Health care reform, part three

by Carla Dolce

HUERFANO- In Part I of this four part series, we saw how 47 million in the U.S. lack health insurance resulting in thousands of deaths each year.  In Part II, we saw how health care spending in the U.S. was about $7,500 per person in 2007 — more than twice the average of other industrialized countries.  Corporations have responded to escalating medical care costs by reducing employee benefits and moving manufacturing facilities to other countries.  Many uninsured individuals, including those in Huerfano County, are coping by simply not going to the doctor.

      This strategy of not going to the doctor works most of the time.  Unfortunately, most people don′t remain perfectly healthy until they reach that magic age of 65 when they can look to Medicare for health care benefits.  Many of the 1,800 Huerfano County residents without health insurance eventually have health problems that mandate a trip to the doctor.  Given that most uninsured patients wait until an illness progresses to the point of being serious before seeking medical help, that trip to the “doctor” may well be a trip to the Spanish Peaks Hospital emergency room.  A trip to France might be cheaper. 

    Since our local hospital is a public institution, it can′t refuse treatment despite the patient′s inability to pay.  The result:  the hospital wrote off over $1.1 million in bad debts in 2007.  To be fair, this bad-debt write off is not solely attributable to the uninsured.  A good part is attributable to patients unable to pay high deductibles and/or amounts billed and not paid by the patient′s insurance.  

    Even when the patient agrees to pay, the payment may be spread over years.  For example, Joe Kancilia, owner of the Pawn Shop on 7th Street in Walsenburg, was insured at the time he went into the hospital for knee surgery.  According to Mr. Kancilia, his insurance company agreed to pay only $5,136 of the $14,309 bill claiming that that amount was the standard payment for the services rendered and refusing to pay what it deemed excessive hospital charges.  While Mr. Kancilia also contended the charges were excessive, he nonetheless agreed, after much wrangling with the hospital, to pay the remaining bill of $9,173 over about a ninety-month time period.  After this experience and with significant increases in the cost of health insurance, Mr. Kancilia has joined the growing ranks of the uninsured. 

    Rising health care costs not only result in individuals going without health care or straining financially to pay for it, they leave providers like our local hospital scrambling to find the funds to stay in operation.   Reimbursements from government-run programs like Medicare and Medicaid have not kept pace with rising costs.  The bad-debt write-offs for the Spanish Peaks Regional Hospital pale in comparison to the write-offs for amounts not reimbursed by Medicare and Medicaid.  In 2007, the hospital wrote off over $5.3 million in billed amounts not reimbursed by Medicare and over $1.6 million in amounts not reimbursed by Medicaid.  This isn′t all the write-offs.  Other government programs and regulations, as well as patient concessions, require additional write-offs.  According to data provided by Steve Perkins while he was still the hospital administrator, the sum of all write-offs for 2007 was $11,044,842 out of  total patient charges billed of $19,683,488 or a little over 56%  of all patient charges written off as a loss.  The specter of these losses increasing paints a grim picture for our hospital′s future.   

    One final consequence of rising health care costs and rising insurance premiums is an increase in the amount of money leaving the county to pay for health insurance premiums for the approximately 77% of Huerfano County residents who have insurance.  In 2007, for example, the county paid $718,504.75 in health insurance premiums for county employees while RE-1 School District paid roughly $345,000.  This money comes from virtually every Huerfano County resident through property taxes.  Some of it comes back in the form of payments to medical providers in the county.  However,  given that many residents seek medical care from providers in Pueblo and other cities, it′s likely that much of the money that leaves the county to pay for premiums never find its way back home.

    With hundreds in the county having little or no access to health care, with rising costs straining individuals as well as our local hospital, and with a dollar drain leaving the county to pay for rising insurance premiums, which health care reform plan will help us the most?  Stay tuned for Part IV!