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Perfect Storm of Factors Burdening V.I. Public Health

Aug. 6, 2008 — The U.S. Virgin Islands public health system is burdened by a combination of too many uninsured patients, a cap on Medicaid payments to the territory and high levels of chronic illness, according to officials from the Health Department and the territory's two community clinics who spoke during Senate budget hearings Wednesday.
In the United States, Medicaid operates as an entitlement, with funding based on both population and ability to pay. On the mainland, the local share is determined on a sliding scale depending on local incomes. In the territory, it is granted as a lump sum and the territory matches it, paying 50 percent. (See "Christensen Keeps Pushing for Medicaid Changes.")
"The Medicaid cap imposed on the territory gravely impacts the ability to access this coverage," said Masserae Sprauve Webster, director of the Frederiksted Health Clinic.
"A family of four cannot exceed $8,500 to qualify for this medical coverage. Thus an income of $15,000, although we may not consider this high, is too high for a family of four to qualify."
"(T)he local government cannot handle this lopsided burden of the Medicaid program nor can it handle the legislated 50 percent burden," Health Commissioner Vivian I. Ebbesen-Fludd said.
The number of uninsured patients at area clinics is higher than the 40 percent national average, too.
In 2007, the Frederiksted Health Clinic saw nearly 10,000 patients, of whom 58 percent were uninsured, Webster said. Another 31 percent were covered through the local Medical Assistance Program, which handles federal Medicaid and the local government's matching funds. Ten percent were on Medicare and only one percent had private insurance, Webster said.
At the St. Thomas East End Medical Center, 62 percent of clients were uninsured in 2007, said center director Anneta Adams Heyliger. That's up from 58 percent in 2006, she said.
An unhealthy populace adds to the situation.
"Chronic diseases, including cardiovascular disease, cerebrovascular disease, several types of cancer and diabetes are all well above the U.S. average," Webster said. "The death rate for diabetes among Virgin Islanders is twice the rate of the U.S."
The reasons for these high rates are complex and not fully understood, but genetics, diet and lifestyle all play a role, Fludd said.
For Health, Gov. John deJongh Jr. has recommended a 2009 budget of $75.8 million, an increase of $3.4 million or 4.5 percent above fiscal year 2008 funding of $72.4 million. Of the total, $41 million is to come from the V.I. government's general fund and $2.3 million from the Health revolving fund, comprised of fees generated by Health for medical services. Federal funds add $32.2 million and several other funding sources add the remaining few hundred thousand.
Frederiksted Health Clinic is asking for a total budget of $3.2 million. Of that, $1.2 million is federal funds and $1.5 million from the general fund, and half a million in funds generated by the clinic.
St. Thomas' East End Medical Center Corporation's total projected 2009 budget is $2.1 million, nearly 20 percent more than this current year. Of the total, $1.1 million will come from the general fund, another $600,000 from federal funds. Most of the remaining $400,000 will come from fees generated at the clinic.
No votes were taken. Present were Sens. Terrence "Positive" Nelson, Neville James, Juan Figueroa-Serville and James Weber III. Absent were Sens. Liston Davis, Carlton "Ital" Dowe and Ronald Russell.
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