Steve Zuckerman: "That sense of human failure matters since the literature on the health effects of man-made disasters makes it clear that the consequences can be even more profound than those of natural events. "
Is the New Orleans health care system operating as it did before the storm?
No, restoration of the city's health care system has been slow. As of June 2007, only half of all hospitals—acute and long-term care—had reopened. And Charity Hospital, the heart of the region's health care safety net, has been shuttered since just a few days after Katrina.
Some of the facts are truly stunning. According to the Louisiana Department of Health and Human Services, of an estimated 4,500 physicians who had to leave the New Orleans metropolitan area, only about 1,200 were practicing there again by March 2006. This slow-paced recovery of the Gulf Coast region, particularly around New Orleans, doesn’t bode well for the long-term health of storm victims. In fact, studies suggest that a return to normalcy is a vital intervention strategy to helping disaster victims.
What was the federal policy response to ensure that people dependent on public health insurance could maintain coverage and access to care?
It granted 32 states Medicaid waivers so they'd have the wherewithal to maintain access for evacuees from the counties and parishes hit by the storm. That way, states wouldn't have to expend their own resources on Gulf Coast evacuees. Also, the waivers set and uniform eligibility guidelines for people who may not have been enrolled in Medicaid and earmarked funds for covering the uninsured.
16 percent of current New Orleans residents report deterioration in their mental health, 19 percent report worse physical health, and 36 percent say that their access to health care is reduced. (Kaiser Family Foundation survey)
Under these waivers, states serving evacuees got about $22 million and over 118,000 evacuees received health care.
The waivers weren't independently evaluated. But states were required to report to the federal government on the impact of the demonstration on evacuees, the host states, and the community. The summary of these reports—prepared by the federal government—indicates that the states reported that evacuees' needs were met even though health care needs of individuals were complex. Not surprisingly, states did site challenges that can serve as lessons learned in moving forward.
Are the health effects of Katrina likely to surpass those of other natural disasters?
Katrina was natural, but had elements of a man-made disaster. Most obvious was inadequate levee maintenance and the poorly coordinated evacuation efforts. That sense of human failure matters since the literature on the health effects of man-made disasters—whether mass shooting sprees or violence—makes it pretty clear that the consequences can be even more profound than those of natural events. Among other things, man-made events can destroy exposed individuals' basic beliefs about human nature and the world, as well as make them feel worthless and vulnerable. Indeed, one survey conducted in Houston storm shelters two weeks after Katrina found that four out of five respondents felt that the government's response was "too slow and there's no excuse." Nearly 70 percent felt that race and income affected the government's response, and three out of five said that their treatment made them feel that the government did not care about people like them.
Has there been much progress on the state and federal government's agreement to rebuild the health care safety net and change the approach to indigent health care in New Orleans?
In October 2006, the Louisiana Health Care Redesign Collaborative submitted a broad plan to the Centers for Medicare and Medicaid Services. It outlined a way to rebuild the post-Katrina health care system in the New Orleans area under a Medicaid demonstration project (Available here). Features of this plan include expanded coverage for children, parents, pregnant women, individuals with disabilities and childless adults using direct enrollment in Medicaid and premium assistance for private insurance.
So far, the federal government hasn't approved this plan largely because of disagreement over how to finance an eligibility expansion. Louisiana fears that if too much is spent on making more people eligible, the state won't have enough left to continue subsidizing the costs of caring for the 300,000–400,000 uninsured who still wouldn't qualify.
