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Health Care Reform:

Health Insurance & Affordable Care Act

Rethinking Charity For Those Declining Coverage

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“Even those with health insurance are ‘uninsured’ for an increasing percentage of the medical care they need” because many have high annual deductibles, said Steven Lipstein, president and CEO of BJC HealthCare, in an opinion piece published in The St. Louis Post-Dispatch.

Still, as the health law changes the insurance marketplace, “we are seeing charity care reductions,” says Michael Miller, director of strategic policy at Community Catalyst, an advocacy group in Massachusetts.

While Miller says the health law will result in more people with insurance, the need for financial assistance programs remains. He disagrees that charity programs would dissuade uninsured consumers from enrolling in coverage since most will need other health services besides hospital care.

“It’s really premature for hospitals to start presuming that level of calculation on the part of someone who shows up uninsured,” Miller says.

Is The Patient Unwilling, Or Unable To Pay?

Hospital executives say they are weighing many questions in evaluating whether to change their policies.  Did people choose not to enroll – or were they unable to get through the new health insurance marketplaces during the open enrollment in the fall and spring? Did they know subsidized coverage is available? Could they afford insurance, even with a subsidy, given that many insurance plans have deductibles that can run into thousands of dollars annually?

“That’s something hospitals have struggled with for decades: Is the patient unwilling to pay or unable to pay?” says Katherine Arbuckle, senior vice president and chief financial officer at Ascension Health.

At Ascension, one of the nation’s largest not-for-profit hospital groups based in St. Louis, Mo., a special task force will make recommendations before the end of the year on whether changes are needed.

“How do you treat those who decline [coverage]? Do they get free services when others have paid?” asks Arbuckle.

While nothing has been finalized, Arbuckle says the Catholic hospital chain has ruled out some changes, saying it will not reduce the income threshold for those who qualify for free care, currently at twice the federal poverty rate. That’s about $23,340 for an individual.

Many hospitals are simply checking to see if their policies comply with the health law’s requirements, says Todd Nelson, a director at the Healthcare Financial Management Association, which represents more than 40,000 people who work in health care finance.

He is not surprised that some require applicants to apply for insurance coverage.

“Hospitals have always encouraged patients to apply for coverage they are entitled to receive, whether commercial insurance through employer or through programs like Medicaid,” he says.

Tenet, HCA Make No Changes

Several hospital chains, including two of the largest -- Tenet and HCA -- say they don’t have plans to change their charity care policies. Both offer free care to those who meet certain requirements, including earning less than twice the federal poverty rate.

Fri, Aug 15 2014

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