Yesterday, Mr. Bush set foot on American sacred ground, our beloved New Orleans.
I asked myself, "how dare he?"
President Bush paused Tuesday to remember the hundreds who died in New Orleans, which has been slow to recover from the devastation of Hurricane Katrina a year ago.
Looking to local leaders to design a rebuilding plan that can speed its revival, Bush went to breakfast with Mayor Ray Nagin before attending a somber prayer service marking the first anniversary of the nation's costliest natural disaster. Half the power is still out here, and half the people have not yet returned.
http://www.nytimes.com/...
Today, the journal Health Affairs released a portrait of shame, a stinging indictment about what amounts to almost non-existent healthcare for the impoverished American citizens who remain in the once proud city.
What has happened to the tattered healthcare safety net that existed in New Orleans prior to the storm one year ago?
Imagine, an American city, American citizens, the richest country on the planet.
Before Hurricane Katrina struck in August 2005, New Orleans had a largely poor and African American population with one of the nation's highest uninsurance rates, and many relied on the Charity Hospital system for care. The aftermath of Katrina devastated the New Orleans health care safety net, entirely changing the city's health care landscape and leaving many without access to care a year after the storm. State and local officials face the challenge of rebuilding and improving the city's health care system by assuring health care coverage for the population and promoting broader access to primary care and community-based health services. [Health Affairs 25 (2006): w393-w406; 10.1377/hlthaff.25.w393]
http://content.healthaffairs.org/...
We all remember the images. Katrina wiped away any illusion we might have had about poverty in America, the richest country on the planet.
In July 2005, before Katrina struck, Orleans Parish (the core of New Orleans) had a population of 437,186; another 448,578 people lived in the adjacent Jefferson Parish (Exhibit 1). At that time, about 23 percent of New Orleans residents were living in poverty ($16,090 for a family of three in 2005). Nearly half (48 percent) of Orleans Parish residents and a third (32 percent) of Jefferson Parish residents were low income (family incomes below 200 percent of the federal poverty level). Along with these high rates of poverty, Louisiana also had some of the poorest health statistics in the country, with high rates of infant mortality, chronic diseases such as heart disease and diabetes, and AIDS cases. There were large disparities in health status for minorities, as the sizable African American population--who represented one-third of all residents in the state and two-thirds of all residents in New Orleans--were more likely than their white counterparts to suffer from heart disease, diabetes, and asthma.1
I shake with a mixture of rage, and overwhelming sadness as I type this diary. How can it be? Why do we allow this? As a nation, as a people we will be judged based on how we care for the most vulnerable among us.
Health care coverage. Low rates of private coverage, high rates of poverty, and limited public assistance through Medicaid for adults left Louisiana before Katrina with more than one in five, or almost 900,000, residents without health insurance and one of the highest uninsurance rates in the country (21 percent, versus 18 percent of all nonelderly Americans).
. . .In New Orleans, Charity Hospital was the hub of the LSU system, serving a largely poor, predominantly minority population through inpatient care, a network of outpatient clinics, and one of the busiest emergency departments (EDs) in the country. Nearly three-quarters of its patients were African American, and 85 percent had annual incomes of less than $20,000. In 2003 more than half of the inpatient care provided by Charity Hospital was for patients without insurance, compared with only 4 percent of inpatient care at other New Orleans hospitals.8 Charity Hospital accounted for 83 percent of all inpatient and 88 percent of all outpatient uncompensated care costs in the New Orleans area.9 It was also the dominant provider of substance abuse, psychiatric, and HIV/AIDS care in the New Orleans area and the only Level 1 trauma center on the Gulf Coast; the only other center in the state is more than 300 miles away in Shreveport.
. . .Louisiana historically had very high rates of ED visits, particularly at public hospitals, which is an indication of limited access to primary care and preventive services. In 2004 the state ranked fourth in the nation for high ED use, with 548 visits per 1,000 people; the national average was 383 visits.
. . .With only two federally qualified health centers (FQHCs) in the New Orleans area, a lack of private providers willing to treat the uninsured, and the use of Medicaid disproportionate-share hospital (DSH) funds to finance inpatient and outpatient care at the state-run hospitals, the clinics at Charity Hospital were a dominant source of ambulatory care for the low income, providing 350,000 outpatient visits at more than 150 primary and specialty care clinics.12 However, despite its substantial role, the hospital was faced with shrinking public resources, a high burden of uncompensated care, and a lack of capital to make much-needed infrastructure improvements even before Katrina hit. Replacing the poor physical plant with a smaller inpatient facility and primary care clinics located throughout the city was already being considered but had not been funded.
One year later, New Orleans struggles, all but abandoned.
One year after Hurricane Katrina, much of the city and its health care infrastructure are still devastated. Plans are being debated, but action is slow, and access to health care continues to suffer. The damage of the storm resulted in more than 1,500 lives lost, 780,000 people displaced, 850 schools damaged, 200,000 homes destroyed, 18,700 businesses destroyed, and 220,000 jobs lost.17 A survey of evacuees in the Houston shelters conducted 10-12 September 2005 documented the hardship many evacuees face: Most were African American and had extremely low incomes, low educational levels, no bank accounts or available credit cards, and no transport or savings to facilitate evacuation. Many had chronic health conditions and had relied on Charity Hospital for their health care both because they lacked health coverage and because this was the historic source of care for their families. Immediately following the storm, evacuees reported that they had spent time trapped in homes; living on a street or an overpass; and enduring harrowing and stressful conditions, often lacking food, fresh water, prescriptions, and medical care.18 How many of these evacuees will be willing or able to return to New Orleans remains an open question as the city seeks to rebuild.
. . .Impact on health care coverage. One survey of residents living in Federal Emergency Management Agency (FEMA)-supported housing after Katrina found that 44 percent of caregivers and 10 percent of children lacked insurance, with many respondents indicating that they lost their insurance when they lost their jobs after the storm.22 Earlier estimates from Blue Cross Blue Shield of Louisiana indicated that 200,000 people could have lost employer-sponsored coverage statewide, pushing up the rate of uninsurance in affected areas.23 In addition, the workers reconstructing New Orleans lack adequate access to health care despite their potential work-related health hazards. Only 43 percent of them have medical insurance, and only 27 percent of workers reporting health problems sought medical treatment; the statistics are far worse when one looks only at undocumented workers.24
Katrina survivors continue to live in desperate conditions.
Interviews were conducted with low-income hurricane survivors in New Orleans, Houston, and Baton Rouge roughly six months after the storm to gather their stories and to lend survivors' voices to hurricane statistics.40 These interviews revealed that although survivors often experienced health problems before Katrina, they were now facing even more daunting challenges in obtaining needed health care. Despite suffering emotional and mental trauma from the storm, with many experiencing anxiety, depression, and trouble sleeping and eating, almost none had received formal counseling services for themselves or their children.
Beyond these traumatic impacts, some survivors also experienced problems caring for the physical and mental health problems they had before the hurricane. A number of interviewees had been unable to obtain critically needed care or prescription drugs, even up to six months after the storm. Several bipolar and schizophrenic interviewees endured weeks without their prescriptions, in the worst cases attempting self-inflicted harm while without medication. Survivors expressed difficulty finding pharmacies, reconnecting with former providers or finding new ones, and paying for their care. Access to specialty care was especially challenging; some pregnant women were unable to find prenatal care. Some attributed negative impacts on their or their children's physical or mental health to their lack of care. In the absence of care, some were trying to manage their conditions themselves--for example, trying to control diabetes through diet rather than insulin while living in a FEMA hotel without kitchen facilities.
. . .At the end of March 2006, the Centers for Medicare and Medicaid Services (CMS) announced the allocation of $1.5 billion of that $2 billion to the states. Louisiana received 51 percent of the initial allocation, of which $384 million was for the uncompensated care pool to help hospitals that were caring for uninsured patients. The distribution of federal funds came more than six months after Katrina struck and does not appear sufficient to compensate fully for the tremendous health care needs caused by the storm. The fiscal year 2006 Emergency Supplemental Appropriations Act includes $550 million to rebuild the Veterans Affairs New Orleans Medical Center, but the majority of the $19.8 billion in hurricane relief funds is devoted to housing and levee repair, not to health care.42 LSU and the Department of Veterans Affairs (VA) signed a Memorandum of Understanding to coordinate development and operation of replacement hospitals in the New Orleans area, which could lead to a replacement facility for Charity Hospital as part of the new VA complex.
People and businesses will not return to New Orleans unless they feel confident that the levees are capable of withstanding another devastating hurricane. Reports are not encouraging on this front.
Assistance also needs to be provided to the thousands who lost their jobs, and thus their health coverage, in the wake of Hurricane Katrina. Exploring ways to shore up the employer market by helping employers rebuild their businesses and provide health coverage to their workers through tax credits or subsidized assistance would also help establish more stable financing for the health system. Together with maintaining and expanding coverage through Medicaid and SCHIP for low-income children and adults, these strategies would broaden access options for health care services and provide needed revenues to the health care institutions struggling to restore services and rebuild the health care infrastructure.
A legacy of neglect under George Bush. The. Worst. President. Ever. A man whom I despise with every cell in my body.
A sad anniversary for our once great nation.
Only 50 percent of New Orleans has electricity. Half its hospitals remain closed. Violent crime is up. Less than half the population has returned. Tens of thousands of families still live in trailers and mobile homes with no real timetable for moving to more permanent housing. Insurance settlements are mired in red tape. The city still has no master rebuilding plan. And while much debris has been cleared, some remains as if the clock stopped when the storm struck.
http://www.nytimes.com/...