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Beyond The Shattered Lives And Bodies, Money Worries Weigh On Las Vegas Victims

Kaiser Health News:Insurance - October 27, 2017

Listen here to Anna Gorman’s radio version of this story, as it ran on Here & Now.

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LAS VEGAS — Kurt Fowler and his wife, Trina, were celebrating their 18th wedding anniversary at a country music festival when the shooting started. Fowler, 41, knew he’d been hit in the ankle and couldn’t run. He hid under the stage until the gunfire ended.

“I knew my foot was completely useless,” said Fowler, a firefighter from Lake Havasu City, Ariz., and a father of three. He underwent surgery, spent nearly two weeks in the hospital and still may need another operation. He also will need rehabilitation and follow-up visits with a specialist.

Fowler has a Blue Cross Blue Shield PPO through his job, but he said he doesn’t know how much he will have to pay out of his own pocket for the care he is receiving. In an era of higher deductibles and limited choice of in-network doctors, however, he knows he could face significant medical bills.

This story also ran in CNN Money. It can be republished for free (details).

His insurance card says his individual deductible is $5,000 and his coinsurance 20 percent. He said he didn’t know how much his health plan would cover for out-of-state care.

“Medical expenses are astronomical these days,” Fowler said from his bed at Sunrise Hospital & Medical Center here. “It’s a mountain that just doesn’t seem like it’s gonna be climbable, but we are gonna do our best.”

As hundreds of survivors struggle to recover emotionally and physically from the Oct. 1 attack, they are beginning to come to terms with the financial toll of the violence perpetrated against them. Even those who are insured could face untold costs in a city they were only visiting.

The total costs of medical care alone could reach into the tens of millions of dollars, said Garen Wintemute, who researches gun violence at the University of California-Davis. And that is just the beginning. Many survivors will be out of work for months, if they are able to return at all.

“We really don’t have a good handle on the intangible costs of something like this … the ripple effects on family and friends and neighborhoods when a large number of people have been shot,” Wintemute said.

Fowler has health insurance through his job as a firefighter from Lake Havasu City, Ariz. But he doesn’t know what out-of-pocket medical costs he may face from the shooting. “Medical expenses are astronomical these days,” he said from a hospital bed at Sunrise Hospital & Medical Center. (Anna Gorman/KHN)

More than 100,000 people are shot every year in the U.S., according to the Centers for Disease Control and Prevention. That generates about $2.8 billion per year in emergency room and inpatient charges alone, according to a recent study in Health Affairs. The average emergency room bill for an individual gunshot victim is $5,254 and the average inpatient charge is $95,887, according to the study.

The U.S. senators representing Nevada, Dean Heller and Catherine Cortez Masto, wrote a letter to America’s Health Insurance Plans, an industry trade group, and CEO Scott Serota of Blue Cross Blue Shield requesting help with out-of-network bills, copayments and deductibles for the Las Vegas shooting victims. Many of the people who were shot had traveled from other states, including California, Iowa and Tennessee.

California and some states protect consumers from such bills, but Nevada is not one of them, said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms. But Corlette said most insurers allow patients to request exceptions based on the circumstances. “In this situation, I imagine most insurers are going to want to be compassionate and work something out,” she said.

The victims and their families aren’t the only ones who will be affected financially by the mass shooting. Taxpayers, too, pick up much of the tab for the health care costs associated with gun violence because many patients are covered by Medicaid and Medicare, two government insurance programs.

And hospitals will also be on the hook for some of the care for patients who don’t have insurance. Hospitals in Las Vegas quickly mobilized to treat the hundreds of victims who were streaming in that night, and they don’t know yet how much of the care will be reimbursed.

At Sunrise Hospital & Medical Center, staff treated more than 200 patients. Sunrise plans to file insurance claims and will “be extremely sensitive to the financial status” of patients when considering their out-of-pocket portions, a spokeswoman said.

Valley Hospital Medical Center is encouraging patients to complete paperwork for a state program called Nevada Victims of Violent Crime, which would pay their balances. And Dignity Health’s St. Rose Dominican said it will bill insurers and accept donations but will not require payment from victims.

California victims can also get help with medical expenses and income loss from the California Victim Compensation Board.

In addition, a GoFundMe account started by a Clark County commissioner has raised $11 million thus far. And many survivors have individual GoFundMe accounts.

Kurt Fowler’s GoFundMe page has raised about $39,000. Fowler said he doesn’t have disability insurance so he will rely on the funds to help cover his expenses while he is recovering and missing work.

Michael Caster, 41, who lives in Indio, Calif., has a GoFundMe account that has raised about $26,000 so far. He’s paralyzed from the waist down after a bullet lodged in his spine.

Michael Caster, from Indio, Calif., was shot as he ran from the Route 91 Harvest festival in Las Vegas. Now, he is paralyzed from the waist down. He spent about two weeks at Sunrise Hospital & Medical Center before being transferred to a rehab center for people with spinal cord injuries. Fowler’s mom, Patricia, was also at the festival and said she fears how expensive his medical care may be. But she said, “Whatever expenses come down the road, we’ll handle it somehow.” (Anna Gorman/KHN)

At Sunrise Hospital, doctors drained the blood from Caster’s lungs and removed some of the bullet fragments. Sitting in a hospital bed 11 days after the shooting, Caster said he didn’t know how much of his care would be covered by his health insurance.

He works in human resources at a California hospital and has a job-sponsored policy with Anthem Blue Cross. “I’ve never really dealt with injury,” he said. “I don’t want to be stuck with a bunch of bills.”

His bills could rise further: That day, he was scheduled to be flown to a rehabilitation center in Colorado for people with spinal cord injuries.

Mary Moreland, whose daughter Tina Frost was shot during the country music festival, said that at first she didn’t understand why so many families were setting up fundraisers. Then, the severe financial strain the shooting would take started to dawn on her.

Now, Moreland said she’s grateful for the $580,000-plus raised through GoFundMe.

A screenshot from a GoFundMe page set up for Tina Frost, who was shot at the country music festival in Las Vegas. Frost was at Sunrise Hospital & Medical Center for two weeks and was recently flown to a hospital near her mother’s home in Maryland. (Courtesy of GoFundMe)

Mary Moreland gets an update on her daughter from neurosurgeon Keith Blum at Sunrise Hospital & Medical Center. Moreland’s daughter, Tina Frost, was shot in the eye and was in a medically induced coma for two weeks. Frost has insurance through her job as an accountant in San Diego, but her mother said she knows it won’t cover everything. (Anna Gorman/KHN)

Frost, a resident of San Diego, had emergency brain surgery the night of the shooting. A bullet had pierced her eye and exploded in her brain. As she lay in ICU earlier this month, her mother said small improvements were major milestones. “Today she squeezed my hands,” Moreland said.

The next night, Frost came out of a medically induced coma and was later flown to Johns Hopkins Hospital in Baltimore, near her mother’s home. Over the next weeks and months, she will need multiple operations and a slew of specialists, including neurosurgeons, plastic surgeons, occupational therapists and mental health counselors.

Moreland said she cannot even begin to imagine what her daughter’s care will cost. Frost has Blue Cross insurance through her job at Ernst & Young in San Diego, but Moreland said she doesn’t know what the deductible and copayments are.

“Being realistic, knowing what I know about costs of health care, it’s scary,” Moreland said. “But she’s alive. She’s not one of the 58 other people.”

KHN’s coverage in California is funded in part by Blue Shield of California Foundation.

Millennials Embrace Nursing Profession — Just In Time To Replace Baby Boomers

Kaiser Health News:Marketplace - October 27, 2017

The days are long past when the only career doors that readily opened to young women were those marked teacher, secretary or nurse. Yet young adults who are part of the millennial generation are nearly twice as likely as baby boomers were to choose the nursing profession, according to a recent study.

These young people, born between 1982 and 2000, are also 60 percent more likely to become registered nurses than the Gen X’ers who were born between 1965 and 1981.

What gives?

“There’s no perfect answer,” said David Auerbach, an external adjunct faculty member at Montana State University’s College of Nursing and the lead author of the study, which was published this month in Health Affairs. The trend could be associated with economic factors, he said. Millennials came of age during a period of deep economic uncertainty with the Great Recession, which began in 2007, and the nursing profession generally offers stable earnings and low unemployment.

Insuring Your Health

KHN contributing columnist Michelle Andrews writes the series Insuring Your Health, which explores health care coverage and costs.

To contact Michelle with a question or comment, click here.

This KHN story can be republished for free (details).

In addition, researchers have teased out generational characteristics that might make nursing more attractive to millennials.

“These people are looking for more meaningful work and work that they care about,” Auerbach said.

One thing that hasn’t changed since the 1950s: Nursing is still dominated by women. In 2017, women made up at least 83 percent of registered nurses and licensed practical nurses, according to data from the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)

For the study, researchers analyzed Census Bureau data on 429,585 registered nurses from 1979 to 2015. The study excluded data on advanced practice nurses.

The study found that the number of new entrants into the field has plateaued in recent years. Still, the millennial generation’s embrace of the nursing profession should nearly compensate for the retirement of baby boomer nurses over the next dozen years and may help avert shortages, according to the researchers.

Many factors will influence whether the supply of nurses is adequate in coming years. The health care needs of an aging population is only one of them.

“The growth in accountable care organizations and alternative payment models is probably the biggest factor,” Auerbach said. For example, as hospitals move away from fee-for-service medicine toward models that pay based on quality and cost effectiveness, nurses’ roles may shift, and fewer of them may be needed in hospital settings as inpatient care declines.

Please visit khn.org/columnists to send comments or ideas for future topics for the Insuring Your Health column.

HHS Acting Secretary Declares Public Health Emergency to Address National Opioid Crisis

HHS Gov News - October 26, 2017

Acting Health and Human Services (HHS) Secretary Eric D. Hargan issued the following statement upon declaring a nationwide public health emergency regarding the opioid crisis, as requested by President Donald Trump on Thursday:

“Today’s declaration, coupled with the President’s direction that executive agencies use all appropriate emergency authorities and other relevant authorities, is another powerful action the Trump Administration is taking in response to America’s deadly opioid crisis.

“President Trump has made this national crisis a top priority since he took office in January, and we are proud to be leading in this effort at HHS. His call to action today brings a new level of urgency to the comprehensive strategy HHS unveiled under President Trump, which empowers the real heroes of this fight: the communities on the frontlines of the epidemic.”

Background:

  • Each day, according to the Centers for Disease Control and Prevention, more than 140 Americans die from drug overdoses, 91 specifically due to opioids.
  • 52,404 Americans died from drug overdoses in 2015, and preliminary numbers indicate at least 64,000 died in 2016.
  • Declaring a nationwide public health emergency will enable HHS to accelerate temporary appointments of specialized personnel to address the emergency (pending any funding needed); work with DEA to expand access for certain groups of patients to telemedicine for treating addiction; and provide new flexibilities within HIV/AIDS programs.
  • Under President Trump, in April 2017, HHS unveiled a new five-point Opioid Strategy, with the five following priorities:
    • Improve access to prevention, treatment, and recovery support services
    • Target the availability and distribution of overdose-reversing drugs
    • Strengthen public health data reporting and collection
    • Support cutting-edge research on addiction and pain
    • Advance the practice of pain management
  • In Fiscal Year 2017, HHS invested almost $900 million in opioid-specific funding, including to support state and local governments and civil society groups—to support treatment and recovery services, target availability of overdose-reversing drugs, train first responders, and more.
  • HHS has supported the efforts of the President’s Commission on Combating Drug Addiction and the Opioid Crisis, and the department looks forward to reviewing the upcoming final report.

Read the opioid public health emergency declaration *

 

* Temporary accomodation has been requested until document can be made 508 accessible

What The Health? Open Enrollment is Nigh

Kaiser Health News:HealthReform - October 26, 2017

Despite the best efforts of President Donald Trump and the GOP-led Congress, the Affordable Care Act is still the law of the land. And after a turbulent year, open enrollment for individuals who buy their own health insurance begins Nov. 1 and ends Dec. 15.

In this episode of “What the Health?” Julie Rovner of Kaiser Health News, Sarah Kliff of Vox.com, Margot Sanger-Katz of The New York Times and Alice Ollstein of Talking Points Memo discuss the current state of the health law. Julie also interviews Lori Lodes, a former Obama administration health official and co-founder of the new group “Get America Covered.”

Among the takeaways from this week’s podcast:

  • Unveiling of the 2018 policies on the federal healthcare.gov website reaffirms the anomalies of pricing this cycle. For many customers, there will be some gold plans that are cheaper than the standard silver plans — even though the gold plans offer more comprehensive coverage. Consumers will definitely have to shop around to find the right plan for them.
  • Although a federal judge in California turned down a request from states to stop President Trump from ending payments to insurers for some health subsidies, the case is not over.
  • The Internal Revenue Service’s decision to require taxpayers to say whether they had insurance this year is a key turnaround for the administration.
  • As Congress fails to renew the Children’s Health Insurance Program (which expired Oct. 1), states are slowly creeping up to the funding cliff.

Plus, for “extra credit,” the panelists recommend their favorite health stories of the week that they think you should read, too.

Julie Rovner: BuzzFeed News’ “A Trump Official Once Suggested Women Who Get Free Contraception Should Swear They Won’t Get An Abortion,” by Ema O’Connor.

Sarah Kliff: StatNews.com’s “The ‘Uber for birth control’ expands in conservative states, opening a new front in war over contraceptives,” by Max Blau

Margot Sanger-Katz: From the Food and Drug Administration, Scott Gottlieb’s testimony before the House Committee on Energy and Commerce Health, “Federal Efforts to Combat the Opioid Crisis: A Status Update on CARA and Other Initiatives.”

Alice Ollstein: Reuters’ “The Body Trade: Cashing in on the donated dead,” by Brian Grow and John Shiffman.

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcher or Google Play.

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