Op Ed: Inadequate healthcare funding for local residents

PART 3: Follow the Money

In my last edition of this Op-Ed, I left you to consider whether ASG (and LBJ, but I believe that we can even include the DOH here too, etc.) has been claiming anywhere near all of the money that it is entitled to under the various healthcare options available to a U.S. Territory. Now, let’s follow the money and see if we can figure out what in the world is going on within the applicable governing bodies, which are involved in this process?

Given that I worked pretty much exclusively in Pediatrics, one might point out that most children don't have MediCARE rights or entitlements anyway. As such, it could logically follow that I wouldn't have been getting any of those kinds of requests for documentation.

But while that is partially true, I certainly did help to take care of a very large number of children who are eligible for Medicaid according to the Program’s rules, not to mention a number of dependents from the families of Active Military servicemen/women (and other folks with their own private insurance, etc.).

Plus, there are always exceptions to even MediCARE’s general exclusion of children.  There clearly are children who still have MediCARE benefits, even though they haven't worked yet and as such haven’t contributed to the program via income taxes. One example of which is any child with end-stage kidney disease on Dialysis, one or two of whom I actually did help to take care of over my years at LBJ.

With regards to MediCAID though, it takes some further explanation: American Samoa is the only State/Territory out of 56 total that does not determine individual MediCAID eligibility (again, MediCARE is different, because one generally earns those benefits over their working lifetime by paying that "FICA Medical" tax that we see on our paystubs). 

Furthermore, for MediCAID the Territory received a waiver many years ago, and proudly thereafter decreed that 88% of its population was MediCAID eligible... But since there is no determination made on a case-by-case basis, there is no way to establish if a given patient is in the poorer 88%, or the wealthier 12% of the Territory.

Voila, everyone in American Samoa has since been de facto MediCAID eligible, despite the fact that it is really designed to be a stopgap health insurance program only for our poorest citizens!

Based on that percentage and the official population figures (and I believe, some formulae involving the Federal Poverty Level determinations), the U.S. Govt. gives ASG a large yearly "block grant," and then basically trusts the Territorial leaders to distribute among the charges made for its eligible residents. Given the fact that “trusting ASG” is much easier said than done, and that ASG must match all of this funding on a 50/50 basis, one can only imagine how poorly this has gone for the Territory?!

Including even yours truly (as a resident of the Territory under contract), whenever I used LBJ for my own medical needs. While I in no way consider myself "rich," I certainly wasn't at any time among the poorest of the population there either. And I even maintained my own private health insurance the whole time that I lived and worked there (Blue Cross/Blue Shield of CA), which mind you I was never even once asked for by the hospital.

And that is just about tragic, isn’t it? I pay a large amount of money for that insurance, and it should be able to be used…? Not to mention that LBJ could have benefitted from it! 

In any case, whenever I was charged by LBJ I dutifully paid my $10 for a medication or whatever it was, but was it really FAIR when I think about all of the other people there who couldn't even afford that much...? Not hardly. That just seems to have forever been the way that things work under the auspices of ASG, which is very sad, indeed.

My final thoughts next time should help to illustrate how and why the residents of American Samoa should be able to force ASG and the Territorial leaders in their respective offices to stop being so “penny-wise, yet pound foolish…” — especially when it comes to healthcare.

Until next time,

Dr. Jim Marrone

Comment Here