Some hospitals pull back on charity care

In light of the millions of low-income Americans who now qualify for free or heavily subsidized health insurance coverage as a result of the Affordable Care Act (ACA), some hospital operators are reconsidering their charity care policies for those who refuse to obtain coverage.

Some hospitals rescinded their charity care policies when a patient who qualifies for subsidized coverage or Medicaid refuses to obtain coverage, Kaiser Health News reported. Southern New Hampshire Medical Center, for example, posted notices saying it will not extend charity care to such patients. After a fractious debate, Granite State lawmakers agreed to expand Medicaid eligibility to its residents earlier this month.

"We are seeing charity care reductions," Michael Miller, director of strategic policy at Community Catalyst, confirmed to KHN, noting that many hospitals are concerned that extending charity care to those who lack coverage will encourage patients to not obtain coverage.

How the ACA has impacted the levels of uninsured varies from state to state, pivoting on their willingness to use federal funds to expand Medicaid coverage. The percentage of uninsured in states that expanded Medicaid dropped an average of 2.5 percentage points, about three times the rate of states that did not expand Medicaid, according to a recent Gallup poll. 

In Missouri, a state that did not expand Medicaid, BJC Healthcare kept its current charity care policies in place, according to KHN, although the hospital operator now charges uninsured patients $100 to receive care at its emergency rooms.

But in addition to the Medicaid expansion equation, many Americans refuse to obtain coverage, citing philosophical or political reasons. Another poll by the Kaiser Family Foundation said that about half of those uninsured as of late spring intended to remain that way.

Miller noted that hospitals that use charity care in a stick-and-carrot scenario may not be the way to go, since many patients need healthcare services despite their insurance status. "It's really premature for hospitals to start presuming that level of calculation on the part of someone who shows up uninsured," he said.

To learn more:
- read the Kaiser Health News article