Cost of Treating Uninsured Takes Toll on Hospitals, Patients

Understaffing combined with patients' fears that they won't be treated — or won't be able to pay — create health care crises daily in hospitals across the nation. So say nurses represented by CWA in New York, New Jersey and Iowa.

They blame a profit-driven health care system that, in the words of Kathy Boyd of Nurses United/CWA Local 1168, "just doesn't work for a lot of people."

Boyd is an RN in Pre-Op Services at Kaleida's Millard Fillmore Suburban Hospital in Buffalo, N.Y. She performs blood tests, EKGs and physicals to prepare patients for surgery. Her colleague Sandy Miller is an RN at Fillmore's Critical Care Unit.  Both have seen what happens when uninsured patients come in for medical emergencies.

Miller spoke of a man in his late forties who owned a restaurant and had suffered a heart attack.  "He was trying to accelerate getting his tests done. He was preoccupied with not having insurance and was afraid he'd lose everything because of the cost of staying in the hospital. He was extremely stressed. He couldn't rest." Against medical advice, he left within 24 hours.

"We would never discharge a patient after a heart attack that quickly," Miller said.

She said the man should have gone through "cardiac rehab," received a thorough explanation of what had happened to him, coaching on danger signs and what to do if it happened again. He should have had an angiogram.

"When things like this happen, we feel like we haven't done our jobs right," Miller said. "He might not be so lucky next time."

The United States spends nearly $100 billion a year to provide health services to uninsured residents, according to the National Coalition on Health Care, and hospitals provide about $34 billion worth of uncompensated care annually.

Hospitals are only required to treat patients who cannot pay when they have life-threatening situations. People without means often defer preventive care and visit emergency rooms only when they must. When admitted, they usually stay in the hospital longer.  Hospitals tend to offset these costs by keeping staff to a minimum and raising charges for privately insured patients.

Boyd said staffing at Kaleida is always an issue. "We have a skeleton crew and high vacancy rate as far as full-time positions being filled. The hospital likes to hire part-time, probably because it is cheaper, benefit wise."

Janice Allen, co-chair of the New Jersey Nurses Union/CWA Local 1091, is an RN in the Family Care Center, the obstetrical unit of St. Barnabas Hospital in Livingston, N.J. Caring for young mothers and their newborn babies, she also worries about short staffing.

The ratio of nurses to patients on her unit is typically 1:8. She'll file a complaint with management if it exceeds that. "I would like to see it 1:6," she said. "I do a lot of teaching. We want to make moms comfortable and educate them about newborn care, but you prioritize and you do the best you can." In California, the only state that has established a nurse-to-patient ratio by law, it's 1:5.

Ironically, nurses themselves often lack good affordable health care.  Boyd says that because of their CWA contract, nurses at Kaleida can choose from several different health plans and, overall, have good benefits. But she worries about her two adult children, a son age 25, who is an engineer and her daughter, 22, an LPN at a non-union nursing home. "They have pretty basic insurance, which has high co-pays. They have to pay a lot for their medications, so they don't go to the doctor; they don't go to the dentist," said Boyd.

Even some nurses working under CWA contracts pay high premiums for health insurance. Lauri Lilli, an RN at Great River Medical Center in Burlington, Iowa, said she pays about $3,500 a year in premiums for her family plan. Her local has tried, without success, to win prescription drug benefits in three rounds of bargaining. And they still have no health insurance for retirees.

"You'd think, as a nurse, you'd have good health insurance," Lilli said. "It's because the hospital is having to eat all those costs of people who can't pay. It affects everybody."