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By The Skanner News | The Skanner News
Published: 29 September 2009

MILWAUKIE, Ore. (AP) -- A look inside Providence Milwaukie Hospital illustrates how the nation's health care system is unraveling for people who can't afford it.
The hospital for the first time offered free mammograms to uninsured women older than 40. A total of 45 slots were made available over three evening clinics, and they filled immediately. An additional 21 women were put on a waiting list.
Two women who called for the breast cancer screening said they had lumps in their breasts. Another woman said she had stopped treatments for breast cancer because she had lost her insurance. It is too late for a mammogram for those women, and the hospital will offer them medical care.
Shelley Grove, 47, a hairstylist who works and lives in Oregon City, showed up for the Wednesday evening clinic. It has been two or three years since she had her last mammogram, she said.
Having no health insurance is worrisome, she said, "but it is just not in the cards right now."
The women who visited the clinic last week reflect the growing ranks of uninsured nationwide now at about 45 million, according to a U.S. Census Bureau survey released last week. The census estimates 614,000 people in Oregon lacked health insurance in 2008.
As health care eludes a growing tide of Americans, Congress and President Barack Obama are pushing for a reform bill to make health care universal and more affordable.
Like Grove, many of the women visiting the Milwaukie clinic had not had a breast cancer screening for years even though experts recommend women 40 and older get mammograms annually. But a mammogram costs about $280, and women cannot expect to get one free in the emergency room.
Skipping annual mammograms is just one way the uninsured cut corners with their health care and become vulnerable to diseases that can be prevented with early detection. They also, for example, forgo Pap tests for early detection of cervical cancer and colonoscopies to detect colorectal cancer.
A Harvard University study estimates that lack of insurance leads to between 35,000 and 45,000 deaths a year among adults 18 to 64. In 2005, having no insurance contributed to an estimated 558 deaths in Oregon and 708 in Washington.
Sheila Jensen, 57, of Beavercreek works in the office of a commercial lawn equipment company but gets no health insurance. Her husband, a building contractor, bought their insurance for years. After work dried up in January, they could no longer afford $830 a month for a premium that came with a high deductible.
So for the first time in her life, Jensen has no insurance.
"It is really scary," she said. "It is a concern, a worry ... that if something happened to myself or husband, what the effect that could have. Everything you've worked for could be lost."
Grove, the hairstylist, was able to get on the Oregon Health Plan earlier in her life as a single mother raising two children on a modest income. But about five years ago, she was bumped off the state insurance plan, though her 15-year-old daughter remains covered.
She can't afford the $350 a month it would cost to insure herself, so she lives without insurance, paying as she goes for doctor visits and prescription medicines. She said she tries to stay healthy by working out twice a week, taking vitamins and eating healthy food.
Carrie Kikel, a public relations manager for Providence Milwaukie, said the hospital decided to offer the mammogram clinic after seeing numerous women at one of the hospitals community health fairs admit they hadn't had a mammogram in years.
"I was saddened by one woman in particular who had not had a mammogram in 10 years, and she accepted that," Kikel said. Safeway's Portland district, which includes 117 stores, agreed to chip in $15,000 for the free clinic, and Providence Milwaukie doctors volunteered their services. Safeway also will donate up to $5,000 more to cover those on the waiting list, said spokesman Dan Floyd.
The hospital has pledged to provide care to any woman visiting its free clinic who turns up with breast cancer, which happens three to five times per 1,000 screenings.
Providence of Oregon's network of nonprofit hospitals follows a policy of cutting charges to uninsured patients by 28 percent. The hospitals set up payment plans for uninsured patients on a sliding scale based on patient finances.
Generally, if they have no income, uninsured patients get care at no charge. The hospitals will not require people to sell their homes or cash out their retirement savings, said Terry Smith, chief operating officer for Providence.
People who have health insurance help pay for those who don't. Providence, like most hospitals, will cover a portion of its charity care costs by charging more to insured patients. Nationally, that amounts to $1,017 of the average $13,378 annual family health insurance premium per year, according to a recent report by Families USA, a nonprofit based in Washington, D.C.
But Providence's charity care costs have climbed so fast from $8 million in 2000 to $83 million this year, or more than 900 percent that the hospital has had to absorb much of the burden by slashing its expenses, Smith said.
The uninsured women visiting the Providence mammogram clinic this week represent "a symptom of our sick health care system," said Bill Kramer, a Portland health care management consultant.
"At some point in the future when everybody does have access to affordable, high-quality health care," he said, "we will look back on today and ask how we could let so many of our mothers and sisters and wives and daughters get sick and die from breast cancer."



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