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Uninsured get medical care in Katrina's wake

/ Source: The Associated Press

Rocio Roberts’ right eye has a yellow tinge to it — a possible sign of liver disease. It’s worried her for two years, but she never had the money to see a doctor about it.

Then Hurricane Katrina came, forcing her to flee New Orleans for Atlanta. Last week, the 27-year-old college student decided to take advantage of a free medical clinic set up for evacuees.

“I don’t have insurance,” she said. “I’d like them to look at it.”

Public health experts say cases like Roberts’ point to an unusual phenomenon that’s developed in the wake of Katrina: The health-care safety net has temporarily expanded for hundreds of thousands of uninsured Gulf Coast residents, and some patients’ long-standing illnesses are finally being diagnosed and treated.

For example, at the clinic Roberts visited in southwest Atlanta, health-care workers have seen as many as six cases per day of previously undiagnosed high blood pressure and as many as four cases of undetected diabetes.

New cases of chronic disease

That’s not surprising, said Diane Rowland, executive director of the Kaiser Commission of Medicaid and the Uninsured, which tracks U.S. health care coverage.

About 22 percent of Louisiana residents and 19 percent of Mississippians lack health insurance. “We know the uninsured generally delay getting care,” she said, so it’s to be expected that new cases of chronic disease will be detected as a result of the hurricane.

In some cases, evacuees are seeking care now because they have to. Roberts had diarrhea and her boyfriend, 26-year-old Randy Starita, had abdominal pain.

“They’re having acute problems that sort of force the issue,” said Edwin Fisher, chairman of the Department of Health Behavior and Health Education at the University of North Carolina School of Public Health.

Also, some Gulf Coast residents may have been apprehensive or distrustful of doctors in their hometowns, but are less put off by the friendly medical volunteers at shelters and evacuee clinics, he added.

No one has a good estimate about how many undiagnosed illnesses are being revealed in care centers for hurricane survivors. Whatever the number, it’s something to celebrate, said Carolyn Johnson Davis, executive director of the Diabetes Association of Atlanta.

Preventing long-term complications

“If you can get diagnoses early, you can get people on medications and change their diet and really prevent long-term complications,” said Davis, who assigned staff to do blood sugar tests at one clinic.

Preventing complications can cut down on costly emergency room visits and hospital stays, ultimately saving the U.S. health care system money, Rowland said.

However, she and others noted that while the doctors, hospitals and pharmacies have been willing to provide free care to evacuees in the short term, that largesse can’t last forever.

Patients are being given prescriptions for a week or even a month, and medical centers have pledged to devote staff to shelters and evacuee assistance centers for the time being. But they will ultimately need to be paid for those services or have to pull back.

Yes, some uninsured are getting a sort of gift by a twist of fate that helped them learn about a serious and treatable health condition, said Ron Pollack, executive director of Families USA, a Washington-based health-care consumer organization.

But unless government insurance programs are expanded to pay for these new patients, they won’t be able to get the insulin, high blood pressure medicine or other long-term treatments they need, he said.

“These conditions require care for more than 30 days,” Rowland said.

Medicaid cuts on the table

Before Hurricane Katrina struck, Congress was discussing cutting about $10 billion from Medicaid, the health insurance program for the poor and disabled.

Federal officials say they are working on providing extra financial support to states that provide Medicaid to evacuees. Patients’ advocates are watching the action closely.

“Of all the policy issues going on right now in Washington, this is probably the most important,” Pollack said.

It’s important that the people who entered the health-care safety net as a result of the hurricane remain in the system, said Ken Thorpe, a health policy professor at Atlanta’s Emory University who was a health policy administrator under President Clinton.

“Hopefully the discussion about cutting Medicaid is off the table,” he said. Indeed, perhaps this situation will propel proposals to restructure the Medicaid systems in Louisiana and other states and expand primary care for people currently uninsured, he said.

“This provides an opportunity for us to think anew,” he said.

However, many conditions may continue to go undiagnosed.

Roberts visited a clinic at Atlanta’s Adamsville Recreation Center staffed by West End Medical Centers Inc., a federally funded community health center. West End decided to routinely check the blood pressure of patients and take other readings that can reveal conditions like high blood pressure and diabetes.

But other sites don’t provide such screenings.

Acute care still primary focus

At many shelters along the Gulf Coast, acute illnesses and injuries were the focus — not prevention or uncovering chronic conditions, said Tom Skinner, a spokesman for the federal Centers for Disease Control and Prevention.

Those clinics that do fuller screenings may not be open much longer. In Atlanta, the Red Cross and other agencies have been consolidating help centers as lines have been dwindling. West End staffers were seeing as many as 200 patients a day at the Adamsville clinic, but it was relocated this week, and the number of visits fell.

On Tuesday, for example, only one case of high blood pressure was caught. Melvin Terrance. Terrance, 41, doesn’t normally go to a doctor because he has no health insurance and he said he felt fine. But when he went to donate blood on Monday, a health-care worker said his blood pressure was 178 over 80. (Normal is considered at or below 120 over 80.)

The diet and stress of the storm can alter blood pressure and blood sugar readings and make a borderline problem seem worse than it is, doctors said. Terrance, of New Orleans, was asked to come back the next day, and this time got a reading of 180 over 110.

He was prescribed a blood pressure medicine, Norvasc, and told to change his diet. He feels grateful, he said Wednesday. “It’s important to be alert to your health.”

As for Roberts, the college student, she got a prescription for her stomach illness. But a physician assistant told her the yellow eye could be a sign of hepatitis, and referred her to one of the permanent West End Medical Centers sites for further diagnosis.

“Yeah, I’ll go,” she said.