By Chris Weaver and Adele Shartzer
March 2007
In recovery from disasters, health care systems and
people have at least one thing in common. Some people get a few scrapes and
bruises that take only time to heal.
Some can be treated quickly and move on.
Still others have serious chronic conditions that are exacerbated by
the disaster, and the morbidity inflicted by interruptions to their care
requires intensive medical care.
Hurricane Katrina caused some scrapes and bruises in
New Orleans’ health care system: It flooded emergency
departments, moldy ICUs, and displaced physicians.
In other ways, however, the structure took deeper hits to older, more
severe problems.
The trouble with health care in New Orleans before the storm was that the
state concentrated medical care funding for the poor at a few massive
institutions. As a result, there was no broad-based, comprehensive coverage
for low-income patients. When
Charity
Hospital, the massive
public care facility, was damaged, the poor and insured were left without
access to health and medical resources. Hurricane
Katrina’s effects on the city’s few hospitals has shown us that we need a
waterproof health care infrastructure, not weather-resistant bricks and
mortar, if we are to survive future disasters of its magnitude.
Prior to the storm,
Louisiana
had a higher-than-national average rate of people living in poverty (23% vs.
17% nationally), a higher prevalence of non-workers (23% vs. 19% nationally)
and higher than average rates of actual chronic diseases such as cancer,
diabetes, and heart disease. Statewide, and in New Orleans in particular, the health care
system functioned under enormous strain. Because employer-sponsored health
coverage was less prevalent than the national average, the public system
bore the majority of this strain. Tourism, the mainstay of the pre-Katrina New Orleans economy,
typically generates service and retail jobs with high turnover, low pay, and
no health coverage. About one in
five Louisiana residents lived
without insurance before August 2005.
Public programs such as Medicaid covered about 16% of Louisiana’s residents—nearly 1 million
people—before the storm.
Louisiana’s Medicaid program,
which provides coverage for certain low-income people, received $2.30 from
the federal government in 2006 for every $1 in state and local spending.
States have considerable latitude for administering the program, and
while Louisiana had taken steps to increase the
number of children with public coverage before Katrina, eligibility for
parents remained lower than the national average. The eligibility cutoff for
a parent with two children was $3,218 a year in income in 2005.
Adults without dependent children were not eligible at all for public
coverage. Limited eligibility
levels left many, like those with chronic mental illness or most adult
workers living in poverty, in the gap between Medicaid and private coverage.
Continued
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