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Schools feel trickle-down effect of families without insurance

Feb. 28, 2011

Some area school districts are noting evidence connecting a significant change in demand for school services with a lack of health insurance for families of students.

Whether through higher absenteeism, more health room visits or the additional need for social worker contacts and visits to school psychologists, a trickle-down effect is being felt in the Lake Country area.

It's a shift that has been observed in the Kettle Moraine School District.

"What I have noticed most in Kettle Moraine is (concern) with the higher co-pays and what it costs to go to the doctor. We have an advantage in that every building in KM has a part-time RN. I get a lot of calls from parents saying can you check and see if I really need to get to the doctor, or can I wait it out?" said Melinda Vose, coordinator of Nursing Services. "Parents will ask, 'will you look in their ears to check for infection, or listen to their chest? Do I need to go to the doctor?' "

"I'm finding people, because medication is getting more expensive, reducing the dose, or don't give it as often as required or supplement with over-the-counter medications instead of filling the prescription," she added.

Another shift Vose has observed is that many families can no longer afford to keep a separate set of medication for students at the school. Items such as asthma inhalers, epi pens, and diabetic supplies may no longer be on hand if the student needs them.

The nuances of such a shift may be subtle.

"We're not seeing anything different at Arrowhead," said Craig Jefson, superintendent of Arrowhead High School, noting that it is a hard issue to quantify.

Wendy Wong, public information coordinator for the Pewaukee School District, said the district nurse refers families to other resources as needed, but she did not think that demand has increased.

But at Oconomowoc High School, Associate Principal Mike O'Connor said the issue is a concern.

"It just seems like we've been hearing about that more frequently and having to consider that in situations where we may not have had to consider it before," he said.

O'Connor pointed to a situation that had occurred earlier that day where a student, in need medication for a psychological condition, was worried about his mother, who was in the hospital and the family does not have health insurance.

"On top of his own personal problems, now he has the anxiety of 'I don't know how this is going to get paid for,' " O'Connor said.

O'Connor said the student did not want to seek medical treatment or have his mother find out about is problem, because he the family could not afford it.

"To hear that out of the mouth of a 15-year-old puts a lot into perspective for us to consider. Obviously, we do the best we can to put resources into the hands of the family, but it's a scary time," he said. "It's got to be such a weighty consideration for young kids."

"Absenteeism is a big area we see it in. There is this tension between what our obligation is to the county and the state in terms of attendance and keeping track of students' attendance and making sure they are accountable," O'Connor said.

If a student has an excessive number of excused absences, they are required to provide medical documentation.

"That's an issue when you're talking with families who say I know my child is out sick a lot. We can't provide you with the documentation because we can't afford it," he explained.

School officials weigh each instance on a case-by-case basis in an attempt to balance support of the family with their obligation as a school district.

"What we try to do is put as many people that have knowledge and experience on it," he said. In such instances, they may rely on the expertise of the school social worker or school psychologist.

"It's not just with students being physically ill, but mental illness this year; that is the part we hear a lot of," he said.

The school official noted that parents may say they see signs of depression, but can't afford the psychologist bill and even if they could, cannot afford the medication to keep up with it.

"That's heartbreaking, to hear a family who can clearly see there is an issue with their child and have to make choices between: am I not going to pay the rent, get food or pay for heat or do we get the medical treatment? That's really, really hard to see," O'Connor said.

"We have things we can offer families. The best we can usually do is our school psychologist can meet with the student, but his job is not to diagnose and he cannot prescribe medication, but we can offer some support here.

"The school social worker, Deb Fowler, has a greater role trying to connect the families with the available resources," he added.

"That's not always easy for families either; it's a difficult step to accept assistance. She really does a great job of connecting those resources that can help them," O'Connor said.

The associate principal said that 17 percent of students in the high school are part of the free and reduced lunch program; he estimates that has risen 5 to 7 percent over the last two years.

"When we say 17 percent are enrolled, that's not an indicator of those who qualify. There's a much larger number of families who could get that assistance, but don't. We use it as an indicator of socioeconomic status, but know it's always under," he said.

While no hard and fast figures exist to track the trend, the Sussex-Hamilton School district has also observed effects from families living without health insurance.

"We are seeing more families struggling and in need of healthcare coverage," reported Denise Dorn Lindberg, public information officer for the district, after conferring with a district social worker.

"They can apply to Badger Care, but one thing she noted is the wait process can be stressful and concerning if there is an immediate need," she said.

The social worker helps families with the enrollment process and connecting them with area resources.

"The social worker is referring families to some free services in the community, specifically Community Memorial Hospital's free clinic as well as St. Joseph's in Waukesha, which offers medical and dental services," she added.

Fowler said she sees increased pressure on families in stressful situations, which might include lost jobs, lost income or mortgage issues.

"That impacts their discretionary income, so they don't have the resources they once had," she said.

"Kids who need medication may go without, or go longer in between when they fill the medication," she added.

Even with the availability of the state insurance program, problems still exist.

"If the family is on unemployment, they may be in a gray area for Badger Care. They could be making too much for that, but not enough to pay for insurance, or the out-of-pocket expenses," Fowler said.

"That's fairly common; they're in that little piece of lower-middle-income where they have too much for Badger Care," she said.

Fowler praised the efforts of the local resources.

"The Lake Area Free Clinic (in Oconomowoc) has been a lifesaver. We refer a lot of families and students, once they turn 18, there. It's just been such a wonderful service for the community," she said.

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