| We want our cake, and we want to eat it, too. We all want affordable, accessible healthcare. Instantly accessible. Fast and friendly. No hassles. Just down the street, please. Or right around the corner. And it has to be the best state-of-the-art high tech care money can buy. As long as it’s not our own money. We like it better when it’s our employer’s money. Or maybe the government’s money.
Somebody’s got to pay. And when it’s not employers, or the government, or those who can afford to pay their own bills, it’s hospitals that usually get stuck paying. And because the number of uninsured Americans continues to rise, hospitals are subsidizing billions of dollars in uncompensated healthcare. An amount that grows larger each year. “What’s the problem?” you ask. “Isn’t that a hospital’s mission; to take care of the sick, regardless of ability to pay?” Of course it is. For the hundreds of hospitals founded as part of religious ministries, the point of their existence is to provide care to the indigent. “At the heart of our very existence is our ministry to the poor and vulnerable,” says Mary Jo Gregory, chief operating officer of the Lenexa-based Sisters of Charity Leavenworth Health System, which owns and operates nine hospitals in California, Colorado, Kansas and Montana. “Providing care to those who cannot pay for it is not a burden, it’s an opportunity to serve. It’s why we were founded all the way back in 1864.” For other hospitals, specifically state university-based academic medical centers, it’s not a ministry, but it is an obligation. State law mandates they provide care to all patients regardless of ability to pay. “We’re required to care for the indigent and uninsured,” says William H. Marting, vice president of financial operations at the University of Kansas Hospital. “But, that requirement is also a commitment. We’re committed to the community we serve. That’s part of our purpose as a teaching hospital.” In 2006, the cost of fulfilling that purpose was $65 million in uncompensated care provided by the hospital to Kansas residents. On the other side of State Line, in 2005, hospitals affiliated with the University of Missouri–Kansas City School of Medicine—Truman Medical Center, Saint Luke’s Hospital, Children’s Mercy Hospital and Western Missouri Mental Health Center— provided nearly $80 million in un- compensated care, according to the Missouri Hospital Association. “Uncompensated care” is an internally conflicted phrase. “Uncompensated” is an impersonal accounting term; a line on the liabilities side of a ledger page. “Care,” on the other hand, is intimately personal. The cost of services rendered for which no payment is received can be calculated, but the value of care provided to real people in real need is incalculable. “There is value in what we do,” says Mike Rowe, chief financial officer of the Sisters of Charity Leavenworth Health System. “There is immediate and lasting value to the families and individuals we serve. There is value to the community. And there is value to us, those of us that provide the care.” Mike Quintero, Director of Patient Financial Services at KU MED says the care it provides to those who cannot pay is a valuable and essential safety net. “The cost to the community would be far greater if these services were not provided.” Yet, that safety net is coming undone, stretched beyond its capacity by increasing numbers of individuals and families whose employers are reducing or eliminating health insurance benefits for their workers. And, as usual, those most at risk of falling through the widening holes in the safety net are those who need the net most. Studies conducted by the Kaiser Family Foundation have determined that families with lowest household incomes were the least likely to work for companies that offered health insurance benefits to their employees. According to the report, “the percentage of working families with a worker who is offered health insurance fell over the 1998 and 2005 time period, with most of the drop between 2001 and 2005. The percentage point changes we show over the period are relatively small, but with over 150 million people covered by employer-sponsored health insurance, even a small percentage point drop in job- based coverage being offered to families at work can affect millions of people. People who are not offered health insurance at work are less likely to be insured than people who are offered job-based coverage. The decline in job-based offers of coverage to families is one factor that may help explain the increase in the number of people without insurance.” The Kaiser Family Foundation says its study is based on analysis of data gathered over an eight-year period—with more than 30,000 observations. Not surprisingly, the data show that the uninsured are significantly less likely to receive medical care than those who are insured. Following an accidental injury, 78.8 percent of those without insurance received the care they needed, as opposed to 88.7 percent of those with insurance. Likewise, only 81.7 percent of uninsured individuals with a new chronic medical condition received the necessary care, vs. 91.5 percent of those with insurance. This fact is evident to local healthcare providers. “We know that those without health insurance are less likely to seek the care they need,” says KU MED’s Marting. “That’s a serious situation. It only aggravates health problems. Which means that addressing those problems becomes more expensive. The problems don’t go away. Our commitment is to provide care to people sooner, rather than later.” At the Sisters of Charity System, Mike Rowe says “Our ministry is to everyone. We don’t look for market opportunities that will take us out of the path of the uninsured. In fact, we seek them out.” The number of individuals needing such ministry is growing. The Kaiser report states that, in 2006, one in every six Americans under the age of 65 did not have health insurance—a total of 46.5 million people. From 2000 to 2006, the number of uninsured Americans grew by approximately 10 million. The primary reason behind these alarming numbers is that the cost of providing insurance benefits to workers has skyrocketed. As expensive new technologies, treatments and medicines become available, as labor costs rise, and as new facilities are built to serve growing communities, healthcare costs have increased at rates far greater than the rate of inflation. American manufacturers say that the cost of providing health insurance benefits to workers and retirees has severely compromised their ability to compete in the global marketplace. When labor union and company contract negations stall or collapse, health insurance benefits are likely to be the cause. Officials at Kansas City hospital acknowledge that the nation’s healthcare system is broken. And though they bear much of the burden when care is not paid for, they are willing and prepared to continue to do so, until equitable solutions can be found. It appears that all the parties in this predicament are beginning to understand that assigning blame for the problem is counterproductive. There is also a growing understanding that the responsibility for solving the problem will be shared by everyone. The numerous candidates seeking the Democratic and Republican nominations for president have each put forth healthcare plans that spread responsibility for carrying the load among employers, insurers, providers, government, and individuals. Yet, late on a Saturday night, when a frantic mother arrives with a sick child in an urban Kansas City hospital emergency room, no one will stop to ponder the nuances of a politician’s position paper on healthcare reform. And no one will stop her at the door to ask if she will be able to pay for her child’s care. It is understood that uncompensated for is better than uncared for.
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