You recently published an opinion piece by Sen. Jennifer Fielder (Jan. 2) arguing in favor of charity care as opposed to taxpayer-funded solutions for Montana’s uninsured. In a (Jan. 30) letter to the editor, Tony Kimberlin supported her position. Their comments are made in the context of the discussion of Medicaid expansion. Both make what sound like compelling arguments but both arguments are based on a false statement of the choice.
Fielder and Kimberlin posit the choice as one between taxation and voluntary charity care, but that is not what happens. For the last fiscal year, Mineral Community Hospital had right around $600,000 in uncompensated care. This is sometimes referred to as charity care but in fact no charities write checks to cover these bills. So who does pay these bills?
The hospital has to recover the costs associated with this care. The only way to do that is to build these costs into hospital rates. Medicare and Medicaid don’t pay according to the hospital’s rate schedule and insurance companies negotiate and demand discounts. Their payments help cover some of this “charity care” (which they add to their health insurance premiums) but the biggest burden falls on those who have the ability to pay but have for whatever reason no insurance. There is also some “other people’s money” involved in the form of a hospital district mill levy, money we would prefer to see spent on keeping our facilities up to date.
Another part of this picture is that the communities with higher numbers of uninsured are usually our poorer communities. More uninsured people means more people who delay care until they require emergency treatment. The result is higher uncompensated care costs which end up being passed on to those “other people” least able to afford them. The higher these passed-on costs, the more who are unable to pay their bills and the more uncompensated care we are forced to pass along.
The choice is not other people’s money or charity. The idea that there are charities out there covering these costs is a myth perpetrated by using the label “charity care” rather than the more accurate term “uncompensated care." The only option is other people’s money or let them die outside the emergency room door (currently illegal, always immoral). The only question is whether we get that money from others least able to pay and who have the misfortune of getting sick and injured without insurance or under a system planned and controlled by our democratically elected representatives and designed to spread the burden in a more affordable and equitable fashion.
There is another critical piece of this picture. Some of these costs are not recovered. Bankruptcies and closures of Critical Access Hospitals (by definition, small hospitals where there is no nearby alternative) are rising and many more are in trouble. Most of these failures are occurring in states that refused Medicaid expansion.
When a Critical Access Hospital closes, in most cases it means that for many, the closest emergency room is now at least a half hour farther away. This in turn means that people who might otherwise have survived will die and people who might otherwise have recovered will be disabled. This in turn will result in more demands for “other people’s money’ to support the disabled and those left behind.