No insurance? You

YAKIMA, Wash. -- Art Garza's in basket is more than twice as full as it used to be.

As the charity-care coordinator for Yakima Valley Memorial Hospital, Garza gets 15 to 20 applications a day from people who have a balance on their medical bill. That compares to six or seven when he first started the job two years ago.

"I'm very busy. We have a lot of hardship cases on a daily basis," said Garza.

The recession and high unemployment have combined to push more and more Yakima County residents into medical debt, according to anecdotal evidence from hospital employees such as Garza.

He sees not only people who have lost their health insurance benefits after a prolonged layoff, but also those who have inadequate insurance that leaves them with big balances after an unexpected surgery or a trip to the emergency room.

"I see a lot of gall bladders and appendicitis," he said.

Now the state insurance commissioner says the number of uninsured is expected to grow before expected federal legislation to fix the problem takes effect several years from now.

In 2008, Yakima County was home to roughly 34,330 people with no health insurance, according to calculations by Commissioner Mike Kreidler's office. That number is expected to rise to 43,054 by the end of 2011.

The percentage of Yakima County residents without health coverage is expected to rise from 14.6 percent in 2008 to 17.6 percent by the end of 2011.

Statewide, the number of uninsured will approach 1 million by the end of this year, Kreidler said in a recent report titled "A problem we can't ignore: The hidden and rapidly growing costs of the uninsured and underinsured in Washington State."

Kreidler said uninsured workers are common in the retail, entertainment, recreation, tourism, agricultural and administrative-
support sectors.

His office estimates that undocumented immigrants make up, at most, 7.5 percent of the uninsured statewide. Kreidler's office did not break down that rate by individual counties.

The growing number of uninsured correlates with increasing levels of uncompensated care at hospitals as well as a jump in emergency room visits by people who have lost their insurance.

At Memorial, uncompensated care -- which reflects bad debt and charity care -- jumped 25 percent in the last fiscal year, to $16.6 million in 2009 compared to $13.3 million the year before.

Hospitals incur bad debt when people disappear without paying their medical bills. Charity care, which all hospitals are supposed to provide at minimum levels, is for people who can demonstrate they can't afford all or part of their bills.

Under state law, hospitals must provide free care for those with incomes below the poverty level, and sliding scale discounts for those up to 200 percent of poverty. The poverty level for a family of four is $22,050 a year.

Kreidler said hospitals and other health care providers end up shifting the cost of uncompensated care to consumers and businesses that buy health insurance. He estimates what he calls "this hidden or invisible" expense costs individual workers about $457 a year in premiums and out-of-pocket health payments.

Both Yakima hospitals have seen an increase in visits to their emergency rooms. At Memorial, ER visits numbered 77,000 as of March 2009, up 16 percent over the prior year, said John Vornbrock, chief financial officer.

While visits to emergency rooms aren't exclusively linked to the rates of the uninsured, hospital emergency rooms are often the last resort for people who don't have a group or individual health insurance plan that entitles them to see a family doctor.

Yakima Regional Medical and Cardiac Center has seen the same trend. Emergency room visits, for example, for the first three quarters of 2009 numbered 27,061 compared to 24,578 in the year-earlier period, according to reports with the state Department of Health.

Bad debt was up from $3.6 million to $4 million for the first three quarters of 2009 compared to the same period in 2008. Charity care is up slightly for the period at about $9 million.

"Like most hospitals across the country, we've seen an increase in ER visits this past year, and in addition to that, an increase in charity care as well as private pay patients without health insurance," said Debra Yergen, spokeswoman for Regional.

* Leah Beth Ward can be reached at 509-577-7626 or lward@yakimaherald.com.