left arm at the same fatal festival in Las Vegas. Bullet and shrapnel in her leg led to permanent nerve damage and severe pain. A woman cheerfully and gently tries to pay the bill for the account independently. Ludmerer and Golgert used to the “new normal” life. Both families do not allow medical bills to get in the way of their happiness and quality of life to which they aspire, says Janice.

All of this raises the broader question of how to enable people with partial disabilities to continue working, instead of giving them no alternative but to apply to receive disability benefits the social security program and Medicaid.

In 2005, hurricane Katrina struck Southeast Louisiana, leaving unprecedented destruction and in dire need of medical care. Because of the storm and accidents on the Causeway in Louisiana was killed 1577 people, while in Mississippi — still 238 people. Thousands of people suffer from immediate health problems as a result of the hurricane, many could not access medical care or medications, prescription, for existing conditions. Countless people have experienced serious mental health problems, including depression and post-traumatic stress disorder that continues for many years, writes Center for American Progress.

Although the Bush administration approved the temporary expansion of Medicaid after the September 11 attacks, to reach survivors with low incomes, she refused a similar approach after Katrina and have supported restrictive rules of admissibility. As a result, thousands of uninsured evacuees who tried to sign up for insurance coverage was rejected in moments of extreme need.

The expansion of Medicaid through the affordable care Act service, or ACA, rolled these restrictive eligibility rules in most States and created a more reliable system of medical insurance. However, despite the ability to significantly improve access to health services during and after future disasters, States of coast of the Gulf of Mexico still refused to expand Medicaid.

At a time when the hurricane struck the US, the level of uninsured in the United States on the way the disaster was one of the highest in the country. Annual study in public health have included Mississippi and Louisiana as one of the two least healthy States in the country in 2004. Consequently, public health in these States was particularly vulnerable to disasters.

A survey of evacuees from New Orleans in a shelter in Houston in September 2005, confirmed the immediate impact of the storm on health. The interviewed evacuees were predominantly African American, low-income, and 52% had no insurance. A third of respondents reported having health problems or injuries as a result of hurricane and floods, with 41% of respondents cited these health concerns are “serious”. Every fifth Respondent with health problems related to the hurricane, did not receive medical care at the time of the survey. In addition to its new health problems, many of the evacuees had pre-existing medical needs, such as prenatal care for pregnant women or chronic diseases for the elderly. It was assumed that more than 40% had taken prescription drugs, and a third of all respondents are left without drugs, they were needed at some point after the storm.

A survey conducted in October 2005 among the returned residents of New Orleans and neighboring Jefferson County, showed that more than half of all surveyed families was the person who was sick or injured within two months after the storm, and a quarter of families experienced difficulties with access to medical care or prescription drugs during this time. Two years later, after a survey of the Federal emergency management Agency (FEMA), in trailer parks in Mississippi, found continuing deterioration in physical and mental health. Adult respondents are twice as likely to report “fair or poor” health, compared with surveys before the storm, and children — four times more often than before.

While in the affected States with a high level of uninsured was long before Katrina, many previously insured people were without insurance when the company closed and jobs disappeared after the storm. It is estimated that in Louisiana, up to 200 000 people have lost health insurance from employers due to hurricanes Katrina or Rita, the last of which struck the region shortly after Katrina in September 2005. Katrina also dramatically reduced people’s access to health services.

In addition to the impact on physical health, hurricane Katrina left behind a devastating level of mental illness — especially depression and post-traumatic stress disorder, or PTSD. A survey in October 2005 showed that a third of respondents experiencing PTSD and probably need the services for protection of mental health. Despite this, less than 2% of households included someone who actually visit and seek counseling or other psychiatric treatment during the two months after Katrina.

Among people who remained displaced for many years after the storm, indicators of mental illness was even higher and long-lasting. More than 70% of people reported symptoms of depression, and almost 60% had signs of serious depression. In addition, according to the researchers, “24% of respondents reported about suicidal thoughts, and 5% reported personal suicide attempts”. The few residents of the trailer Park have access to the services of mental health; of those who struggle with mental health issues, two thirds had not received any treatment or counseling since their evacuation.

Children suffered from the most severe and prolonged health effects from hurricane Katrina. In February 2006 researchers from Columbia University surveyed children in FEMA-supported housing across Louisiana and found that the gaps in access to health care during and after the hurricane exacerbated chronic diseases, which had suffered 40% of the children. Every fifth child in need of prescription medications, was not able to take all your medication — the rate was 12 times higher than among children from Louisiana before the storm. In addition to the difficulties associated with income loss of parents or lack of health insurance, access to such medicines were blocked by the loss of medical records or history of the recipes, inability to contact the previous child’s doctor or the closure of local pharmacies. Parents are three times more likely to describe their children’s health as “fair or poor” and 43% of parents indicated that their children manifested behavioural changes or other symptoms of emotional distress.

Assessment of PTSD in school children in four districts in the southeastern part of Louisiana showed that in the 2005-06 school year 49% of students scored high enough score to get a direction to a psychiatric service. Students will be more likely to suffer from PTSD if they still lived at home, were separated from their parents or guardians, if they were evacuated to a shelter, not the house of a relative, or if a family member or friend was killed during a storm or flood.

Since a significant portion of the affected population had a low income, Medicaid coverage has played an important role in ensuring access to health care after hurricane Katrina, but only for those who can get to it. Before Congress passed the ACA,only people with low income who meet strict eligibility rules — including some people with disabilities, children, the elderly, pregnant women or parents with very low income were entitled to coverage for Medicaid. All other low-income individuals, especially without disabilities, adults without children were ineligible for participation. In addition, the enrollment process in Medicaid was slow and required excessive documentation. It was a significant obstacle for the displaced population, which was in urgent need of assistance and often did not have access to the necessary records.

It quickly became apparent that the need for insurance has eclipsed the traditional right to participate in the program. By the beginning of October 2005 have been evacuated from low-income filed nearly 7,000 applications for insurance coverage Louisiana Medicaid; however, 58% of those applications not approved, mainly due to limitations of the program not related to income. In addition to the waivers in the submission of the application, one in five people said that they do not correspond to any of the traditional categories of admissibility.

To quickly alleviate the suffering of refugees due to natural disasters, many policy makers turned to the example of Medicaid assistance in case of natural disasters, which the government of new York state and created in collaboration with the Bush administration after the September 11 attacks. It was a temporary extension of coverage of four months, which allowed all low-income people in the disaster area to register in the Medicaid program through an abbreviated one-page application.

Many experts in the field of health policy, including the staff of the Center for American progress, called for the establishment of a similar program for the us Gulf coast after Katrina. With significant bipartisan support, senators Chuck Grassley and Max Baucus introduced the legislation modeled on the new York program, which has suspended additional requirements and offered from 5 to 10 months coverage to all low-income people in areas affected by natural disasters. The proposed program would be fully funded by the Federal government to ease the burden on the ruined state budgets. However, for ideological and budgetary reasons, the Bush administration rejected this approach, putting pressure on Republican members of Congress that they refused and blocked the bill.

To date, in most States, the ACA law has extended the right to receive Medicaid to all Americans earning less than 133% of the Federal poverty level. This measure removes a major barrier that does not allow uninsured low-income people to obtain insurance coverage after hurricane Katrina. However, the U.S. Supreme court’s decision on support for the ACA in 2012 made expanding Medicaid optional for States.

It is important to note that the cost of covering this new group of eligible persons was financed almost exclusively by the Federal government until 2016, when the expenditures appeared, the proportion of States and in 2020 reached 10%.

Some figures lead Vox:

  • Before Katrina in New Orleans was 4083 hospital beds. A year later, 1 971.
  • About 4,500 physicians serving three urban parish have been forced to move because of Katrina, a year later, only 1,200 have returned to practice.
  • The number of nursing homes decreased from 51 to 29, with the result that the city was less than 2200 beds.

But everything has improved over the years.

In August 2015, the Kaiser researchers summed up their findings about how the city has changed 10 years after the storm:

  • In 2006, 85% of people said they are concerned that medical services will not be available if they need them. By 2015, this share fell to 54%.
  • In 2006, only 1% believed that the city has sufficient medical services for the uninsured and poor. In 2015, this figure rose to 28% — still low, but the indicator has improved significantly.
  • 74% of residents said that the disaster helped them learn to cope better with stress.

Had a lot of problems. There was significant racial differences: for example, African Americans are more likely to have claimed that they have postponed treatment or struggling trying to pay medical bills than white residents. Known minority residents, 21%, said that they still find it difficult to sleep many years later due to the trauma caused by the storm.

You can get assistance from the government, if suffered from a catastrophe or natural disaster in the United States. To learn about available options such assistance at this link.

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