An Issaquah doctor believes that the effects of cuts to the state’s Basic Health Care Plan will spread throughout the health care industry, and could harm the ability of hospitals to efficiently treat emergency room patients.

State legislators are expected to announce funding cuts of about 40 percent to the Basic Health Care Plan, which provides subsidized insurance to low income families.

Last week, Dr. John Milne, an emergency room physician at Swedish Hospital in Issaquah, expressed his fear that people who can’t afford basic health care will defer necessary medical treatment, leading to crisis situations in the future that could have been resolved with earlier treatment and preventative care.

Milne told The Reporter he was expecting that more people would utilize emergency room facilities, where doctors were obliged to treat patients regardless of their ability to pay.

“We see this already – patients coming in through the ER for a sore throat, or a sniffle,” he said. “From our standpoint, we will take care of everybody who comes through the door, regardless of their insurance status. For the uninsured, we are their care of last resort.”

And the number of uninsured people in Washington is about to skyrocket.

The Basic Health Care plan currently has 102,000 enrollees, more than half of which earn less than the poverty level – $18,310 a year for a family of three.

The new budget is expected to cut about 43,000 places.

It will be up to the Washington Health Care Authority to decide who those people will be, people who are unlikely to be able to afford any health insurance without the plan’s support.

A statement on the Washington Basic Health Website reads “To stay within the appropriated budget, Basic Health is no longer processing incoming applications to determine eligibility and has officially implemented a waiting list. New applicants will be placed on a list behind those already waiting.”

“This will hurt the working poor,” Milne said. “It is not about the minimum wage, or the unemployed or the elderly, who receive Medicaid and Medicare. It is the low income workers, the cooks, the clerks, the backbone of our service economy.”

“The only place left for these people to go will be the ER.”

While cutting access to the Basic Health Care Plan is expected to save about $255 million, it is the opinion of Milne and many others in the public health community, that funding medical access for low income families is far more medically, and financially, efficient.

Milne said that he expected the newly uninsured to put off necessary medical treatment, resulting in severe medical issues that will have not only disastrous impacts on the patient’s health but will also place a greater strain on the financial resources of the system.

“Diabetes, high blood pressure, congestive heart failure – when we see them in the ER they will be out of control, as the patients will have been unable to get into primary medical care,” he said. “In any health care system, taking care of the patient at the right time is the most cost effective practice, through preventative care. A large population of of uninsured people is going to cost society a lot more.”

“For us, when people use the ER, we pay for it, and write it off. But we have to move the cost across, into things like higher rates for other services.”

“We are already getting accustomed to doing more with less money.”

“And, of course, it is in the best interests of everybody to ensure that ER facilities are not compromised and are always made available to those who need them.”

Milne said that the cost of uninsured workers would flow further into society through problems such as greater worker absenteeism and dissatisfaction.

Metropolitan King County Councilmember Larry Phillips echoed Milne’s sentiments, saying last week that the adopted state budget cuts will translate into more uninsured patients requiring subsidized care at King County’s Harborview Hospital and public health clinics, at a time when the county is wrestling with its own budget crisis.

“With more families losing their incomes in this tough economy, this is the worst possible time to drastically reduce access to affordable health insurance for low income families,” said Phillips. “Without health insurance, families get desperate, showing up in emergency rooms with conditions that could have been prevented with access to primary care. This so-called ‘budget cut’ will actually end up costing more and puts citizens’ health at risk.”

Phillips said that the King County Children’s Health Initiative seeks to help enroll eligible uninsured children in subsidized health care programs such as Medicaid.

Families can visit the County’s Children’s Health Initiative Web site to determine their child’s eligibility at www.kingcounty.gov/healthServices/health/partnerships/kchap