Watauga County has

the highest rate

of uninsured
By Scott Nicholson

Watauga County has been among the state’s leaders in many categories, but one pinnacle has led to a burdened health-care system and a possible indicator of other social ills.

A recent report from the U.S. Census Bureau ranked Watauga County as having the highest number of uninsured residents in the state. The Small Area Health Insurance Estimates were based on 2005 surveys and data for those aged 18 to 64 years.

Nearly a third of Watauga County residents are without insurance, and surrounding mountain counties are also among the worst for numbers of uninsured. Watauga’s 31 percent was trailed by Avery County’s 27.4 percent and Ashe County’s 25.5 percent. According to the report, Watauga County could have up to 9,600 adults without insurance and its rate is nearly twice the national average.

Alice Salthouse, community outreach director for Watauga Medical Center, said the high number places a strain on local health services, often leading to cost increases across the board.

“One in five people is living at poverty or below, and one in three doesn’t have insurance,” Salthouse said.

“When you think about our hospitals, our doctors and our programs, we’ve got something going on that not many people are aware of. We have high rates of childhood obesity, diabetes related to being overweight and people not taking personal responsibility (for their health).”

While the problem is complex, as evidenced by various national and universal health-coverage plans that have been proposed but not enacted, wellness programs may be the best way to head off escalating health-care costs. Watauga County recently received a $475,000 grant to fight childhood obesity, and other preventive efforts have been aimed at boosting physical fitness and reducing smoking.

Watauga Medical Center operates the Appalachian Healthcare Project, which has 175 people enrolled to go through a screening process and then be matched up with services.

“We provide them with a primary-care physician who has agreed to see them free of charge,” Salthouse said. “We connect them with medicine and health services.”

The program started in 2001, with participants paying a small co-pay for each doctor visit. Those participants are also enrolled in a program for free prescription medicine and other preventive programs designed to keep conditions from becoming acute and therefore more expensive to treat.

“In the last 24 months, charity care and bad debt at our hospital has doubled,” Salthouse said. “Our hospital is probably one of the top charities we have in this county when you talk about what we do for the community.”

The Hunger & Health Coalition’s executive director Compton Fortuna said there has been an increase in demand for prescription medicine in the free pharmacy in Boone. “People are having to make more choices between food and some of their other basic needs,” Fortuna said.

“We have decreased our service area but still our numbers have continued to increase.”

The coalition’s prescription-assistance program helps connect patients with drug companies for lower-cost drugs. “Those work well with chronic-disease patients,” Fortuna said. “It takes a while to get enrolled, so it doesn’t work for emergencies.”

Fortuna characterized the additional demand as a result of a weak economy, saying additional need has shown up in food services as well.

Nationally, the number of uninsured rose from 15.3 percent to 15.8 percent from 2006 to 2007. Among children, the number of uninsured rose from 10.9 to 11.7 percent over one year.

Adam Searing, a specialist in health issues for the N.C. Justice Center, said people are losing their jobs and therefore their health-care coverage, which is contributing to the problem.

Searing said health insurance gets more expensive because people get more procedures and are on more prescriptions, which spreads out the overall burden of health costs.

The cost for a family’s insurance is about $12,000 and for many small businesses, “that’s out of reach,” Searing said.

Most N.C. families have wage earners either in small businesses or in low-wage jobs where family income is less than $42,000 a year.

“The increase in health-care costs are not a mystery,” Searing said. “It’s happening because of increasing (procedure) prices and increases in costs of prescription drugs. Many of these drugs are not necessary.”

Searing said overuse of “fancy medical technologies” is also driving up costs. He said those machines lead to more imaging because hospitals have a lot of money invested in equipment.

“I’ve been in Raleigh advocating for better health care for 11 years, and we have a plan,” Searing said. “We propose getting these universities together to form an institute to research health-care costs and procedures. I don’t think it’s going to work if an insurance company says it, or if the government says it, but hopefully people will trust the universities.”

The N.C. Justice Center also supports more time spent with primary-care physicians to promote overall patient wellness instead of relying on a number of specialists. Lack of preventive care also leads to more emergency-room visits, which create higher costs, Searing said.

Ultimately, the federal government may have a prime role in any expanded health coverage, Searing said.