Taxpayers pick up tab for gun violence

US public pays for 80 percent of hospital care costs for firearm assault victims

Emergency responders transport a person to a waiting ambulance after a 2012 shooting in Yuba City, Calif.
David Bitton/Appeal-Democrat/AP

Taxpayers have largely picked up the hospital tabs for victims of gun violence in the United States -- around 80 percent of their emergency department and inpatient care -- and funded more than half a billion dollars in medical care for firearm assault victims in 2010, according to a new study.

The victims, mostly young males and residents of low-income areas, are disproportionately more likely to be publicly insured or not have any insurance at all, while they are hospitalized more than twice the national average, according to the study by the Urban Institute, a nonpartisan think tank.

The cost of a stay for a firearm assault injury was nearly $14,000 more than the average inpatient stay, so the medical bills of gun violence victims amount to about $630 million a year, according to Embry Howell, author of the study and a senior fellow with the Urban Institute's Health Policy Center.

"Many hospitals get special federal subsidies for absorbing the cost of the uninsured," Howell told Al Jazeera.

"The hospital will likely bill the patient, but if the patient is poor he or she may not be able to pay for care. This becomes 'bad debt' for the hospital," which is paid for by taxpayers, she said

Kim Russell, outreach director for Moms Demand Action for Gun Sense in America, an organization founded after the December 2012 massacre at Sandy Hook Elementary School in Newtown, Conn., told Al Jazeera in an email that the public health care costs of gun violence could be curbed by stronger gun legislation.

"Background checks on every gun purchase would significantly help to prevent guns from getting into the wrong hands time and time again," she wrote. "This is absolutely a public health crisis, no doubt about it."

Howell also framed the issue as a "public health prevention issue" that reaches beyond the purview of the criminal justice system regulating gun legislation.

States with gun-friendly laws have higher rates of gun-related emergency care hospital visits, the study found. The South and Midwest have the highest rates of both emergency care visits and gun ownership, the study said. 

Still, some gun rights advocates argue that guns make the nation safer. Yet in a study published Wednesday by The American Journal of Medicine, the authors say they have evidence that "debunks the widely quoted hyptothesis." The researchers concluded that there exists a strong link between the number of firearm-related deaths in the U.S. and the number of guns per capita, the highest in the world.

The National Association for Gun Rights declined to comment for this story. The National Rifle Association wasn't available for comment before publication.

As the nation turns to efforts to control the cost of health care through prevention strategies, the prevention of firearm assaults should receive increased attention as a high public health priority.

Tip of the iceberg

Uninsured victims of firearm assaults also appear to receive a different quality of hospital care, the study notes. While their emergency care vists are the most expensive, they are subsequently hospitalized less often, and, if they are admitted to the hospital, their treatment is less costly or spans a more limited number of days compared with their insured counterparts, according to the study.

"The numbers indicate that some hospitals may be making treatment decisions based on the insurance status of the patient rather than on the patient's condition," Howell said.

And the cost of hospital visits is just the tip of the iceberg. Psychological therapy bills can run in the thousands for a single assault.

Russell, of Moms Demand Action, is herself a victim of gun violence: In 1999 she was grazed by a bullet while running away from an armed assailant near Inman Park in Atlanta. After the shooting, Russell said she spent more on the costs of a psychiatrist than on her physical recovery.

"My injuries required X-rays to ensure my ribs were not cracked, which for a gunshot wound isn't a high dollar amount for medical care of my physical injuries," Russell said.

"However, I subsequently suffered from PTSD (post-traumatic stress disorder) and incurred nearly $2,000 from costs associated with the psychiatric treatment I required. This cost came at the taxpayer's expense (the City of Atlanta covered my treatment), and ultimately I was barely hurt," she said.

And then there's the problem of underreporting. If a hospital forgets to categorize injuries of gun violence as those incurred during a firearm assault, the incident does not get counted toward the total tally of gun incidents and goes unnoticed, Howell said.

Projected Obamacare effects

Howell also warned of unexpected budgetary consequences of the Affordable Care Act's implementation. Since many uninsured victims of gun violence will become eligible for Medicaid or other forms of insurance, "the public cost will go up," she said.

"As the nation turns to efforts to control the cost of health care through prevention strategies, the prevention of firearm assaults should receive increased attention as a high public health priority," she said.

And because more than half the hospital costs of gun violence victims are incurred by patients who live in the country's lowest median household income quartile -- with families making $45,000 annually or less -- the problem seems poised only to get worse.

"We're a country in crisis," Russell said.

Al Jazeera

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