As the number of Americans without health insurance reaches epidemic proportions, LIUNA and its signatory employers work hard to sustain these benefits for Laborers and their families. Like home ownership, health insurance is an anchor to middle class life in the United States.
“Overall, the Laborers’ health and welfare funds provide excellent health benefits to members and their families,” says Cynthia J. Smith, Director of the Central Laborers Welfare Fund (CLWF) in Jacksonville, Illinois, “but, for technical reasons, certain gaps in coverage exist. For instance, each fund has eligibility rules that require members to attain a certain number of employed hours before they earn their coverage. New members may have to work for many months before they reach the threshold. Similarly, retirees may face a gap in coverage when they stop working but are not yet eligible for Medicare.”
The situation in central Illinois may be typical. There, in 2004, employers made contributions to the CLWF on behalf of 3,833 Laborers. However, during the year, only 3,348 (87.4 percent) became eligible for benefits. About one in eight remained uncovered.
As with any other individuals without health coverage, uncovered Laborers are less likely to get regular check-ups or to see their doctor, even when they have health problems. “The danger in postponing examinations is that conditions can deteriorate,” says Smith. “To help make the decision to obtain needed medical care, to reduce the cost of that decision and, more importantly, to enhance the quality of life of our underinsured or uninsured members, we started Medical Access 101.”
The purpose of Medical Access 101 is to find affordable help for Laborers and their family members who temporarily lack coverage. It also assists insured members who have high out-of-pocket expenses because of specific chronic conditions that are not fully covered by the plan.
“We have established relationships with the health care providers in our area,” says Smith, “and they earn substantial revenues from our purchase of services. With Medical Access 101, we’re able to tap these vendors to get something back for our uninsured members.”
A designated staff person manages the program, working with members to assess their needs and contacting providers to enlist services. “Typically, hospitals, medical and nursing schools, clinics, universities, health departments and pharmacy companies already have programs designed to help low-income or uninsured people,” says Smith. “Our staff compiles an updated resource list, checks on website and contact information, plans for anticipated needs and intervenes in specific situations as needed to explain a member’s financial situation to a health care provider.”
For instance, a letter from the CLWF can explain to a doctor why a new member does not now have coverage but is likely to have it in future years. This may encourage the provider to offer services at a temporarily lower rate until the coverage kicks in. Sometimes, the intervention is of a more general nature. Preparing for next year’s flu season, the Medical Access 101 coordinator already is searching out resources that can provide flu shots in October. Childhood inoculations are also addressed. In addition, the program helps members with vision, dental and maternity needs. Prescription drugs are another concern. A number of pharmaceutical resources will provide discounts (see www.xubex.com, for example).
“One of the problems we have is simply getting the word out to our members that this help is available,” says Smith. “Each situation is different, and we need to find out what the individuals need.”
The chief expense is the cost of the program coordinator. “It is very important to have a plan to keep the program going because the members will come to rely on it,” says Smith. “Resources are always evolving, contact information changes and the members in need keep rotating. Though it often is simply a matter of a phone call, someone needs to stay on top of the whole process.”
After about a year’s experience, Smith calls Medical Access 101 a “great program,” though she acknowledges that it is impossible to measure its cost effectiveness. Nevertheless, she says, “It’s not about the money saved. If it were, we would just be the members’ insurance company. It’s about fulfilling the role as our participants’ healthcare advocate and helping our members get the services they need.”