September 15, 2005
Uninsured Get Medical Care After Katrina
By THE ASSOCIATED PRESS

ATLANTA (AP) -- 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.

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.

''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.

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.

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.