WASHINGTON – In order to avoid what could be another monumental problem in the aftermath of Hurricane Katrina (search), policymakers are trying to figure out how thousands of people, maybe tens of thousands, left without work months after the storm will get basic medical services.
By making sure regular health benefits are paid, private employers are the backbone of the nation’s health insurance system. But after the storm, the private insurance system has been left in tatters.
On Thursday, the Department of Labor (search) estimated that 363,000 people have filed for unemployment as a result of the storm. About 71,000 businesses, many of them small companies, were displaced or destroyed in Louisiana alone.
While some temporary measures have been put in place by federal and state governments to make sure people can fill prescriptions and see doctors without having to pay full price, most of those measures are set to expire early next year.
“I don’t think the rest of the country understands the magnitude of the problems we’re facing,” said Tres Bernhard, a lawyer for the Louisiana Independent Pharmacies Association, which has been involved in crafting health care solutions since Katrina struck on Aug. 29. “We are trying to rebuild a state from scratch.”
In an emergency rule instituted two weeks ago by the Louisiana Department of Insurance, generally everyone who lived in areas affected by the hurricane were to be covered for necessary medical claims until the state lifts its emergency declaration, not expected until the end of the year.
But once the state of emergency is lifted, some people — likely those who had private insurance before their companies were washed away — will have to pay up to 50 percent of medical claims under the Department of Insurance plan.
In a separate arrangement, the Bush administration is operating a plan that sets up individual agreements with states and a simplified application process for the federal Medicaid (search) program, said Centers for Medicaid and Medicare Services (search) spokesman Gary Karr.
Under those agreements, rules have been loosened to allow some people who wouldn’t normally qualify for Medicaid into the program, and documentation standards have been suspended, Karr told FOXNews.com.
But those so-called "uncompensated care pools" will not last forever. Medicaid waivers that serve as agreements between the states and federal government are set to last for five months. And while Alabama and Mississippi have signed agreements, Louisiana has not.
Medicaid Will Cover Some, Others Left Behind
Parents and pregnant women, even those employed before Katrina struck, should fare well under the federal Medicaid program. Low-income residents with disabilities also will generally qualify.
But Sen. Max Baucus, D-Mont., one of the senators leading the fight to expand federal health care coverage for displaced Louisianans said as many as one-third of those applying for Medicaid are being turned away because they don’t meet qualifications.
And even if Louisiana reaches agreement with the federal government for temporary waivers, when the state insurance plan expires, single, able-bodied folks who were employed before the storm will not likely fall into any government program, said Medicare and Medicaid Services spokeswoman Mary Kahn, who works with Karr. They could simply be out of luck, she said.
One of those people outside the coverage plans is Elizabeth McFarland, a single 46-year-old who served as public relations director for New Orleans’ City Park. After the storm left the facility unable to open for the public, McFarland was laid off.
McFarland, who was staying with a friend in Pensacola Beach, Fla., while New Orleans continued its slow march to renewal, was diagnosed last year with asthma. She also has basic living expenses, including a mortgage, to pay.
“I certainly feel lost at sea. I don’t even know if my primary care physician is in town. … I don’t even know where to start,” McFarland told FOXNews.com last week as she was planning to return to the city. She added that she was able to fill prescriptions for free in Florida through its health department, which set her up for a few weeks.
On Thursday, Sen. Charles Grassley, R-Iowa, chairman of the Senate Finance Committee, criticized the Bush administration for opposing a Senate measure that would open Medicaid to single, childless adults for as long as 10 months. The Emergency Health Care Relief Act was introduced by Grassley and Baucus on Sept. 15, but has been held up by cross-Washington bickering.
"Unfortunately the White House is working against me behind the scenes and I resent that considering how I have delivered for the White House so much over the last five years," Grassley said during a Senate Finance Committee on Katrina spending on Thursday.
“The administration doesn’t have the authority to do what needs to be done. It is slow-walking, it is opposing, it is obfuscating, it is delaying, it is not acting,” Baucus added.
Health and Human Services Secretary Mike Leavitt has questioned the efficiency of the Grassley-Baucus bill, and last Friday, Sen. John Sununu, R-N.H., a budget hawk, raised objections to the cost of the bill, which has been estimated at about $8.9 billion over the next five years by the Congressional Budget Office.
White House officials say the administration's estimated $6 billion price tag for the Grassley-Baucus plan is too expensive. The remaining Katrina victims can be covered at a third of that cost. They add that the administration plan allows for more flexibility and many people will be assisted by job creation that will substitute the need for government aid.
With major reconstruction projects planned for New Orleans, McFarland said if all else fails, she’s likely to be able to get a job in the construction sector.
“It’s still a little surreal. ... It might not be in my field, but I’ll acquire some new job skills,” McFarland said with a laugh. Nevertheless, she said she doesn’t have a choice in finding something and making it work.
“I have to make it work,” McFarland said.
As the conflict grows in Washington, members of America’s Health Insurance Plans, an association that represents major health insurers, have made policy changes to help people unable to keep up with their payments. But a time will come when that won’t work any longer, said Mohit Ghose, the association’s spokesman.
Ghose said it’s important to try to make sure people’s coverage does not lapse, a situation that can lead to patients’ inability to be covered for some disorders. It's not clear how that will be worked out six months or more into the future when the current rules will probably expire, he said.
“It’s a major issue for the consumer that has been displaced in the way they have,” Ghose said. “We want to ensure that consumers are protected as far as possible,” but it is going to have to be a political solution that will include a combination of public assistance, likely through the Medicaid and Medicare programs, other government help and private insurance.
Who's Left to Care for the Covered
If the dim prospects of long-term health care coverage isn't problematic enough, Bernhard of the Louisiana Independent Pharmacies Association said another problem is looming on the horizon.
A recent study by the University of North Carolina-Chapel Hill said 6,000 doctors were displaced from the Gulf Coast by the storm. And Bernhard said he’s seen advertisements in the local papers trying to lure doctors to other states. He guessed some will take the bait.
“You have to figure that a good number of them aren’t coming back,” Bernhard said. If that’s the case, it leads to another set of questions of how to maintain a diminished health care delivery system
“You start playing this out, and it gets real scary,” Bernhard said.
FOX News' Major Garrett contributed to this report.