Low-Income Maryland Residents Face Difficulty Accessing Care, Have Debts When They Do, Study Says

Maryland's low-income residents are experiencing problems accessing medical care and face mounting debts and are "hounded by collection agencies" when they do receive care and cannot pay for it, according to a study released July 30 by the Open Society Institute-Baltimore, the Baltimore Sun reports. The institute interviewed 274 patients at Baltimore's health clinics and resource centers, finding that about 50% of the patients were insured but still had difficulty covering copayments, deductibles and treatments not included in their health plans. Researchers found that some patients were receiving care, but more than 50% said they were having "problems getting care" for chronic conditions. The study also found that 46% of participants said they owed money for medical treatment. Participants reported an average medical debt of $3,409, almost half the average annual income of those interviewed. Approximately 80% of patients with medical debt said they had been contacted by a collection agency. In addition, the survey found that those with medical debts were "more likely" to switch care providers to "avoid going to one [whom] they owed money" or to receive care only in an emergency department. Dr. Thomas O'Toole, assistant professor of medicine at Johns Hopkins University School of Medicine and a program officer for the Open Society Institute, said those patients "lose the whole effect of having continuity of care." He added, "These people are clearly falling through the cracks in the system." The institute, a foundation backed by philanthropist George Soros that grants some $7 million each year to deal with urban problems in Baltimore, did not demonstrate how many state residents had difficulty receiving care for "financial reasons" (Salganik, Baltimore Sun, 7/31).

'Unacceptable' Situation, Editorial Says
The study findings illustrate an "unacceptable situation for a wealthy and progressive state -- particularly when the problem has been largely neglected for years," according to a Baltimore Sun editorial. The editorial notes, however, that "[f]ortunately, some good ideas for change have been advanced recently" by an advocacy coalition and lawmakers (Baltimore Sun, 7/31). The Maryland Citizens' Health Initiative earlier this month announced a three-part plan that would raise cigarette taxes to expand public health program funding, negotiate drug discounts for seniors and block the conversion of CareFirst BlueCross BlueShield from a not-for-profit to for-profit insurer. In addition, state House Speaker Casper Taylor (D) unveiled a proposal in June to expand coverage to the uninsured by expanding the state's Medicaid program (Kaiser Daily Health Policy Report, 7/10). The editorial says that Taylor's plan in particular has "the virtue of addressing a need too long neglected by government in Maryland." The editorial concludes by advocating "a prudent and cooperative spirit" to address the problems of low-income, uninsured Maryland residents (Baltimore Sun, 7/31).