| Continued from Page
1
Many student nurses in California do not have
health insurance, said Patricia McFarland, RN,
MSN, executive director for the Association of
California Nurse Leaders. “We’re very
concerned,” she said. “We really have
to see what we can do to get more health care
insurance for nursing students.”
Advanced practice nurses are experiencing the
effects of insurance programs — private
and public — that do not reimburse them
for the actual cost of care or put limits on the
kind of care that will be reimbursed, Jarrett
said.
Mouthpiece for the masses
Felder Gillis said her clinic treats some uninsured
patients without payment because clinic workers
see it as their mission to give the best care
they can. But free care takes its toll on the
clinic’s operating budget, she said. The
clinic is part of the San Francisco Community
Clinic Consortium, a group of private, nonprofit
clinics that treat many uninsured people in San
Francisco, said Mark Fantone, director of communications
for the consortium.
Sue Omel, RN, MPH, MS, BSN, a public health nurse
in Oregon, said she and her staff spend more and
more hours each week helping parents fill out
forms to obtain some sort of health coverage for
their children and sometimes for other family
members. Her caseload hasn’t increased,
she said, but she and her staff of nurses have
less and less time to spend on actual patient
care.
“We spend a huge amount of time trying
to advocate for families because they don’t
have insurance,” said Omel, field team supervisor
at the Washington County Department of Health
& Human Services in northern Oregon. “The
advocacy piece is becoming overwhelming.”
Nurses in emergency departments, where an estimated
one in three patients are uninsured, find themselves
in a similar situation. They must triage patients
who come in for basic primary care and spend time
away from real emergency cases, Dodd said.
Nurses in clinics, hospitals, and home health
also must deal with patients who have advanced
cases of illness that could have been prevented
or easily taken care of had they sought care earlier.
Reports by the Institute of Medicine found that
uninsured Americans received about half the care
of those with health insurance. As a result, they
tend to be sicker and die sooner. About half of
uninsured children visited a physician in 2001,
compared with three-quarters of insured children,
the reports stated.
Felder Gillis said she has seen patients with
diabetes who might have been able to prevent some
complications had they been diagnosed and treated
earlier. Omel has seen uninsured parents who become
ill with a condition such as diabetes or a mental
health problem and don’t seek treatment
because they can’t pay for it. “Our
job is not diabetes care,” she said. Nurses
in her department make home visits to care for
infants and pregnant mothers with health problems.
“But you can’t ignore that.”
So she ends up looking for ways to get health
care for parents as well as their children.
“People need to have health insurance because
they can’t afford the catastrophic things
that happen,” Myrna Allen, RN, MSN, CHE,
chief operating officer of the American Nurses
Association\ California. “The problem is,
we don’t know how to pay for it.”
Some states are trying new ideas. Last year,
the California Legislature enacted an employer
mandate law, which comes before voters in a referendum
this year. If voters do not repeal the law, starting
in 2006, employers with more than 50 employees
will have to either provide some sort of coverage
to their workers and dependents or pay into a
state purchasing pool to cover them. Employers
with more than 200 employees must extend coverage
to dependents.
Employee contributions will be limited to 20%
of premiums or 5% of wages for low- and middle-income
workers, and limited deductibles. The state-provided
coverage probably will be some sort of expansion
of California’s Medicaid program, Allen
said.
|
Reply
to Article