May 09, 2011 17:05 ET

Health Affairs Blog: 80% of Uninsured Patients in 4 Busy Hospital ERs Are Eligible, but Not Enrolled in Public Programs, According to

Health Leaders Suggest "Point-of-Service" Enrollment to Improve Public Application Process

SAN JOSE, CA--(Marketwire - May 9, 2011) - A startling 79.7% of uninsured patients seeking emergency care in four San Diego hospital ERs could have had some form of government insurance, but did not, according to a recent study posted today on the well-regarded health policy journal Health Affairs by the Foundation for Health Coverage Education (FHCE) (

As a result, the four hospitals did not receive government payments for significant portions of the emergency medical care provided, estimated to total millions of dollars. The data within the article was uncovered through an analysis of the FHCE's Eligibility Survey results, which also found that 61.7% of national online respondents seeking to obtain coverage were likewise unaware that they were eligible for government coverage. The analysis suggests that the real issue facing the uninsured today is not the availability of free and low-cost programs, but the poor communication and faulty application processes that need to be streamlined.

The outcomes of the Point-of-Service ER Survey were drawn by querying 13,069 uninsured patients who sought and received care in four high-volume emergency rooms over an 11-month-period. The separate Online Survey captured data over a 17-month-period from 180,250 visitors seeking information on their health coverage options.

"The findings in the hospital ER survey are extremely troubling because it very likely these four hospitals will not be paid for the care given to patients who were qualified for government programs," said Phil Lebherz, executive director of FHCE. "These hospitals are not unique; they're typical of any institution with a 24-hour emergency room."

Key findings in the unique Point-of-Service ER Survey, which was given primarily to California residents entering a San Diego Emergency Room include:

  • 79.7% of patients were eligible for state and federal health coverage programs,
  • 16.9% were eligible for private coverage -- this includes group coverage of 2 or more employees, individual coverage with medical underwriting, COBRA and Cal-COBRA,
  • 3.3% were eligible for high risk pool coverage -- this includes California's state-run high risk pool, Major Risk Medical Insurance Program, and the newly implemented Pre-Existing Condition Insurance Plan (PCIP).

Key findings of the Online Survey, which was given to web visitors from all 50 states and Washington, D.C. include:

  • 61.7% of respondents were eligible for state or federal health coverage programs, most of which require individuals to have income of $44,700 or below for a family of 4 to qualify,
  • 21.1% were eligible for private coverage -- this includes individual, group, or COBRA and MiniCOBRA,
  • 15.4% were eligible for high risk pool coverage -- this includes state-run high risk pools, as well as the newly implemented Pre-Existing Condition Insurance Plan (PCIP).

The blog posting was written by four health care leaders, Leonard D. Schaeffer, Alain Enthoven, Ph.D., David S. Helwig, and the aforementioned Lebherz. It expresses concern over the future planned expansion of public programs by the federal government in light of three key issues not yet addressed by health care reform, including: 1) Underfunded programs causing erratic enrollment and "blackout" periods, 2) Bureaucratic barriers with varying eligibility requirements and application procedures, and 3) Poor provider incentives for enrolling uninsured patients, which results in substantial medical provider losses. The American Hospital Association estimated hospitals lost $36.5 billion in uncompensated care due to underpayments for service by Medicaid in 2009.

Based on the Eligibility Survey findings and analysis of the current application system, the authors suggest the best strategy for solving the dilemma is to use point-of-service enrollment. When a person without insurance seeks treatment, a trained staff member in any qualified health care setting could simply go to an online address, input basic patient data, check for available options, and promptly enroll the person in the relevant government health coverage program. Point-of-service enrollment would have automated check-points for eligibility and implement a transparent system with fraud controls. Through point-of-service enrollment, the government could significantly reduce a costly administrative system that drains resources

"Those of us involved in this analysis believe that the government cannot simply expand public health coverage programs without addressing enrollment issues," said Lebherz. "Rather than entrenching the mistakes of the past, processes already proven to work within the health care marketplace of today must be adopted."

The Foundation for Health Coverage Education is a non-profit organization with a mission to help simplify public and private health insurance eligibility information in order to help more people access coverage. The website and U.S. Uninsured Help Line
(800-234-1317) receive over 100,000 visitors or callers each month. For more information, visit, friend us on Facebook or follow us on Twitter (@CoverageForAll).

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