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What Katrina can teach us about health care after Hurricane Harvey

Dylan Scott covers health care for Vox. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo and STAT before joining Vox in 2017.

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It will take years for Houston to rebuild from Hurricane Harvey. One essential part of that recovery will be reassembling the city's medical capacity and infrastructure.

The New York Times published a harrowing report Monday on the city's hospitals and nursing homes that are heroically seeking to provide care and shelter for Houstonians in need, while also enduring flooding and other dangers themselves.

It is obviously much too soon to assess the damage to Houston's health care system and estimate how much it will cost or how long it will take to repair. But looking back at New Orleans and Hurricane Katrina might give us at least a sense of what to expect and what the coming years could bring.

In this Health Affairs piece, Kaiser Family Foundation researchers, who carefully tracked the Big Easy's recovery, laid out where the city stood one year after devastating flooding left much of New Orleans uninhabitable.

"The aftermath of Katrina devastated the New Orleans health care safety net, entirely changing the city’s health care landscape and leaving many without access to care a year after the storm," they wrote. "The storm of 2005 exposed problems that had existed for years and made solutions more complex and difficult to obtain."

Some numbers:

  • Before Katrina, the New Orleans metropolitan area had 4,083 hospital beds. A year later, it had 1,971.
  • About 4,500 doctors serving three of the city's parishes were forced to relocate because of Katrina, and a year later, only 1,200 had returned to practice.
  • The number of nursing homes fell from 51 to 29, leaving the city with 2,200 fewer nursing home beds.

That's just the beginning. Many people lost insurance because they lost their jobs. One of the major New Orleans hospital systems serving poorer residents actually lost access to some federal funding because its volume shrank after the hurricane. That in turn had led to the hospital, part of Louisiana State University, furloughing much of its staff.

It was a dire scene. But things did get better.

In August 2015, the Kaiser researchers summarized their findings and how the city's feelings about itself had changed 10 years after the storm.

On health care, here is what they found:

  • In 2006, 85 percent of people said they were worried that health care services wouldn't be available if they needed them. By 2015, that share had fallen to 54 percent.
  • Only 1 percent thought in 2006 that the city had enough health care services available for the uninsured and poor. That had increased to 28 percent in 2015 — still low, but a substantial improvement.
  • 74 percent of the city's residents said the Katrina disaster had made them better able to cope with stress.

Plenty of problems remained. There were notable racial disparities: For example, African-American residents were more likely to say they had postponed medical treatment or struggled to pay medical bills than white residents. A notable minority of residents, 21 percent, said they had still trouble sleeping 10 years later and thought it was because of trauma caused by the storm.

Every city and every disaster is unique. But this gives us an idea of the medical infrastructure challenges Houston is likely to endure in the coming months — and a sense of the subtler difficulties that could linger for much longer.

But it should also give us hope. Houston can recover.

Chart of the Day

Congressional Budget Office

How recovery money is spent. The easiest way to think about disaster recovery, after I talked to some experts today, is that the resources come from the top down but are administered from the bottom up. The bulk of the federal money is spent on public assistance — that's the funding to be used for hospitals and other medical nonprofits to rebuild. Read more from the CBO on hurricanes and federal spending.

Kliff’s Notes

With research help from Caitlin Davis

Today's top news

  • “In Trump states, Sanders tries to push Democrats to the left on health care”: “As Washington prepares for a month of spending deadlines, and as Republicans and business groups try to shift the conversation to tax reform, Sanders is trying to drive a discussion about single-payer health care — a debate that he admits would last for years before any legislative action.” —David Weigel, Washington Post
  • “Heller walks tightrope on ObamaCare repeal”: “Sen. Dean Heller is trying to walk a fine line on ObamaCare ahead of his tough reelection race next year. The Nevada Republican, considered the most vulnerable GOP senator in the 2018 midterm reelections, is under attack from both the right and the left and is trying to stake out a middle ground.” —Peter Sullivan, the Hill
  • “Trump’s Threats on Health Law Hide an Upside: Gains Made by Some Insurers”: “The continuing churn among insurers and the anxiety pervading the industry — stirred largely by President Trump’s predictions of collapse and threats to withhold critical government payments to insurers — have obscured an encouraging fact: Many of the remaining companies have sharply narrowed their losses, analysts say, and some are even beginning to prosper." —Reed Abelson, New York Times

Analysis and longer reads

  • “What could happen next on ACA taxes”: “Lobbying campaigns to repeal or delay the health insurance tax and the medical device tax are ramping up, yet there's no clear vehicle for Congress to take action. Well-wired lobbyists and Hill aides say the appetite for doing anything major on health care isn't really there.” —Caitlin Owens, Axios
  • “Obamacare's unsubsidized customers face higher prices and doctor changes”: “Several difficult decisions lie ahead for customers, particularly those who will not receive any help paying for their premiums. Those customers are facing significantly higher costs for their policies, and those whose current insurer isn't providing coverage for 2018, whether subsidized or not, likely will have to change doctors and hospitals to make sure they aren't slammed with high out-of-pocket medical expenses.” —Kimberly Leonard, Washington Examiner
  • “An Untapped Opportunity For Health Care Progress: Redesigning Care For High-Need Patients”: “Providing quality care for these high-need patients is a sizable challenge — yet it’s also an area where strategic attention and investment could yield significant payoffs for patients and the entire health system.” —Peter Long, Health Affairs

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