Many in area lack health coverage

Schenectady County outnumbers other counties in the Capital Region in its population of those without health insurance among people under 18 or over 65 years old, according to data released Tuesday by the U.S. Census Bureau.

More than 3,000 children in Schenectady County were uninsured, higher than Albany County’s 2,310, Rensselaer County’s 1,975 and Saratoga County’s 1,991, according to the 2008 American Community Survey, which included a health insurance question for the first time.

Schenectady County’s uninsured population of those aged 65 and older was 649, significantly higher than Albany’s 225, Saratoga’s 181 and Rensselaer’s 112.

Joe Gambino, CEO of Schenectady-based Hometown Health, challenged the Census numbers as being somewhat low, noting the agency’s internal numbers show higher figures.

“We have here alone just 3,500 children classified under 18 that are presently uninsured,” Gambino said. “The number should be zero, because every single one of them qualifies for a program.

“It’s a serious problem. We have a lot of uninsured in Schenectady.”

The state of New York has programs like Children’s Medicaid, Child Health Plus, and State Children’s Health Insurance Program to help uninsured children.

Health care officials say the higher uninsured numbers are attributed to parents and older adults simply getting lost in the process while applying for state subsidized health insurance programs.

“The parents sometimes don’t complete the application. There may be some people who may be undocumented or afraid to sign any forms,” said Gambino. “Sometimes they get frustrated by the process. It’s a vicious circle.”

About 7,200 people pass through the doors of Schenectady’s Bethesda House on State Street each year.

Executive Director Margaret Anderton said the increase in family homelessness she’s seen creates frequent moves and the lack of a stable address — both of which make it hard to complete the paperwork needed to gain free health insurance.

“Paperwork just gets lost,” Anderton said. “Some people have two or three applications processed. If the family continues to move or be displaced [the process] never catches up.”

And for other uninsured people, it comes down to process problems, like language barriers, Anderton said.

“For some it’s a matter of not knowing how to apply and they start the application process and are not able to follow through,” Anderton said.

The Capital Region has a lower rate of people without health insurance than the national average, according to Census figures. In the Albany-Schenectady-Troy area, 11.8 percent lacked health coverage, falling in line with the state rate. The national rate was 15 percent.

Census figures show Schenectady County had around 12,000 people aged 18 to 64 without health insurance, compared with 19,162 in Albany County, 15,783 in Saratoga County and 10,620 in Rensselaer County.

“As people either lose their job or their employer stops providing health insurance based on expense, we’re getting more and more calls for people to come into the clinic because they have no insurance,” Schenectady Free Health Clinic Executive Director Bill Spolyar said. “I probably get five to six phone calls a day.”

Spolyar said often those who have lost health coverage because of changes in employment normally don’t say anything until they have some need. “If people don’t have insurance, then obviously they’re not getting preventative care,” he said. “The long-term effect of it is that the health care system is going to be managing crisis rather than practicing prevention.”

Insured people who are regularly going to the emergency room for treatment instead of seeing a primary care physician continue to cost facilities like Ellis Hospital millions of dollars in uncompensated care, and the bill grows as the ranks of uninsured and underinsured in the area increase.

“That really makes it challenging for health care organizations during uncertain economic times,” Ellis Hospital spokeswoman Donna Evans said.

Last year, Ellis Hospital absorbed a total of $33 million in uncompensated care, which is expected to inflate to $42 million next year.

“That’s reflective of unemployment and the uninsured and underinsured in our region,” Evans said.

Helping the uninsured get access to coverage keeps local agencies busy.

Bethesda House, for example, offers mailboxes to those needing a consistent mailing location.

“We actually encourage people if their housing situation is not stable for them to get their mail here,” Anderton said.

In October, Bethesda House will add a financial case manager to its staff to help people gain access to benefits including insurance.

“We’ve already got about 57 people in the program without having a specific financial case manager,” Anderton said. “We anticipate at least triple that will be helped with the new position.”

strong programs

Ellis Hospital continues to develop its Medical Home program, which debuted last year.

The program creates one-stop shopping for primary care, dental health and pediatrician services while facilitating insurance enrollment with the help of special “navigators” and a community shuttle.

The program reflects the responsibility and mission of Ellis Hospital to provide care for everybody, especially the uninsured, Evans said.

The program picks up people who are at the Schenectady City Mission, YMCA and Bethesda House and takes them to the Ellis Health Center on McClellan Street. The participants are provided with a bus token to return home.

Hometown Health also has special facilitators to help people enroll for state insurance programs, Gambino said. An on-staff eligibility coordinator helps fill out screening forms for children that can help provide coverage for 45 to 60 days, giving parents more time to go through the formal process of taking advantage of state health insurance programs.

“We’re doing what we can to try and make sure the patients who come here, children or adults, and are eligible for public health insurance, that they’re able to navigate the system and get help with enrollment and get the necessary services that they need,” Gambino said.

Mike Saccocio, executive director of the Schenectady City Mission, said “The simple correlation is that we have such high percentages of people in poverty and children in poverty.”

The Census Bureau is expected to release 2008 data on Capital Region poverty rates next week.

Saccocio said numbers that put Schenectady County in the extreme are far more complex than just one explanation.

“In Schenectady, there is more housing capacity, so people find it easier to move from one place to the next.”

The transient nature of impoverished people affects their ability to be stable enough to fill out the paperwork required to participate in social service programs.

“That high degree of transients keeps people from following through on all the applications you need to for Medicaid and other programs. That can be part of an explanation,” Saccocio said.

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