Shut Out on Healthcare After Storm

Like most of those whose lives were upended by Hurricane Katrina, 52-year-old school bus driver Emanuel Wilson can thank the federal government for the fact that he has money to pay rent. He’s also been given food stamps to make sure he can buy groceries. And if he had young children, the government would almost certainly be helping them get back to school.

But what Wilson needs is chemotherapy, and that is something the government seems unable to help him with. Wilson was being treated with monthly chemo injections for his intestinal cancer before the hurricane.

He has been denied assistance largely because, before the storm, he had what the government says it wants every American to have: health insurance.

The New Orleans man’s plight illustrates one of the most perplexing twists in the still-faltering federal effort to help Gulf Coast hurricane victims: a seemingly inconsistent approach to victims’ healthcare needs that appears to punish those who had taken the most responsibility for their own care.

Under the present rules for Katrina victims, if you are destitute, the government will pay your medical bills. Ditto if you are severely disabled or have children. But if you’re an adult who had a job that included health benefits and you lost that job because of the storm, the government can’t seem to help.

That’s true even if, as with Wilson, there is every prospect that you can get your old job back as soon as things begin returning to normal.

“I went to Medicaid, and the lady I talked to let me know that Medicaid is mostly if you’re disabled or pregnant,” said Wilson, who fled New Orleans to Baton Rouge, La. “I don’t want to become disabled, and I don’t think I can become pregnant, so that leaves me out in the cold.”

Wilson can’t reinstate his health insurance -- which expires at the end of this month -- because the storm wiped out his job. The government says he doesn’t fall into any of the rigid eligibility categories for federally sponsored Medicaid.

He’s not alone. Of 6,322 displaced households that had applied for Medicaid through Sept. 23 in Louisiana, more than half, 3,456, were not eligible under current rules, according to the state.

In the Senate, a bipartisan bill would open Medicaid -- the federal program created to serve the needy -- for tens of thousands of displaced people like Wilson for up to 10 months. The Bush administration opposes that, saying it would create a major new entitlement.

Former House Speaker Newt Gingrich (R-Ga.) said Wilson’s predicament illustrated deeper problems with health coverage in America. The administration, he said, is missing an opportunity to use the disaster as a laboratory for reforms. But he also disagrees with the approach proposed in the Senate.

“We ought to give these people vouchers to buy private health insurance,” Gingrich said. “There is no reason you can’t help everybody who is displaced. If you voucherize everyone in this displaced group, that could be a major step toward a better healthcare system.”

While Washington debates, Wilson’s chances of getting the chemotherapy he needs from local medical providers may be slim, because much of the private and public financing for Louisiana’s healthcare system is drying up. Businesses shut down by Hurricanes Katrina and Rita don’t generate income to pay for employee health plans or state tax revenue to support public programs. Not only patients, but healthcare providers, face a precarious future.

The administration has taken some steps.

Paperwork requirements for getting Medicaid have significantly eased, but benefits remain restricted mainly to welfare families, severely disabled people, and low-income children and their parents. For adults with no children at home, there is only a federal promise to help hospitals and clinics cover the cost of treating charity cases. That might encourage a local provider to pick up Wilson’s treatment, except that the administration has not asked Congress for any money for that purpose.

In the Senate, a $9-billion bill with bipartisan support would help cover costs of healthcare in Louisiana, Mississippi and parts of Alabama. Childless adults with low incomes -- like Wilson -- could get Medicaid. Subsidies would help others maintain private coverage. Hospitals and other facilities could tap into an $800-million fund for hurricane costs.

But opposition by the administration has stalled the legislation. Health and Human Services Secretary Mike Leavitt said it would establish “a massive new federal program” and “a new Medicaid entitlement.”

“We have a massive disruption in public services for healthcare,” said the chief executive of the Louisiana Assn. of Nonprofit Organizations, Melissa S. Flournoy. “If we’re not getting assistance at the federal level, the state of Louisiana will not be able to address the critical needs of our citizens on our own.”

State officials say they expect things to get worse.

Louisiana may have to cut healthcare benefits for the poor and disabled, not expand them to help others, said Charles F. Castille, undersecretary of the state Department of Health and Hospitals, which oversees Medicaid. Already one of the nation’s poorest states, Louisiana expects state revenues to plummet as a result of damage to the New Orleans economy.

“Katrina just blew a hole in our state budget,” Castille said. “We do not anticipate that we will be able to generate anywhere near the state match necessary to support [the current Medicaid] program.” Federal matching funds pay about 70% of the cost, but Castille estimated that Louisiana’s share still exceeded $1 billion.

The expected hurricane-related shortfall in state revenues may lead to a cut of as much as 40% in Louisiana’s share of Medicaid, he said.

The Senate bill calls for Washington to cover 100% of the Medicaid program in the disaster areas through 2006. But the Bush administration says that would require federal taxpayers to pick up expenses not directly related to the hurricanes.

In Louisiana, state caseworkers who deal directly with evacuees say they are troubled by having to deny medical coverage to people whose lives have been upended and who are clearly in need.

“I feel we are neglecting some of our population,” Sue Fremin, director of the St. Martin Parish Medicaid office, wrote in an e-mail to her superiors in Baton Rouge. “These are people who maybe were hurt during or after the storm, and now have no income.” St. Martin Parish is west of New Orleans.

In an interview, Fremin said the case that prompted her e-mail involved a 32-year-old man who tore his Achilles’ tendon while helping to unload relief supplies. He now has trouble walking. He had worked at a hospital before Katrina.

“Trying to help the victims, he became a victim himself,” Fremin said.

At Our Lady of the Lake Regional Medical Center in Baton Rouge, the caseload has jumped since Rita and Katrina, and the share of patients who are uninsured has increased by two-thirds, to 10%.

“When does it bring us to our knees?” asked the hospital’s chief executive, Robert C. Davidge. “The guy adrift in the ocean knows he can’t make it ashore, but he’ll swim as long as he can.”

Wilson, the school bus driver with intestinal cancer, was diagnosed last year and had surgeries in December and June. His monthly chemotherapy costs more than $900. Other medications he takes cost about $300 a month.

“All I want is temporary assistance, because I know the schools can’t stay closed forever,” he said.