John asked a good question on Twitter yesterday about how does the medical care in Orlando or any other region get paid for when there is a mass casualty event:
Who pays for the medical care for uninsured and underinsured in mass shootings? Will a victim be forced to pay for their care?
— (((I Hate Nazis))) (@Johngcole) June 12, 2016
The traditional American response to this is either bake sales or GoFundMe.
That is still the case.
But that is not the complete case. Most states, including Florida, have presumptive eligibility for their Medicaid program. Presumptive eligibility allows hospitals to make a determination that an individual who is currently uninsured is likely to be eligible for Medicaid. They’ll start the paperwork and then get paid by Medicaid. The problem in Florida is that it is a non-expansion state so there is very limited eligibility for adults who were healthy until they were shot. At that point individuals who are uninsured are SOL for their initial emergency surgeries, treatment and recovery. Some people will get out with fairly clean wounds that require bones to be reset and wounds closed. They’ll get out with $10,000 or $20,000 bills that the GoFundMe page could handle. Other people with serious gun shot wounds could easily run up half million dollar claims by next weekend. The hospitals will try to go after any assets, but these people will declare bankruptcy.
Long term some of the people who are currently uninsured and not Medicaid eligible will be sick enough to qualify for Legacy Medicaid. That will cover rehabilitation and recovery expenses. For the individuals who are not sick enough to qualify for Medicaid based on their new disability status, they’ll be eligible to sign up for a new ACA policy on Exchange this November. It could be worth it to some of the individuals to move out of their current rating area to trigger special enrollment periods to buy Platinum plans that will carry them from July to December.
But yes, the people who were shot and lived but are uninsured are most likely financially screwed as they’ll be running up very large bills in a very short time frame and almost none of those services can be deferred until a better insurance plan can be put into place.
Baud
This needed to be repeated.
Thanks, Richard.
Cermet
Now that is what fucking amerika is all about – placing someone into terrible debt when an accident happens and they are not “insured” (read paid people money to profit from possible accidents.) That is real freedumb.
dr. luba
Gun insurance should be mandatory. Just like auto insurance is (at least in my state).
craigie
Gun insurance should be mandatory, and backstopped by the NRA. If you get shot, the NRA pays your medical bills.
Seems fair.
Balconesfault
This is why I believe there should be a tax on ammunition to put into MHMR funding and victims compensation.
JPL
@Cermet: this
BillinGlendaleCA
@dr. luba: I’ve said over and over again and again–guns should be treated like cars.
ETA: My Congresscritter(Schiff) is on Morning Joe.
Cermet
@JPL: If a link, not working, maybe?
JPL
@Cermet: I simply meant that I agreed with your statement.
Another Holocene Human
Medicaid in Florida is pure bullshit. There is so much harm caused by their cruel system. I know someone who is unemployed (and unemployable right now) because she needs prescription only crazy pills to function, but no money to get scrip or crazy pills, but Medicaid is still refused to her, because she’s an able bodied over 18, get a jerb, but she’s unemployable because she needs her crazy pills to function…
They’re going to cover her eventually, but she suffers in the meantime. (It’s been two years and counting.) We all suffer. She and many like her have a lot to give, if they were allowed to.
JPL
Visitors from around the world go to Orlando. What happens if someone from France was in the club?
Guy
While we’re at it, what about the surrounding costs? The cost of the police investigation? They’ll fall on the tax payer.
Jack the Second
I’d just like to take a moment to remind everyone that Justice Scalia is still dead, and once his seat is filled on the Supreme Court we can begin rolling back some of the more insane reinterpretations of the Constitution he made during his lifetime that contributed to this situation (loosening of gun control laws [although Florida], crippling of the ACA Medicaid expansion [Roberts did the weird compromise, but Scalia found the whe thing unconstitutional], …).
It doesn’t help the current victims, but if we can pull off this next election, things might get better.
I'mNotSureWhoIWantToBeYet
@Balconesfault: Excellent idea. Please forward it to your Congresscritters and the White House. Everyone should be able to agree that victims of crimes like these should not be bankrupted. There should be a national fund, and a small tax on bullets would easily pay for it (as well as make ammo less insanely cheap).
Make the GOP and those in the pockets of the NRA do more than offer “thoughts and prayers”….
Cheers,
Scott.
Richard Mayhew
@JPL: For someone from France, their insurer from France will make a payment to the Orlando area hospital, perhaps supplemented by any travel insurance. Once the person is stable enough to fly, they’ll be on the next flight back to Paris and then go to their home area for follow-up care.
Individuals from say Georgia (another non-expansion state) are SOL. Individuals from New York who qualify for Medicaid Expansion will have New York Medicaid pay their hospital claims and then get shipped back to New York for follow-up care at in-network/par facilities.
For people who don’t qualify for Medicaid or Medicaid Expansion but are still uncovered, they are SOL.
TheMightyTrowel
@Richard Mayhew: As an American who lives abroad, it’s worth saying that non-Americans are VERY AWARE of the incredible price of medical treatment in the USA. Travel insurance is pretty common, but anyone travelling to the states has to pay a premium or buy a special US-only policy because if you’re injured in the states (as opposed to literally anywhere else except perhaps antarctica*) getting you treated and getting you home will destroy your finances.
I’ve never met a European over age 20 who travelled to the US without special US-centric travel insurance. The under 20s mostly get their travel insurance bought for them by their parents. There’s certainly privilege there, in that European travellers are more likely to be able to afford costly travel insurance policies IN ADDITION to flights, etc. but
you askedthe question was about French tourists.Uncle Cosmo
They can still do that over medical debt? Color me shocked! shocked! that Big Med hasn’t followed the lead of the student-loansharks & instructed their lapdogs in Congress to make medical bills undischargeable in personal bankruptcy.(And FTR the non-profit hospitals are every bit as rapacious & relentless in their billing as the for-profits.)
hovercraft
The media needs to get into the face of Batboy and every state legislator and ask them what they plan to do for the survivors. These people are your constituents are you going to victimize them a second time. They deserve to receive whatever treatment they need. And if because of your vindictiveness they do not have coverage, then the state of Florida must pick up the tab. They screwed these people and they must be shamed for it. Keep throwing this in their faces, make them own throwing their citizens under the bus.
greennotGreen
The injured and families of the dead are precluded from suing gun manufacturers, but they can and should sue the NRA and every member of congress who voted against rational gun control laws. NOBODY except the military in war zones needs a semi-automatic weapon that can shoot 15-100 shots in seconds. This is insane.
aimai
@Balconesfault: Great idea! There should definitely be a tax on ammunition to fund a national program. And a requirement for every gun owner to purchase insurance at the same time they purchase their gun, insurance that will pay off to the victims/state in the event that their gun is used to shoot anyone. If no insurance? No sale.
CarolDuhart2
Lets not forget the side costs as well-housing, food, home care for those who are going to need long-term therapy. Long-term PTSD care. Some people will have to go on disability just to meet basic costs with that coming out of taxes as well. There was some discussion about gun owners should have $500K insurance. Considering the long-term costs, insurance is the least we could do for both the victims .
gvg
@aimai: I assume you are talking about a yearly policy or something. It’s a promising idea but have you ever thought about the follow up years. If you don’t pay to renew you car insurance, the insurance company informs the state and your license to drive is suspended automatically. If someone doesn’t renew their gun insurance are we going to send law enforcement to take their guns? I am sure that will please our local law enforcement (not). In fact that sounds pretty scarey to me. I think in some ways that is why we don’t get some things done…these people are scarey.
gvg
the tax on ammunition might be more enforcable than confiscating guns if they don’t renew gun insurance. I think they should have gun insurance, but i think the real kooks will evade it so taxes for the ammo would also be needed.
rikyrah
thanks for this information Mayhew.
Nylund
@aimai: I think mandatory gun insurance is a good idea. And unlike healthcare, insurance companies should be allowed to discriminate on pre-existing conditions. And, of course, no government subsidies for those who can’t afford.
Nicole
@gvg: if your driver’s license get suspended, your car isn’t taken away from you unless you’re caught driving it (and not even then; I think you’re more likely to face jail time or a fine). Seems to me that if people don’t renew their gun liability, as long as they keep their guns hidden away in their own homes, and don’t use them, there’s no reason for them to be taken. But if they bring them out for anything- firing range, because they feel insecure about their small penis on the way to the coffee shop, etc., and get caught, then they get in trouble.
MPAVictoria
Once again I must say this is a ridiculous way to run a healthcare system….
burnspbesq
@greennotGreen:
Ok. Outline the complaint. What’s the legal theory under which those defendants can be held liable (hint: I don’t think you’re going to find one that would survive a motion to dismiss)?
Which is a roundabout way of saying that litigation isn’t always the answer. Sometimes you need to flip a state legislature from R to D in order to get a sensible solution. That takes time and hard work.
pat
A tax on ammunition? Gun insurance policies?
Great ideas which means they will never happen.
We are all screwed. Probably 90% of mass murders in this country (just guessing here) are committed by citizens with no particular religious connection (guessing here too) and yet this entire tragedy will be used to attack Obama and Clinton for not using the term “radical islamic terrorism.”
Steve Crickmore
@pat: Just the biggest mass murders are committed by the unmentionable.
r€nato
yeah but at least we have FREEDUMB
freedumb to be shot while going about our daily business
freedumb to go bankrupt from medical bills
god bless murca
r€nato
@Cermet: if something bad happens to you, obviously it’s your fault because you pissed off jeebus.
Luthe
@greennotGreen: The Sandy Hook families have thus far been allowed to proceed in their lawsuit against the manufacturers on the grounds that the manufacturers knew the AR-15 was unsafe for civilian use and was improperly marketed and sold. Whether this argument will result in a win remains to be seen, but the case is on track to go to trial.
I wonder if the Orlando shootings will be introduced as additional evidence/the Orlando victims can join that suit or file their own on similar grounds.
paper
Florida, like most states, has a crime victim’s compensation act. I’m too lazy to figure out what it exactly covers, but one would think that medical expenses would be the least of it.
jl
Immediate emergency care must be provided by a complicated patchwork of state and federal laws and regs, that generally go under the acronym EMTALA, which is the acronym for the federal statute (bit many states have similar laws). I know from talking with EM personnel that they game the system to the max in order to get people admitted to hospital from ER, if they think the person will be in danger if sent away, even if by official definition of emergent condition that threatens life and limb they are supposed to sent home from ER. I’m sure a boatload of EMTALA care was provided after this shooting, as well as others. I don’t know the details of how the costs of that kind of care get covered, and what the mark-up is. Would be interested to hear if Richard knows.
Emergency Medical Treatment & Labor Act (EMTALA)
https://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA/index.html?redirect=/EMTALA/
jl
@jl: I have heard health care money people denounce these laws and regs as ‘commie’ in the sense of the ‘takings’ doctrine. The federal statutes only apply to Medicare eligible hospitals, and some experts have claimed demands of EMTALA and state versions, explain many closure of ERs, and growth of private specialty hospitals and clinics that are not medicare eligible.
KRK
Thanks, Richard. I was wondering about how this would go down in the absence of Obamacare. Obviously not even a chance of Medicaid expansion for the uninsured, but wouldn’t even those who were insured have been facing a payment limit that wouldn’t come close to covering the more seriously injured? And facing termination/inability to get insurance in the future if they’re dealing with long-term recovery/care?
LanceThruster
There’s always that GOP mantra…
“Let them die!”
Xenos
I used to work as a medicaid caseworker in Florida back in the early 90s. Used to get a lot presumptively eligible people from the hospitals, and a fair number of them could not be helped. Assets would sink their application.
One guy got mashed up in a motorcycle accident, half million $ in costs at the schmancy private hospital that the ambulance dropped him off at. He had a second car worth more than $4,000, so no luck. Lots of lower middle class families, especially back before the last 25 years of the modern economy got to them, had little pockets of assets to protect them from the risks of life. Low income, modest assets, no luck.
Minorities often had the same, or even better income, but no assets, and would qualify for benefits. This pissed of my working class white clients to no end, but who voted for these stupid laws in the first place?
Snarki, child of Loki
Ain’t it just wonderful, after getting shot up by a guy what was able to legally buy his guns after the FBI “was looking at him”, to be further victimized by healthcare costs?
Yeah, sue the NRA. As “accessories to terrorism”.
By the standard of proof currently in operation, they can be subject to drone strikes RIGHT NOW.
Qays
Two questions about different ways to game the system:
1. I know it’s too late for the Pulse victims, but can people in non-expansion states simply overestimate their income to 100% of the poverty line during open enrollment and get 94% CSR silver plans? The IRS will come after you if you underestimate your income, of course, but is there actually a provision for punishing people who overestimate their income, seeing as this was surely not foreseen at the time the law was drafted?
2. Why would foreigners bother with travel insurance when visiting the US briefly for tourism? Can’t they just skip town without paying? I find it hard to believe that US hospitals will be able to successfully track down and sue emergency room patients who’ve returned to their homes abroad.