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04-27-2007
Testimony Before the House Finance Committee
Testimony Before the House Finance Committee
April 27, 2007
Good afternoon chairman Matt Dolan and Members of the House Finance Committee. My name is Gabrielle Karpowicz. I have 29 years experience as a registered nurse. The first 14 years of my nursing career was as an emergency room nurse here in Columbus. The last 15 years I have been a school nurse for Columbus Public Schools, where I now serve as the Supervisor of Health, Family and Community Services. I have also served on the Board of Directors of the Ohio Association of School Nurses for eight years. I am here to thank you for expanding Medicaid/SCHIP eligibility to 300% for children and to talk about why access to health care is important for all of Ohio’s uninsured children.
Columbus Public Schools is the second largest school district in Ohio. Our 90 school nurses serve over 59,000 students from a wide range of socioeconomic and cultural backgrounds in 130 schools. We see first hand, on a daily basis, students whose parents can not afford health care. Students come to school with untreated illnesses and injuries. I can not tell you how many times per day students would come to my school nurse office in the morning with an illness or injury, or their parents would call me and ask me to check a student, to see if they really needed to see a doctor, because they could not afford to take them unless it was absolutely necessary. For parents employed in low income jobs without health insurance, taking off time from work threatens the parent’s job and the family’s economic well being. Even if insured the co-pay and deductible are often problematic, or the parent’s are self-employed and private insurance premiums are unaffordable. Families are often forced to make a decision between buying food and getting the child necessary medical care and medications.
Twenty percent of Columbus Public Schools students do not have prescription or vision insurance and yet are not eligible for Healthy Start. In the 2002 Franklin County Health Survey, 17.9 % of Columbus residents reported they do not have prescription drug coverage and 36% of Franklin County parents reported the need for a prescription medication for their child but did not get it because of cost. Doctors can make a diagnosis and then write a prescription for a health problem but many times that parent is unable to buy the medicine. This inability to afford these needed medications or medical care is a major health problem among the students of Columbus Public Schools. Many times medication is essential in our quest to remove non-cognitive barriers to academic success. An example of this is a student at one of our schools who was diagnosed with ADHD and had recently been acting up in class for several days. When the parent was called the mother stated that he had not received his ADHD medication because she could not afford to pick it up. The principal called our office requesting possible resources to help the mother with the purchase of the medication. Unfortunately, there are very few resources for medication purchase assistance.
During the 2005-2006 school year, the Columbus Public Schools school nurses screened the vision of over 9300 students. Of those screened 3700 referrals were made, but only 1450 referrals were completed. Many of those referrals that are not completed are students who fall through the cracks in the health care system, whose parents do not have vision insurance and can not afford glasses. Or as with many insurance plans, the student’s vision has changed but they are only allowed a new pair of glasses every two years and their parents can not afford to pay out of pocket for new lens. To many of these families eye exams and glasses cannot be a priority because of other pressing needs.
As a result of the inability to afford needed health care many of these students end up missing more days of school because they take longer to recuperate, or if they come to school, they are unable to concentrate and end up spending more time in the nurse’s clinic. Untreated illnesses can lead to more serious problems. Strep throat can lead to kidney or heart complications or an ear infection can lead to hearing loss. A simple injured finger can become permanently deformed if left to heal without intervention. Students that come to school with a contagious illness put other students at risk of exposure. Children who are uninsured are less likely to be fully immunized, putting themselves and other students at risk of contracting a communicable disease.
Many of these families that fall through the crack between Medicaid eligibility and full coverage private insurance utilize local emergency rooms for their primary health care provider because they do not seek care until they are extremely ill or because they know they will not be turned away for lack of ability to pay. Not developing a relationship with a consistent, primary health care provider however puts these children at risk of not having access to health promotion activities, disease prevention services, periodic screenings, management of chronic diseases and undiagnosed developmental delays.
School nurses advocate and assist families to get them identified and enrolled in Medicaid. Some families who are eligible for Medicaid refuse the help because they are embarrassed or they are afraid they will be stigmatized. If the eligibility for Medicaid is raised to 300% of poverty and those families above 300% of poverty who are uninsured are able to buy into Medicaid (on a sliding scale) this stigmatization will be reduced or eliminated and more families will get the help and preventative services they need.
School nurses encourage the expansion of health insurance to children in families without insurance including those whose income is above the 300% federal poverty level. The out of pocket expenses for doctor’s office visits, medications and medical supplies can make access to health care prohibitive for many families—including those who are middle class. Having access to health care supports healthy lifestyles, which in turn, supports academic success.
Thank you for the opportunity to testify today. Thank you again for supporting expanding Medicaid/SCHIP eligibility to 300% for children and I urge you to support helping uninsured children beyond that level to also access affordable health coverage.
I would like to end with this quote by Herophilus:
“When health is absent, wisdom cannot reveal itself, art cannot manifest, strength cannot fight, wealth becomes useless, and intelligence cannot be applied.”
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