By Dennis Oda, Star-Bulletin
Olivia Vadisirisak holds son Kevin, 1, as brother Kenneth, 8,
listens to his heartbeat during a visit to the Kalihi-Palama Health
Center. The effect of state and federal budget cuts is evident
here, says the center's director.
Health-care system
in isles is ill
State and federal budget cuts
By Helen Altonn
are squeezing out the poor
Star-BulletinA 3-year-old uninsured girl arrived at a clinic with a fever and a skin disease covering her whole body. Police found the girl locked in a closet after her non-English-speaking grandmother had to go to the hospital for a medical emergency and reported a child at home. The girl was hospitalized for what had become a life-threatening skin infection.
A 3-month-old girl with a heart defect had no heart medicine for a week because her parents had no money or insurance. She ended up spending two weeks in an intensive care unit and having emergency cardiac surgery.
Despite medical advances that are saving and extending lives, officials cite cases such as these at the Kalihi-Palama Health Clinic to show that the poor cannot afford treatment to prevent serious illnesses.
As more uninsured patients show up at state health clinics, health-care workers and social welfare advocates question the public health system's erosion and the state's priorities and spending policies.
"The old axiom is poor people have poor health," said the Rev. Frank Chong, Waikiki Health Center executive director. "And what we are seeing is the poorest of the poor being dumped on."
With fewer opportunities for people to climb out of crisis, some form of political revolution could happen, Chong warned. "In 1954 we saw it, and we see it in other times.... At some point, when the disparity is great enough, people will say, 'We can't have this kind of stuff anymore.'"
"Why is human services getting such low priority?" said Sanford Schram, University of Hawaii associate specialist in political science and social work.
"No state in recent years has cut welfare benefits as much in one time as Hawaii is doing now," he said. And the cuts are coming after holding benefits down for several years, he said. "That's really going to impact families with children, women in particular trying to escape abusive relations, who have a lot of complications in their lives."
Schram predicts "a lot more stress, more hunger, more homelessness and a lot more abuse, because people are going to stay in abusive relationships."
Hawaii's welfare rolls have climbed in recent years - by 20 percent, according to national statistics - while declining in nearly all other states.
"Talk to women on welfare," Schram said. "They are under tremendous stress, with lack of money and inability to drive around and find a job from many employers who don't want to talk to them.... We're going to have to seriously think about changing our economy to adjust to this."
The effect of Medicaid, QUEST and other budget cuts is evident at the Kalihi-Palama Health Center, said Chuck Duarte, executive director.
Social problems wind up as health problems, he said.
"We see a lot of that - patients who transfer their stress and anxiety and mental problems into physical illness. I imagine that is going to increase as people go through the stress of having their incomes cut. Where is the next rent check going to come from?"
Catholic Charities is concerned about the failure of young women to get prenatal care because of poverty and loss of welfare support.
Ana Rosal-Silva, Family Services executive director, said, "When women in poverty don't have good access to prenatal or good health care for children, the impact could be lifelong."
By Dennis Oda, Star-Bulletin
Chuck Duarte: "We see a lot of that — patients
who transfer their stress and anxiety and mental problems
into physical illness. I imagine that is going to increas as
people go through the stress of having their incomes cut.”
Social welfare advocate Ah Quon McElrath said a lot more people are doubling up or becoming homeless and not getting the kind of health care that could prevent a staggering medical bill in the future."A lot of these people will go to community health clinics, and they (the clinics) are not being reimbursed the way they should be," she said.
"The state government has to look at all the priorities and stick to a social policy of universal health coverage," she said. "We have lost that particular place in the 50 states."
Beth Giesting, executive director of Hawaii State Primary Care Association, said it's a myth that Hawaii doesn't have a big problem with uninsured people because of the prepaid insurance act and generous Medicaid.
That's true to an extent, she said, but people who don't work full time, dependents, and people who lose jobs or have part-time jobs are excluded, she said.
Basically, only low-income pregnant women and children can get into the state QUEST health insurance program now without paying premiums, which leaves a big gap group, Giesting said.
A survey conducted a year ago showed that 10 percent of Hawaii residents were uninsured, and that number is probably a lot higher now, she said.
The state's eight community health centers report uninsured visits have increased from a monthly average of 3,800 in 1995-96 to 4,800 this fiscal year.
The centers are taking care of uninsured patients, but at some point they'll reach their limits because of the economic strain, Giesting said. They're asking the Legislature for a $5.6 million subsidy per year so they can "keep doors open and see people when they need services," Giesting said.
With federal law cutting off health benefits to new immigrants without insurance or jobs and free clinics deluged with clients, about 30 Oahu doctors have volunteered free medical services.
They have formed a Bayanihan Clinic Without Walls, sponsored by the Philippines Medical Association, to help jobless and uninsured immigrants who have been here less than a year.
Dr. Charlie Sonido, association president, said about 7,500 immigrants come here annually, and scarce medical services are expected to become more scarce with welfare reforms. He said the inundated free clinics will refer new immigrants to Lanakila Health Clinic for screening, then referral to doctors.
Chong said managed care, which is mostly medicine as opposed to preventive care, is taking over public health.
"And QUEST is really what we'd more appropriately call managed Medicaid," he said. "We're really managing the medical care of poor people, as opposed to providing for the public health of everybody."
The public health system has slowly disintegrated as a result, he said. "We put the most emphasis on the private doctor. Then, when you rip the guts out of QUEST and make everybody go to private insurance, there is virtually no opportunity for poor people to get in. So you will have kids get diphtheria, measles and mumps - things we thought we wiped out."
Effects of less aid
State and federal medical and welfare assistance reforms and pending state budget cuts will have these effects:
About 20,000 people have been dropped from QUEST, the state's health care program.
Source: State Department of Human Services
