Friday, May 14, 2004 - Page updated at 12:00 AM

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ER doctors lament rising uninsured load

Seattle Times staff reporter

The growing uninsured

An estimated 506,000 Washington residents, or 8.4 percent of the population, were uninsured in 2002, says the Washington State Population Survey, the most detailed source of health-insurance coverage data. That's 53,000 more people than were uninsured two years earlier.

The most common reason people forgo insurance is that they can't afford it. Other reasons given include no health coverage at work, aren't eligible for it or are unemployed.

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Hospital emergency rooms have become such vital sources of care for uninsured patients that doctors are treating a growing number of such nonurgent "emergency" cases as fever, rashes and high blood pressure.

A group of Seattle-area emergency-room doctors, speaking yesterday at Harborview Medical Center as part of the nationwide "Cover the Uninsured Week," said the nation must find the means and the money to cover the uninsured so that sick people will receive treatment before they get sicker.

Emergency doctors from three of Seattle's top hospitals said they get frontline views on how lack of insurance hurts patients' health and physicians' pocketbooks.

Dr. Michael Copass, Harborview's chief of emergency services, said that manageable chronic illnesses such as diabetes or hypertension too often escalate into major medical problems for patients without coverage.

At the same time, Copass said, an increasing number of private-practice physicians are refusing to accept low-income Medicaid patients, let alone those with no insurance.

At Harborview, 33 percent of the more than 88,000 emergency-room patients in fiscal year 2003 were uninsured. Patients on Medicaid, which pays far less than private insurers for medical services, made another 30 percent of the visits.

Dr. Paul Casey, chief of staff at Swedish Medical Center and medical director of its emergency department, estimated that as many as half of Swedish's emergency patients aren't truly emergency cases. But such patients can't be referred to their regular doctors because they don't have one.

Casey said average waiting time at the emergency room at Swedish's main campus on Capitol Hill has grown to three to four hours. The goal is less than one hour, he said.

Casey said physicians know which patients lack insurance when they treat them.

"It makes no difference in what I do, but it makes a tremendous difference in the patient getting follow-up care," he said.

According to a survey released yesterday by the American College of Emergency Physicians and The Robert Wood Johnson Foundation, emergency-room doctors cited referrals to specialists, arranging follow-up treatment and filling prescriptions as their toughest challenges in caring for uninsured patients.

Dr. Barry Lawson, president of the Washington chapter of American Academy of Pediatrics, urged Gov. Gary Locke to postpone a plan to charge monthly premiums for children on Medicaid. The plan is scheduled to start in August. Even modest monthly premiums will drop more children from Medicaid and end up costing more money for health care, Lawson said.

Kyung Song: 206-464-2423 or

Copyright © 2004 The Seattle Times Company


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