Hawai‘i 's Department of Human Services projects it will save about 29-million dollars a year by not providing insurance coverage for so-called able-bodied Micronesians of working age. That group has been shifted to plans under the federal Affordable Care Act. But healthcare advocates say the economics are more complicated. Jackie Young has more in her continuing series about the lingering health costs of U.S. nuclear testing in the South Pacific.
Stacy Woode is 32 and lives in Whitmore Village. She was recently switched to the HMSA plan under the Affordable Care Act. Stacy’s husband and 4 children have Medicaid because they’re U.S. citizens. But since Stacy was born in Rongelap, she no longer qualifies.
Her grandmother, Almira Matayoshi, was one of the original nuclear Marshallese survivors who gave birth to 3 “jellyfish babies”. Those were deformed babies with no bones and translucent skin—who died soon after birth. Almira also had thyroid cancer, and Stacy’s mom had thyroid cancer. Stacy has hyperthyroidism, but is worried it might be cancer. “So I just thought that because my grandma had it, my mom had it, I had it because of genetics or from the fallout.”
Stacy stopped going to the doctor at first because it was inconvenient, but now she’s scared of not being able to afford the care because she’s no longer on Medicaid. “I don’t want to know if I have to pay. I guess I’ll take the chance, I don’t know. …If I did have Medicaid I would do all my doctor check-ups.”
Dr. David Derauf, director of Kokua Kalihi Valley clinic, explains why he believes switching the mostly low-income Micronesian group from Medicaid to ACA plans with premiums and co-pays won’t work. “…Oh, pay these co-pays, they seem reasonable to us—middle-income people—doesn’t seem out of line to ask people to pay co-payments, but if you can’t pay it and you don’t get the care, why are we kidding ourselves that that insurance is going to make a difference, it really won’t. …X-rays the co-payment can be $100, specialty visits a $30 co-payment, medications $7 for generic, as much as $30 to $50 for brand-name products. If you’re taking 4 or 5 medicines a day, and you’ve got somewhere between $7 and $30 per medicine, what kind of income do you have to have to be able to make that a reality?”
Another reality of healthcare economics is that those who cannot afford routine medical treatment often wind up in hospital emergency rooms—at a higher cost to taxpayers. Derauf and some other advocates suggest there's a better way: having the state pick up the co-payments and deductibles for this group. “I think we’re being penny-wise, pound-foolish on this whole thing. If we run the numbers of what it would cost to subsidize the co-pays and deductibles for this group of people, my back-of-the-envelope calculations is somewhere in the neighborhood of $3- to $5-million-dollars per year for everyone.”
In our final report tomorrow, we'll look at other options to deal with this growing problem of healthcare, costs, and the Micronesian population.