The Plight of Red State Public Hospitals and the Patients They Serve

[McCamy Taylor]

As I wrote a while ago, the Red State public hospital where I work realized that a bunch of our low income patients were being suckered into signing up for useless “bronze” insurance plans. Plans that would cost them pennies a month—making them affordable---but which piled the entire $5000 out of pocket expense up as a deductible and which had very limited provider lists and benefits (such as prescription services etc.) The companies offering these extra cheap insurance plans would receive several thousand dollars from the feds per person for writing polices that would probably never be used. These plans were designed to appeal to 20 something guys who never saw a doctor and only wanted the insurance in case they got run over by a truck and so they could avoid paying the fine. This kind of insurance was absolutely no use for the average public clinic patient—age 50, with diabetes, high blood pressure, high cholesterol, coronary artery disease, asthma, a bad back, depression---you know, the typical working guy that got laid off from his job in 2008 and who now works in fast food . The guy who would be dead if his city did not spend tax dollars paying for a county clinic and hospital to take care of the medical needs of people like him. This guy needed the silver plan. But even making a low wage, his monthly premium for a silver plan would have been a whopping
$100-200---and he did not have the money. Some months, he could not even come up with the $5 for the copayment for his heart medication. So, he signed up for the only one he could afford---the useless one.

When I reported on the plight of people like these---my own patients---I was called a liar. By now, I assume that enough people have talked to enough other people to know that these folks really do exist---because, hey, private insurance companies have absolutely no qualms about collecting several thousand federal dollars per person selling poor saps an insurance plan that they will not be able to afford to use. Hell, that is how they make money. And it isn’t as if anyone in the federal government can do anything to stop them. Congress is tied up in gridlock. No matter what loopholes are uncovered in the ACA, no one will be fixing them anytime soon. So, all you folks who take any criticism of any aspect of the ACA as criticism of the POTUS, please calm down. This is not about Obama. This is about sick folks who are not keeping their appointments for checkups because they think they are going to get stuck with a bill.

Attendance at the family clinic where I work if down. Down, because so many of our patients think that they can’t be seen “for free” now that they have that $5000 deductible. Those that come in anyway look scared. They ask how much it is going to cost. Boy, are they relieved when they find out that it isn’t going to cost them anything. The county isn’t going to abandon them just because some private insurer is ripping them---and Uncle Sam---off.

http://www.jpshealthnet.org/The-Affordable-Care-Act-and-JPS-Connection.aspx

Q: Can I have an exchange health plan and still be on JPS Connection?
A: Yes, if you meet the income levels, Tarrant County residency requirement, and other requirements. For patients eligible for subsidized insurance on the Marketplace, JPS offers Connection Secondary to Insurance, which may help cover out-of-pocket expenses.

http://www.jpshealthnet.org/For-Patients/Low-Cost-Medical-Care.aspx

As of October 2013, the federal Affordable Care Act provides health insurance for many people who could not afford it before. But the Affordable Care Act, often called Obamacare, does not cover everyone and many of the new insurance plans have high deductibles and coinsurance costs. If you are eligible to sign up for insurance under the Affordable Care Act (www.HealthCare.gov and www.CuidadoDeSalud.gov,) you should do so. If you are eligible to sign up for insurance, you must do so in order to be eligible for JPS Connection. Once you're signed up, JPS Connection can help with your out-of-pocket expenses, if you qualify and if your care is provided at a JPS facility.

Good news for the folks who thought that their tarnished bronze plans meant no more health care. Possibly not such good news for the private plans which sold the policies hoping that the $5000 deductible would be an insurmountable barrier to health care for most enrollees.

Now, those who wish to complain that this will bankrupt the private insurance industry which carefully prices premiums and deductibles in order to ensure the most profit for the least amount of expenditure---i.e. the least amount of actual health care---go right ahead. I am sure that the private health care industry appreciates your efforts on their behalf. However, before you start complaining about all the “rich” charity hospitals getting fat off the ACA, you might want to read this:

Indigent care facilities in states that opt-out of the Medicaid expansion are at a particular disadvantage relative to other hospital systems. Apart from the Medicaid expansion and the exchanges, the ACA also reduces payments to hospitals that serve needy populations.[54] (Lawmakers reduced these payments on the assumption that all states would expand Medicaid.) Hospitals in non-expansion states that serve needy populations will, therefore, be asked to cope with further reductions in payments.

http://www.breckinridge.com/insights/whitepapers.html?id=1421