Even as the debate over health care reform heats up at both the state and national levels, the ranks of uninsured or underinsured people continues to increase in Tooele County, according to social service and health care providers.

Karen Kuipers, relief services coordinator for Tooele County Relief Services, said almost 100 percent of the individuals who come to her program lack insurance for the treatments they need or are without insurance altogether.

"Ninety percent of the people who come here are either uninsured or underinsured, and they are usually low-income people who are struggling and don't have enough resources," she said. "They could have an injury, sickness, substance abuse problem or mental health problem, and it could cause them to have to miss work, lose their job or even make visits to the emergency room. Some people may also need a prescription for something like depression or ADHD but can't afford it, and that can affect their ability to function and be self-sufficient. Some of those prescriptions can be pretty expensive as well."

Kuipers said many uninsured people who come to relief services have waited until their problem is critical rather than seeking preventative care.

"I see people who can't work or do normal, everyday things because of minor problems that they could have taken care of earlier if they were insured," she said. "Something that could have been addressed and prevented earlier may now require surgery or some other serious kind of medical care, or it may even be life-threatening for them. Their unmet needs have caused everything to fall apart for them."

Across the state, roughly 300,000 Utahns are uninsured, which is 16 percent of the population — one of the highest uninsured rates in the nation. However, many more Utah residents would be uninsured if not for several state and federal programs.

In Tooele County alone, a total of 7,220 individuals were served at any time during the year by a medical program intended for those with low incomes or resources in 2007, according to the Utah Department of Workforce Services. Some of these programs included Medicaid, CHIP (Children's Health Insurance Program), Foster Care Medical, Medically Needy Child, Pre-Natal Medical, Primary Care Network, and Qualified Medicare Beneficiary.

There are local health care providers, such as Valley Mental Health's Tooele unit, that help find treatment for those who may be uninsured or underinsured. Doug Thomas, manager for the Tooele unit of Valley Mental Health, said his organization gave treatment for 450 uninsured residents last year, which was an increase up from 2006.

"Those 450 who called in for help and were screened for service last year were adults needing treatment for a variety of issues, including grief, loss, mental illness, parenting problems, or issues their children were having," he said. "We are seeing the same trend so far for 2008, and I'm sure there are several others in the county who are in need of our services but just don't know it's a resource here. There's also still the stigma around mental health that there's something wrong with you if you get treated, and I think that keeps people from coming and getting help."

One oft-cited reason so many Utahns go without insurance is because the state's predominantly small-business economic base is having a difficult time coping with rising premiums. That leaves many fully employed people to fall between the cracks of the system — a trend that's playing out locally as well.

Debbie Winn, executive director for the Tooele County Chamber of Commerce, said many employees go without insurance because local employers cannot afford it, or because they can only afford to pay a portion, leaving the employee to make up the difference.

"It's difficult for small-business owners, especially if their business is new, to pay those premiums, which keep going up because of rising health care costs," Winn said. "If a person wants to get insurance on their own, the premiums are usually reasonable and the company has the option to cover you or not based on your health. However, if a company says they want an insurance plan, they have to cover everybody within the company whether they are healthy or sick, which can be pretty expensive."

Kuipers said some doctors locally will not treat uninsured patients. Some of these patients go to the Fourth Street Clinic in Salt Lake City, which helps provide health care and support services to the area's homeless.

Denten Park, CEO for Mountain West Medical Center, said that for emergency services, many local uninsured people go to Mountain West Medical Center's ER department, which has to take all patients regardless of insurance status. He said that Mountain West saw more than 5,000 uninsured individuals visit its ER department in 2007.

"It's under the EMTALA [Emergency Medical Treatment and Active Labor Act] that we accept any and all people into our ER department," Park said.

There is some evidence to suggest the number of uninsured patients in Tooele County is less than in other parts of the state. Sherrie Ahlstrom, community health director for the Tooele County Health Department, said most of the people who come in for immunizations at the health department throughout 2007 have been insured.

"Most of the people who came here in 2007 came for our immunization programs, and out of those people who came in for immunizations, 3 percent were underinsured, 3 percent had CHIP, 11 percent were on Medicaid, and only 30 percent were uninsured," she said. "Several other county health departments in the state see more uninsured people than we do — sometimes over 50 percent."

Park said that although a large number of uninsured individuals come to Mountain West's ER department, there were few uninsured patients seeking treatment elsewhere in the hospital during 2007.

"For the whole hospital, only about 6 percent of the people who came here in 2007 were uninsured, which is pretty good compared with nationally," he said. "I assume our population here is well-insured compared to other counties in the state."

Park said another reason why MWMC mostly receives insured patients is because places like Valley Mental Health and Tooele County Relief Services are specialized more for uninsured or underinsured residents in the area who are not undergoing emergency situations.

"It's likely that those who are uninsured or underinsured go to places like Valley Mental Health or Tooele County Relief Services first before us, which is good because that's what those places are there for," Park said.

Doug Radunich: dougrad@tooeletranscript.com