Mark Litzler outlines concerns that he and his associates at St. Lukes Hospital and Foundation have with the need to appropriate a growing percentage of investment to indigent care.

Dr. Mike Jurkovich of Catholic Charities finds his most pressing challenge at the other end of the life cycle, namely that of providing services to moms and babies, 50% of whom lack a payor source. To address these needs, and to provide service in a timely fashion, Catholic Charities relies on the foundations.

“We see people who have insurance but that does not begin to cover their needs, ” said Samara Klein of the Childrens Benefits Service for Families, which advocates for children with special needs. As Klein observed, funders want to help fill the gap but without taking place of insurance or public assistance. For Kansas Citys Promise, Denny Barnett noted, the primary issue is also children, and his essential challenge is to work through the various bureaucracies to make sure that children and youth get access to the necessary services to assure a healthy start in life.

Teaching hospitals have their own perspective on the issue of the uninsured and uncompensated care. Janice Benjamin of the Kansas University Endowment Association pointed out that people come to the ER when they are sick even though the costs are much greater. It was critical, she noted, that teaching hospitals work with safety net clinics to make sure that patients get appropriate care and that it extends beyond the primary.

For Eunice Johnson of the Samuel U. Rodgers Community Health Center, the stress point, in her experience, has been the issue of mental health. She has found a “huge need” for services in this area, especially among adolescents.

Dealing with the Uninsured

Samara Klein of the Childrens Benefits Services for Families, Lesa Mitchell of the Kauffman Foundation and Ingrams Moderator Jack Cashill follow the discussion with great interest.

The participants at the Ingrams assembly paid a good deal of attention to the increased burden of un-compensated care deriving largely from uninsured and underinsured patients. Beyond doubt, the uninsured are having an impact on the system. The St. Lukes Hospital Foundation is one of many funders that has had to increase the resources it sets aside for indigent care. According to Mark Litzler of the St. Lukes Hospital Foundation, that proportion has gone from the nominal to about a third of the Foundations annual outlay.

The safety net hospitals are picking up a larger share of uncompensated care, observed Dr. Steve Reintjes of the KC Neurosurgery Group, because the “boutique” hospitals do not shoulder their own share of the burden. Instead, they tend to siphon off the well-insured and leave the indigent care to the safety net providers.

There was also some useful clarification as to who these people are and why they seem to be increasing. “We need to put a human face on the uninsured,” argued Bill Bruning of the Mid-America Health Coalition.

Although 95% of the uninsured are connected to the work force, as Bob St. Peter of the Kansas Health Institute observed, it would be a mistake to think of them as deadbeats who just dont want to pay. In many cases, employers dont offer insurance, and the cost of it, if financed individually, would all but consume a workers salary.

Pre-existing conditions, in particular, make the cost of insurance “astronomical” for many families, added Samara Klein. These are middle class families that have been priced out of the health insurance market. Klein sees an additional problem in that the current system discourages entrepreneurship. Given costs, would-be entrepreneurs are reluctant to leave their existing plans. According to recent surveys, said Bill Bruning, 55% of those queried who are currently covered worried that they would not be able to afford their health care insurance within the next six months. “The fear of not having health care effects just about everyone,” he added.

The misunderstanding about the nature of those who receive public support has affected even the state legislatures in their debates on the funding of indigent care, noted Denny Barnett. As Patricia Wyatt added, some of those who cannot afford to pay for insurance are “our own employees.”