Uninsured numbers rise; hospitals feel pinch growing
by Statehouse News ServiceMassachusetts hospital executives say they're facing a record gap between the cost of providing care to uninsured patients and the amount they are reimbursed for providing such care.
The $200 million gap projected by the Massachusetts Hospital Association is based on historic health care utilization rates and 7 percent medical inflation, said association spokesman Paul Wingle. In 2003-2004, hospitals provided $185 million worth of care to the uninsured without being
reimbursed for any of that care, he said.
The concerns of hospitals are being raised amidst new reports that the state's uninsured population is rising. While recent estimates have put the uninsured population at between
450,000 and 650,000, data released Tuesday by the U.S. Census Bureau estimates more than 11 percent of Massachusetts residents are uninsured, or 748,000 people.
In fiscal 2004, the pool paid for about 44,000 inpatient and two million outpatient visits, covering services rendered to more than 454,000 different individuals, mostly young adults between 25 and 44. More than 85 percent of inpatient services covered by the pool are in emergency
settings, as well as 20 percent of outpatient services.
A rising uninsured population puts added pressure on all hospital and community health center services and a state government-administered pool, funded by hospitals, insurers and taxpayers, that reimburses health care providers who treat uninsured residents.
The association has identified a group of 50 hospitals, of the 105 in Massachusetts, where the disparity is especially great: institutions in that groups are on track to be reimbursed 55 cents for every $1 of treatment rendered to uninsured patients, according to the association.
Pending health care reform proposals offered by Gov. Mitt Romney and Senate President Robert Travaglini may provide relief by helping more uninsured individuals to get coverage, but hospital officials are worried that those proposals won't be enacted in time to deliver relief, or may die altogether due to political and policy disagreements.
Beacon Hill leaders say they will make a push this fall to reach agreement on a health care reform bill.
Senate leaders this spring touted the restoration of so-called uncompensated care pool funding
that had been targeted for cuts by the House, but the new state budget still delivers $466 million in total funding for the pool, down from $500 million in fiscal 2005, according to the hospital industry, which has warned that shortfalls in pool funding and inadequate Medicaid reimbursement rates
are harming the services available to all hospital patients.
During testimony delivered recently to state health care finance regulators, James T. Kirkpatrick,
the association's vice president of health care finance, called the problem "substantial and extremely complicated."
"The project shortfall of nearly $200 million will be one of the largest burdens hospitals have been asked to carry in the history of the uncompensated care pool," Kirkpatrick wrote. "Hospitals and
the communities they serve cannot be expected to continuously carry a burden of this magnitude - one that threatens the economic viability and prosperity of these institutions."
Hospitals, insurers and taxpayers, through a combination of surcharges, premiums and taxes, reimburse hospitals and community health centers that provide care to uninsured patients. The rising price tag of such care is often cited by health care reform proponents who say the money could be used as leverage to help insure the uninsured.
A spokesman for the Executive Office of Health and Human Services, which oversees a Medicaid program that insures roughly one in six Massachusetts residents, says Massachusetts is the only state that supplements assessments on hospitals and insurers with tax dollars to help cover the
cost of treating the uninsured.
And it's one of only six states with a free care pool, according to the spokesman, Dick Powers.
"Even with that said, there is virtually universal recognition that the free care pool is broken," Powers said. "The best solution for this is health care reform whose underpinning is the
responsibility of each person to purchase insurance."
One trend is promising, according to Powers. While the number of medical visits and admissions funded by the pool increased 32 percent between fiscal 2003 and fiscal 2004, such visits and admissions are down 3 percent through the first six months of the current pool fiscal year. During the same periods, free care pool charges were up 29 percent and 6 percent, respectively, Powers said.
Cape Business Newsletters
Keep up with the latest issues affecting your business and your life! To sign up for any of the Cape Business newsletters, click here.