Stacy Brown worries when her 1-year-old son, Mason, stops breathing. And what worries her even more is that she doesn’t know exactly what causes him to stop.
She’s taken him to the hospital and to doctors, but she said she still has no answers.
“He stops breathing if it gets too hot or if he gets sick,” Brown said. “But even in air conditioning, he’ll have spells where he stops breathing and then starts back.”
In his first year of life, he’s been to the hospital three times, she says.
The family’s medical problems don’t end there. Stacy, at 22, deals with chronic depression after finding her 53-year-old mother dead of a heart attack and watching her brother try to revive his 3-month-old son — her nephew — when he suffocated in his crib.
“I can still remember both of their faces,” Stacy said.
Her oldest child, 5-year-old Savannah, was born two weeks early and had colic. And husband Michael, 23, is already experiencing chest pains.
Medicaid helps pay for children’s health care but they say waiting lists at the clinics that take Medicaid often keep them from seeing doctors when they need them.
The Browns are homeless, taking one day at a time and trying to build a better life as part of Family Promise, a nonprofit agency that gives them places to stay in a network of local churches. They focus on survival as they move from church to church.
“I’m just thankful to have somewhere to sleep and something to eat,” Brown said.
The Browns are not the only ones in Anderson County who feel that way.
In 2010, 38 percent of Anderson County’s children were insured through Medicaid. Statewide, the numbers reach 42 percent, said Jeff Stensland, the state’s health department spokesman. In 2009, 56 percent of the children born in Anderson County were born to mothers insured by Medicaid.
South Carolina ranked 45th out of 50 states for overall child well-being in 2010, according to the state’s Kids Count data. Health workers said they are seeing more cases of asthma, respiratory illnesses, attention deficit disorder, hypertension — and even mental illnesses than they used to.
And officials say the state and Anderson County are paying a high price.
At AnMed Health alone, the cost of providing health care to patients insured by Medicaid has risen 429 percent in the past 10 years.
“These numbers tell us that there are a lot of poor people in South Carolina,” Stensland said. “When you look at this stuff globally, the levels of healthy — or unhealthy factors — are pretty high in South Carolina. And yeah, there is a societal price to pay when you have an unhealthy population.”
The budget crunch
By noon on a recent Friday, more than 50 sick children had already entered the AnMed Health Children’s Health Center. Some were quiet, with pained expressions, sniffling with red, puffy eyes. Others danced and pulled on parents’ pants legs as they waited for their turn.
This is the clinic where most of Anderson County’s children insured through Medicaid come for their regular doctor visits.
Director Sheila Woods said this clinic exists because most family practices don’t want too many Medicaid patients.
“Greater than 90 percent of the kids who come through our doors are insured through Medicaid. You can’t make ends meet with only Medicaid dollars,” Woods said. “So, the hospital felt that a clinic like this one is a community service.”
That service costs real money.
From October 2009 to September 2010, 20,000 children passed through the doors of the children’s health center for medical care. That came with a price tag of nearly $3.2 million. About $1.6 million, or 50 percent of the total budget, was paid for by Medicaid and patients’ insurance.
The remaining $1.6 million was added to AnMed Health’s column of unpaid medical costs.
In 2010, AnMed Health submitted a $128.5 million bill to Medicaid and was reimbursed for $38.7 million.
“That’s a significant burden,” said Jerry Parish, the chief financial officer for AnMed Health. “And we know they are going to cut reimbursement rates again. Medicaid has told us that they are going to cut our rates by at least 10 percent.”
That is a drastically different situation than what existed in the year 2000. The total costs for Medicaid coverage in 2000 reached only $29.9 million and the government gave AnMed Health back $21.5 million.
And those Medicaid costs are just one column of the debt that AnMed Health accrues in a year. The hospital’s debt and charity cases saw huge increases as well, even if those areas didn’t climb as fast as the cost of coverage to Medicaid patients did.
Information released by Parrish’s office shows that in 2000, AnMed Health spent $9.7 million in health care for patients who did not qualify for Medicare or Medicaid, but still did not have enough income to pay for their medical care.
By 2010, the patients who qualified for the hospital’s charity assistance reached 6,244 and the cost of that care had increased by 412 percent — to $40.1 million.
And the bad debt — the cost of health care that is not paid for — topped $84 million in 2010. In 2000, the hospital’s bad debt totaled $21.9 million.
“That $84 million, that’s all those who are unemployed or underemployed,” Parrish said. “Maybe they have a full-time job but they don’t have insurance and can’t afford the health care. All of that is then shifted to someone else.
“And there’s no one we can call and ask them to sponsor a patient.”
Not just runny noses
As the Medicaid costs have climbed, children’s overall health in South Carolina and Anderson County has not improved, said Jeff Stensland, the spokesman with the state health department.
The state spent $5.8 million providing Medicaid to residents — most of whom are children, Stensland said. That was an increase from the $4.2 million spent in 2005.
Yet, South Carolina continues to rank near the bottom of the nation in the overall health of its children.
The national Annie E. Casey Foundation, which looks at the overall well-being of children, released data in 2010 that showed South Carolina as 45th in the nation for the health of its children. The factors that placed the state 45th: infant mortality rate, percentage of babies born below a healthy weight, the teen death rate, and the percentage of children living in single-parent homes.
The Centers for Disease Control puts South Carolina fourth in the nation for its number of babies born with a low birth weight. In 2009, 10 percent of the state’s children were born with low birth weights. The state with the highest rate was Mississippi, with 12.2 percent of its children born with low birth weight.
“As long as Medicaid coverage is there, they will have some level of health insurance,” Stensland said. “But that does not always translate into good health because there are so many other factors that play into health other than insurance.”
For Sheila Woods, statistics on low birth weight, Medicaid costs and child-well-being rankings — aren’t just numbers. Those numbers have faces.
Like the 6-year-old girl who came into the clinic, twisting her hands together as Woods talked to her. The girl wasn’t sleeping because her mother, who left in the middle of the night for another state, told her in a letter that she was going to kill her grandparents.
Or like the fourth-grade boy who was thinking of suicide after he lost his grandmother and his father to suicide, all in the span of two years.
“He didn’t have a well-thought-out plan, but he was very set that he wanted to die,” Woods said.Woods cared for children in the Appalachian region of Kentucky for 19 years before taking on the role here in Anderson as the director of the AnMed Health Children’s Health Center. The largest difference she’s seen between the children in Anderson and those in Kentucky is the number of mental health problems they are dealing with here.
“I have to say that my previous practice was in Lexington, Ky., and we did see a lot of mental health issues, but the seriousness of the mental health issues in this Medicaid population is greater,” she said.
Not every child who is treated here has such a sad history. But many of them still have health problems that put them at risk for repeating the cycle of poverty in which they may be living.
The top illnesses that the clinic’s staff sees in young Medicaid patients: asthma, respiratory illnesses, dehydration, attention deficit hyperactivity disorder, high blood pressure as a result of obesity, hypertension and heart problems, Woods said.
“Poverty is such a brutal condition for kids,” Woods said. “When you are a kid and you don’t know if you are going to eat when you get home, that tends to be a trigger for anxiety and depression. And it’s also reflected in poorer school performance. So it really is a vicious cycle.”
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