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From: Christine Helfrich
To: Rep. McKell, M.,
Subject: Medicaid Expansion
Date: 2014-03-08T22:37:40Z

I recently retired from Huntsman Cancer Institute/Hospital. I was the first point of contact for patients or referring physicians trying to set an appointment for a new patient. I became acutely aware of the number of hardworking Utahns who had inadequate insurance or no insurance because they did not work for a large employer who offered group insurance. These are people we encounter every day who cut our hair, mow our lawns, tend our children, repair our appliances serve our food or mend our clothes. Even college students who pay high premiums for student insurance policies have inadequate coverage. Many of these policies are capped at $50,000. A student diagnosed with acute leukemia or Hodgkins Lymphoma will exhaust that amount in a few weeks.

I also scheduled prisoners from the State Prison who had cancer. It is concerned cruel and unusual not to treat someone in custody. Utah taxpayers are paying for their treatment. It is my understanding that federal dollars for Medicaid expansion could also be used to care for these individuals. Isn't it cruel and unusual to deny other Utahns care?

There is one woman I will never forget. "Susan" was single and had worked out of her home as a seamstress her whole adult life. She was 64 years old and uninsured. Susan's orthopedic surgeon called to refer her because she had been diagnosed with "pathologic fractures". Susan had shown up in the ER with a painful leg and imaging revealed metastatic lesions throughout her skeleton which weakened the bone to the point it spontaneously fractured. The surgeon pinned the bone but needed a hematologist to diagnose and treat the primary cancer.

The routine for scheduling uninsured patients at Huntsman (a University facility) is humane but still requires a number of steps to be completed. Intermountain Healthcare has a similar process.  (If the patient was referred by an IHC physician, they are referred back to IHC for charitable care. IHC has the same policy if patient was seen by a University provider. )

First we obtain medical records. Susan did not have a primary care physician and only sought care at an ER when her leg fractured. We then complete a form called a "certificate of medical necessity"which we take to a physician to sign. The physician indicates on the form that they are willing to cut their own charges for services by 50%. (I never had a physician refuse) The physician also has to spell out what services this patient may require (surgery, pathology, chemotherapy, radiation therapy, diagnostic imaging etc.), though they have never met the patient.

The certificate and records are then given to a financial counselor. The financial counselor calls the patient and asks for extensive information regarding income and monthly expenses (rent, car payment, food, etc.). This information is then given to Huntsman CFO Ben Tanner, who reviews the information. If he feels it is an appropriate application, he then sends it to Dr. Thomas Miller, Chief Medical Officer of University Healthcare. If Dr. Miller approves then I could call the patient to schedule an appointment. This process is usually accomplished in 48 hours but on rare occasions took one week.  The patient is routinely told to bring $150 to the first appointment, as this represents 50% of the physician charges for the first appointment. If the patient can't bring the entire amount they are seen anyway.

I was able to get Susan scheduled to see Dr. John Ward within a week. On the day of her appointment I received a call from the clinic nurse indicating that Susan had not appeared for her appointment. I tried to call Susan and her sister and no one answered. I called the referring physician to see if they had more information. Two days later the a Salt Lake Tribune published Susan's obituary. She died on the same day as her appointment. She would have been eligible for Medicare in 30 days.

I never met Susan but I sobbed at my desk. Had she been able to see a primary care physician for the routine health check ups and recommended diagnostic tests in the previous 10 years, she would likely still be alive. Taking care of the poor in the ER is 3rd world country healthcare. We have to do more than fill out death certificates for the people who perform the myriad of jobs we don't do because we don't have time or inclination.

I could tell hundreds of "Susan" stories from my years at Huntsman.

        Huntsman is a regional cancer center and consequently cares for patients from many    surrounding states who seek the advice of specialists in certain kinds of cancer and to have access to investigational treatments. Huntsman does accept out-of-state Medicaid for these patients. It would be highly ironic if patients with expanded Medicaid from Nevada, Arizona, New Mexiso and Colorado could obtain treatment at Huntsman but not Utahns who fall in the coverage gap.

Please do the right thing and expand Medicaid as intended by the ACA. Political posturing might be fine for the campaign trail but do not let Utah taxpayers suffer without adequate and timely healthcare.

Christine B Helfrich
4537 S Park Hill Dr
Salt Lake City, UT 84124
Ph# 8012730087

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