Whither Employer-paid Health Insurance?

Where is corporate responsibility these days? I know it’s in the toilet, but I’m stunned by yet another example that is drastically affecting one state–North Dakota, where the prospects of hydrofracking and other oil exploration and production have dramatically increased the number of uninsured workers in the state.

Today’s New York Times includes an article about the impact of this oil boom in North Dakota on its health care system. Transient oil workers do dangerous work that too often results in an emergency room visit. Indeed, journalist John Eligon reports that ER visits increased by 400% last year alone at McKenzie County Hospital.

Emergency rooms cannot turn people away, so hospitals have to absorb the cost of uninsured care with the hope that it will be relieved by public funds designated for uncompensated care. Eligon cites McKenzie County Hospital’s debt load as an example of the impact of uninsured care on the state’s health care system. That hospital’s debt has increased 2000% over the past four years.

Just the increase in the number of patients to serve in the region has challenged the existing infrastructure, from ER and inpatient space to staffing.

Eligon describes what health care administrators are trying to do to manage this influx of uninsured patients. What he doesn’t address is why the companies that are hiring these workers aren’t paying for health insurance. The Center for American Progress reports that the top oil companies had a banner year in 2011 and did so contrary to the economic theory that higher prices (or subsidies) for a product will result in more product being produced or delivered. According to Daniel White and his colleagues:

“Funny that these rules didn’t seem to apply to Big Oil in 2011, when the highest oil price since 1864 and $2 billion in subsidies to the five largest oil companies—BP, Chevron, ConocoPhillips, ExxonMobil, and Royal Dutch Shell—yielded lower oil production than in 2010. But these five oil companies combined made a record-high $137 billion in profits in 2011—up 75 percent from 2010—and have made more than $1 trillion in profits from 2001 through 2011.[1] This exceeds the previous record of $136 billion in profits in 2008.”

So I’m left asking why the state is not demanding that the oil companies who want to explore and drill in North Dakota provide health insurance to every workers hired–even temporary and parttime ones–or pay an equivalent amount into a state charity pool to cover the uninsured. Should they not be held accountable?

Diana J. Mason, PhD, RN, FAAN, Rudin Professor of Nursing