Nearly 20 Million Have Gained Health Insurance Since 2010

The number of Americans without health insurance has fallen drastically in recent years, according to new data from the National Center for Health Statistics.

In 2016, there were 28.6 million Americans without health insurance, down from more than 48 million in 2010. Some 12.4 percent of adults aged 18 to 24 were uninsured, 69.2 percent were covered by private plans and 20 percent had public coverage.

Among children under 18, 5.1 percent were uninsured, 43 percent had public insurance and 53.8 percent had private plans.

Of those covered by private insurance in 2016, 11.6 million had purchased their plans through the federal Health Insurance Marketplace or state-based exchanges established by the Affordable Care Act.

Young people were more likely to be uninsured than their elders, the N.C.H.S. found. Almost 17 percent of adults aged 25 to 34 lacked insurance, while less than 9 percent of those aged 45 to 64 were uninsured.

The lead author of the report, Robin A. Cohen, a statistician at the N.C.H.S., pointed out that high-deductible health plans have become more popular. In 2010, 25.3 percent of the insured under the age of 65 had high-deductible plans. By 2016, nearly 40 percent had them.

From 2010 to 2016, rates of the uninsured declined in all age groups, down 14.4 percent among those aged 18 to 24, 16.5 percent among those aged 25 to 34, 13.7 percent among those aged 35 to 44, and down 8.9 percent in the 45-to-64 age group.

While rates of the uninsured declined sharply among the poor over those years, 26.2 percent of the near-poor (those with an income of 100 to 200 percent of the federal poverty level) and 23.2 percent of the poor (an income of less than 100 percent of the poverty level) lacked health insurance.

There were stark differences by race and ethnicity. While 25 percent of Hispanics were uninsured in 2016, 15 percent of African-Americans, 8.6 percent of whites and 7.5 percent of Asians lacked health insurance.

States that chose to expand Medicaid coverage to people with low incomes had the ranks of their uninsured cut in half, to 9.2 percent in 2016 from 18.4 in 2013. In states that did not expand Medicaid, the rate moved down slightly, to 17.9 percent in 2016 from 22.7 percent in 2013.

Texas, Louisiana, Mississippi, Georgia and Florida were among the states with the highest percentage of uninsured residents. New York, Ohio, Michigan, Minnesota and California were among those with the lowest percentages.

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IRS: 7.5 Million Americans Paid Penalty For Lack Of Health Coverage

About 7.5 million Americans paid an average penalty of $200 for not having health insurance in 2014 — the first year most Americans were required to have coverage under the Affordable Care Act, the Internal Revenue Service said Tuesday.

By contrast, taxpayers filing three-quarters of the 102 million returns received by the IRS so far this year checked a box indicating they had qualifying insurance coverage all year.

Counting another 7 million dependents who weren't required to report their coverage but also filed returns, the proportion with qualifying insurance rises to 81 percent, the IRS said.

The government had estimated in January that from 3 million to 6 million households would have to pay a penalty: 1 percent of their annual income or $95 per adult in 2014, whichever is greater.

Final figures for the tax year aren't available yet. The IRS has so far processed about 135 million of the estimated 150 million returns expected. IRS Commissioner John Koskinen said the agency was reporting preliminary figures because it has received "numerous requests" from members of Congress.

In addition to penalty totals, the IRS reported Tuesday on tax subsidies the health law provided for people who were buying coverage through the state or federal online exchanges and who qualified based on income. People had a choice of filing for credits in advance — money the government paid to their insurers — or when filing tax returns.

About 2.7 million taxpayers claimed approximately $9 billion in subsidies, reporting an average subsidy of $3,400. About 40 percent claimed less than $2,000, 40 percent claimed $2,000 to $5,000, and 20 percent claimed $5,000 or more.

Among taxpayers who claimed a subsidy, about 1.6 million, or half of taxpayers who claimed or received a subsidy, had to pay money back to the government because their actual income was higher than projected when they applied for the subsidy. The average amount repaid was about $800.

When looking at the individual mandate, the report said the vast majority of people automatically satisfied the individual mandate because they were insured last year. Another 12 million had exemptions, including people whose incomes were too low and Native Americans.

In all, the IRS said it has collected $1.5 billion from the individual mandate penalty included in the health law. About 40 percent of taxpayers who paid a penalty paid less than $100.

About 300,000 taxpayers who made an individual mandate penalty payment should have claimed an exemption but did not, the government said. The agency is sending letters to these taxpayers telling them they generally have three years to file an amended tax return.

More than 5 million taxpayers did not check the box on their tax form saying had coverage, claim a health care coverage exemption, or pay a penalty. "We are analyzing these cases to determine their status," the government said.

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States Refusing to Expand Medicaid Leave 4.3 Million Uninsured

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There's A Startling North-South Divide When It Comes To Health Care

The good news is the uninsured rate in the U.S. has fallen to a record low. The bad news is the benefits of health care reform aren't reaching a large swath of the country.

Over the last year, the uninsured rate in the U.S. fell 3.5 percentage points, from 17.3 percent in 2013 to 13.8 percent in 2014, according to the latest data from Gallup. That's the lowest yearly rate that's been recorded by Gallup's Well-Being Index.

According to Gallup, much of the decline can be linked to President Obama's health care reform law, which implemented a number of new policies to help Americans afford health insurance. But some states' refusal to adapt Obamacare's key provisions are causing a startling gap in uninsured rates across the country.

The states with the highest uninsured rates in 2014 are pretty much all found in the South, the Gallup poll found.


Not coincidentally, all 10 of the states with the highest uninsured rates have refused to carry out two key parts of Obamacare.

"States that have implemented two of the law's core mechanisms -- Medicaid expansion and state health exchanges -- are seeing a substantially larger drop in the uninsured rate than states that did not take both of these actions," Gallup announced. "Consequently, the gap in uninsured rates that existed between these two groups in 2013 nearly doubled in 2014."

That said, two southern states -- Arkansas and Kentucky -- saw the sharpest declines in their uninsured rates, which fell by 11.1 and 10.6 percentage points, respectively. Both states expanded Medicaid and had implemented state exchanges. (Arkansas had a state-federal partnership in 2014 and is transitioning to a state-run exchange.)

Ten out of the 11 states that saw their uninsured rates fall the most had expanded Medicaid and offered either a state-run exchange or a state-federal partnership.

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Studies Show Obamacare is Reducing the Ranks of Uninsured

Data for Democrats to tout ahead of midterm elections

A growing body of research indicates that the number of American adults who lack health insurance has dropped sharply, by about eight million, since the health care reform law’s individual mandate went into effect early this year.

Three independent studies from the Commonwealth Fund, Gallup, and the Urban Institute recently found that roughly a quarter of people who were uninsured last year now have health insurance.

The proportion of people without insurance dropped across all income groups and ethnicities. But the largest declines were seen among the poor and Latinos, for whom the uninsured rate plummeted from 36% in the summer of 2013 to 23% by the spring of 2014, according to the Commonwealth Fund.

In its survey of 45,000 U.S. adults, Gallup found that the uninsured rate for Americans over 18 has fallen to 13.4%, the lowest level since the group began tracking the metric in 2008. The previous low point was 14.4% in the third quarter of that year.

The drop in the ranks of the uninsured marks a significant step toward the President Barack Obama’s goal of universal health insurance coverage in the U.S. and will be welcome news to Democrats heading into the 2014 midterm elections. Campaigning against Obamacare has been central to the GOP’s election-year strategy and Republicans have hammered Democrats over the Affordable Care Act’s initially rocky rollout.

But the news is unlikely to soften Republican opposition to the law. The GOP-controlled House is already moving forward with a lawsuit against the President over his decision to delay implementation of the so-called employer mandate, a key provision of the law that requires companies with more than 50 full-time employees to provide health insurance. Some in the GOP have accused the President of unilaterally delaying implementation of the measure to avoid hurting Democrats going into the midterm elections.

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Highest Uninsured States Shun Health Care Reform Law

Medicaid expansion and state health exchanges are minimal in states with high rates of uninsured residents since the passage of the Affordable Care Act.

As states struggle with implementing the Affordable Care Act, a Gallup study has found that those with high uninsured rates are the least likely to expand Medicaid and establish state-based exchanges.

Texas, Arkansas, Mississippi, Florida and Louisiana are the states with the highest percentage of uninsured adult residents. Arkansas is the only state in the group to expand Medicaid and create an exchange in the health insurance marketplace, according to the Gallup-Healthways Well-Being Index for January through December 2013.

Additionally, eight of the 12 states with the highest uninsured rates do not have Medicaid expansion or their own exchange.

Nationwide, 17.3 percent of adults reported they did not have health insurance in 2013. The rate has increased from its level in 2008, 14.8 percent.

Twenty-seven percent of residents in Texas do not have health insurance, followed by 22.5 percent in Arkansas, according to Gallup. Arizona, Kentucky and North Carolina have uninsured rates of 20.4 percent. Texas continues to have the highest rate of residents without health insurance for the sixth year in a row, while Massachusetts has the lowest at 4.9 percent.

States with the lowest uninsured rates also include Hawaii (7.1 percent), Vermont (8.9 percent), Minnesota (9.5 percent) and Iowa (9.7 percent). Pennsylvania, Wisconsin and Kansas have low rates and have not expanded Medicaid or added an exchange.

Overall, 16.2 percent of adults report they lack health insurance in states that do have Medicaid expansion and state exchanges, compared to 18.7 percent of adults in states with one option or neither.

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full Gallup report

Hospital closures will leave 'medical deserts'

Recent trends in hospital and clinic closures will devastate communities with only one hospital, according to U.S. News & World Report.

The closures are for a variety of reasons, including demographic shifts, politics and the economy, the article states, and reimbursement cuts to hospitals due to healthcare reform may exacerbate the problem. The issue is not just the lack of geographical access, but the fact that residents of "medical deserts" in rural areas are less likely to have good health insurance, Brian Smedley, Ph.D., a health policy expert with the Joint Center for Political and Economic Studies, told U.S. News.

"Unfortunately, health care remains a commodity that's bought and sold on the open market," and it's primarily up to hospitals to determine what the market will bear, Smedley said. "There's reason for concern that the trend will escalate."

Part of the problem is the unequal distribution of healthcare resources in rural areas, according to the article. Of the 5,700 hospitals in the U.S., only about 35 percent are in rural communities, and there are 640 counties nationwide lacking quick access to an acute care hospital. This represents nearly a quarter of all residential areas in the country.

For example, the Shelby Regional Medical Center in Center, Texas, the only hospital in Shelby County, closed last year over allegations of billing fraud and inadequate patient care. The closest hospital is 20 miles away, according to the article. Meanwhile, in Mississippi, the dispute between Blue Cross-Blue Shield and HMA could cause the closure of up to six hospitals statewide.

An August recommendation by the Department of Health & Human Services' Office of Inspector General to rethink critical access hospital certification could result in the closure of  multiple critical access hospitals, FierceHealthcare previously reported.

Underserved urban communities have similar troubles, according to U.S. News. Over the past 50 years, Detroit has gone from 42 hospitals serving 1.5 million people to four hospitals serving 700,000 people, many of whom are uninsured or unable to pay for treatment. Across the nation, the article states, nonprofit hospitals are closing locations that consistently lose money in favor of areas where patients are more likely to be insured.

To learn more:
- read the article

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State leaders deal with consequences of rejecting Medicaid expansion in Obama health overhaul

Rejecting the Medicaid expansion in the federal health care law could have unexpected consequences for states where Republican lawmakers remain steadfastly opposed to what they scorn as "Obamacare." It could mean exposing businesses to Internal Revenue Service penalties and leaving low-income citizens unable to afford coverage even as legal immigrants get financial aid for their premiums. For the poorest people, it could virtually guarantee that they will remain uninsured and dependent on the emergency room at local hospitals that already face federal cutbacks.

Concern about such consequences helped forge a deal in Arkansas last week. The Republican-controlled Legislature endorsed a plan by Democratic Gov. Mike Beebe to accept additional Medicaid money under the federal law, but to use the new dollars to buy private insurance for eligible residents.

One of the main arguments for the private option was that it would help businesses avoid tax penalties.
The Obama administration hasn't signed off on the Arkansas deal, and it's unclear how many other states will use it as a model. But it reflects a pragmatic streak in American politics that's still the exception in the polarized health care debate.

"The biggest lesson out of Arkansas is not so much the exact structure of what they are doing," said Alan Weil, executive director of the nonpartisan National Academy for State Health Policy. "Part of it is just a message of creativity, that they can look at it and say, `How can we do this in a way that works for us?'"
About half the nearly 30 million uninsured people expected to gain coverage under President Barack Obama's health care overhaul would do so through Medicaid. Its expansion would cover low-income people making up to 138 percent of the federal poverty level, about $15,860 for an individual.

Middle-class people who don't have coverage at their jobs will be able to purchase private insurance in new state markets, helped by new federal tax credits. The big push to sign up the uninsured starts this fall, and coverage takes effect Jan. 1.

As originally written, the Affordable Care Act required states to accept the Medicaid expansion as a condition of staying in the program. Last summer's Supreme Court decision gave each state the right to decide. While that pleased many governors, it also created complications by opening the door to unintended consequences.

So far, 20 mostly blue states, plus the District of Columbia, have accepted the expansion.

Thirteen GOP-led states have declined. They say Medicaid already is too costly, and they don't trust Washington to keep its promise of generous funding for the expansion, which mainly helps low-income adults with no children at home.

The remaining states are still weighing options. Concerns about the unintended consequences could make the most difference in those states.

A look at some potential side effects:

The Employer Glitch

States that don't expand Medicaid leave more businesses exposed to tax penalties, according to a recent study by Brian Haile, Jackson Hewitt's senior vice president for tax policy. He estimates the fines could top $1 billion a year in states refusing.

Under the law, employers with 50 or more workers that don't offer coverage face penalties if just one of their workers gets subsidized private insurance through the new state markets. But employers generally do not face fines under the law for workers who enroll in Medicaid.

In states that don't expand Medicaid, some low-income workers who would otherwise have been eligible have a fallback option. They can instead get subsidized private insurance in the law's new markets. But that would trigger a penalty for their employer.

"It highlights how complicated the Affordable Care Act is," said Haile. "We wanted to make sure the business community understood."

The Immigrant Quirk

Arizona Gov. Jan Brewer, a Republican, called attention this year to this politically awkward problem when she proposed that her state accept the Medicaid expansion.

Under the health law, U.S. citizens below the poverty line — $11,490 for an individual, $23,550 for a family of four — can only get coverage through the Medicaid expansion. But lawfully present immigrants who are also below the poverty level are eligible for subsidized private insurance.

Congress wrote the legislation that way to avoid the controversy associated with trying to change previous laws that require legal immigrants to wait five years before they can qualify for Medicaid. Instead of dragging immigration politics into the health care debate, lawmakers devised a detour.

Before the Supreme Court ruling, it was a legislative patch.

Now it could turn into an issue in states with lots of immigrants, such as Texas and Florida. It could create the perception that citizens are being disadvantaged versus immigrants.

The Fairness Argument

Under the law, U.S. citizens below the poverty line can only get taxpayer-subsidized coverage by going into Medicaid. But other low-income people making just enough to put them over the poverty line can get subsidized private insurance through the new state markets.

An individual making $11,700 a year would be able to get a policy. But someone making $300 less would be out of luck, dependent on charity care at the emergency room.

"Americans have very strong feelings about fairness," said Weil. "The notion of `Gee, that's just not fair' is definitely a factor in the discussion."

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CEO of BCBSNC says containing health care costs will take time

Blue Cross Blue Shield of North Carolina President and CEO Brad Wilson is optimistic that the Affordable Care Act and changes within the health care and insurance industries will be able to address the country's swelling health care costs.

But Wilson told Triad health insurance agents Tuesday that what keeps him up nights is not whether change is on the way, but whether it's coming fast enough.

"I believe that it (the Affordable Care Act) is going to stay on the books, and I believe it is going to change over time," Wilson told members of the Triad Association of Health Underwriters during its monthly meeting at Starmount Forest Country Club in Greensboro. "I truly believe we are at the beginning of a long journey."

Over the long-term, the so-called "fee-for-service" model that has dominated health care for decades is changing, Wilson said. But the short-term impact of the Affordable Care Act, which expands insurance coverage to millions beginning in 2014, will be to drive premiums up for individuals and small groups as the health insurance industry takes on new taxes and fees and health care spending increases.

Blue Cross Blue Shield, the state's largest health insurer with more than 3.7 million members, anticipates its annual tax bill will nearly double to about $80 million beginning in 2014 under the Affordable Care Act. That revenue in part will help subsidize the extension of coverage to hundreds of thousands in the state not currently insured who will become eligible for premium subsidies in 2014.

Wilson said those subsidies, meant to help make coverage more affordable for individuals and small groups, won't likely cover the anticipated increase in premiums in the short term. When asked by a broker Tuesday if estimates that say some small groups could see premiums rise by as much as 50 percent, Wilson said he expects increases would vary, but such a large increase wouldn't surprise him.

"(Subsidies) will not reduce costs any more than the Pell Grant program has reduced the cost of college tuition," Wilson said, referring to the higher education grant program for lower-income students. "Even with the subsidies, ... many are going to find that the amount of (premium) increase is greater than the amount of subsidies."

But Wilson's message wasn't all gloomy. He pointed toward investments BCBSNC is making in the delivery of care, and the collaborations it has undertaken with providers to change from the "fee-for-service" model that values quantity to one that focuses on quality and efficiency. That includes more bundled payments to providers that cap payments for an episode of care.

Wilson pointed to his company's partnership with UNC Health Care in Carolina Advanced Health, a new medical practice in Chapel Hill built around an accountable care organization model. Such a model rewards providers for preventive care and improving outcomes while allowing them to share in cost savings realized through such efforts.

"It is truly a patient-centered experience," Wilson said of Carolina Advanced Health, which launched in December 2011.

Wilson, who started with Blue Cross Blue Shield as general counsel, was tapped to head the company just six weeks before the passage of the Affordable Care Act in March 2010, which he said changed all that he had known about the health insurance industry.

But despite the coming cost increases in the short term, Wilson still said it's a "wonderful time" to be involved in health care and health insurance, saying that the industries are at the beginning of a "revolutionary" change.

Wilson's visit to Greensboro comes shortly after Blue Cross Blue Shield of North Carolina released its annual earnings report, which saw the not-for-profit entity generate $57.7 million in income on $5.7 billion in revenues, while giving top executives substantial increases in compensation through bonuses based on performance, an expansion of responsibilities and benchmarking with peer companies, according to the company.

The insurer reported that it spent 87 cents of each premium dollar on medical care in 2012, up from 85 cents in 2011, and paid $92.1 million in federal, state and local taxes.

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Experts Say Texas Needs Healthcare Reform

HOUSTON -- Many of the state’s elected officials – including Gov. Rick Perry and a number of state legislators – refuse to expand Medicaid under the Affordable Care Act (ACA), despite Texas having the largest proportion of uninsured citizens in the nation.

According to experts who spoke during an ethnic media roundtable discussion in Houston, fully implementing the ACA is the right thing to do. The  roundtable was organized by New America Media.
“Expanding Medicaid will save lives,” said Charhonda Cox, executive director for Texans Together. “Everybody pays less when more people have insurance. Costs go down and quality of care goes up.”

The expansion, which is one component of the larger ACA, is set to take effect in January 2014 and would guarantee coverage for families earning at or below 133 percent of the federal poverty level.
Currently, there are about a quarter of Texans (6.2 million people) are uninsured. With the expansion in place that number is projected to drop down to just under 12 percent.

In addition to more healthcare coverage for adults and children, the expansion would also bring in billions of dollars in federal funds to the state.

For the first three years, the federal government would cover 100 percent of the costs. By the fourth year, states that choose to keep the expansion would pay a percentage of it out of their own budgets.
“This is a great financial deal,” said Laura Guerra-Cardua, Texas associate director for the Children’s Defense Fund. “Over the next 10 years, we would have to put in $15 billion to get $90 billion back. This is money infused back into our communities, creates tens of thousands of jobs and could really benefit everyone.”

Still, there are opponents who argue that expanding coverage would cost the state too much, especially long term.

Eva DeLuna Castro, senior budget analyst for the Center for Public Policy Priorities in Austin, said many legislators fear that Texas would get stuck paying for the program well after the initial free years.

“It doesn’t make sense to refuse to do a good thing now because 10 years down the road it might present a challenge,” she said. “At least for 10 years we had something good happening for our children and our adults.”

Moreover, Guerra-Cardua said taxpayers would end up paying for Medicaid costs regardless of whether Texas accepts the expansion.

“People who are uninsured still get sick,” she said. “But the difference is, they usually wait to go to the doctor and when they show up, they are much more sick…and they go to the emergency room, which is far more expensive than a doctor’s visit.

“When costs are not covered by these families, they are passed on to local taxes,” she said. “And we pay for them without the opportunity to get federal tax dollars back to help pay for that care.”
Cox said with the legislative session ending in May, there is not much time left to change the minds of legislators who refuse to accept the expansion.

“We want to make sure the folks we put in office have pressure to vote yes,” she said. “The only way they’ll do that is if they know that the people who can vote for them again want this to happen.”

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Walmart Looking to Shift Costs of Employee Healthcare to Taxpayers?

Walmart, the nation’s largest private employer and the world’s biggest retailer plans to begin denying health insurance to newly hired employees who work fewer than 30 hours a week, according to a copy of the company’s policy obtained by The Huffington Post.

The online news outlet reports that under the policy, set to take effect in January, Walmart also reserves the right to eliminate health care coverage for certain workers if their average workweek dips below 30 hours, something the report says happens with regularity and at the direction of company managers.

Walmart did not disclose how many of its roughly 1.4 million U.S. workers are vulnerable to losing medical insurance under its new policy and in an emailed statement a company spokesman said Walmart had “made a business decision” not to respond to questions from The Huffington Post, accusing the publication of unfair coverage.

The paper reported that labor and health care experts portrayed Walmart’s decision to exclude workers from its medical plans “as an attempt to limit costs while taking advantage of the national health care reform known as Obamacare. Among the key features of Obamacare is an expansion of Medicaid, the taxpayer-financed health insurance program for poor people. Many of the Walmart workers who might be dropped from the company’s health care plans earn so little that they would qualify for the expanded Medicaid program, these experts said.”

Ken Jacobs, chairman of the Labor Research Center at the University of California, Berkeley told the newspaper that, “Walmart is effectively shifting the costs of paying for its employees onto the federal government with this new plan, which is one of the problems with the way the law is structured.”

The report noted that because of Walmart’s huge size and its massive number of employees, the company’s policies tend to influence American working conditions more broadly and that other companies are now crafting similar policies that will exclude some part-time workers from medical coverage. 

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Health care ruling a victory, says Dignity CEO

"Life," said Lloyd Dean, CEO of Dignity Health, "is not too bad today."

Dean, a strong supporter of President Obama and a longtime advocate of universal health insurance, said Thursday's Supreme Court ruling was "a victory for patient care, and for those underserved by the health care system."

He had initially been skeptical of Obama's one-fell-swoop approach, telling The Chronicle in 2008 "some incremental steps" might be best, given the exigencies of the Great Recession. "There are not the resources available we could have hoped for," said Dean, who was on the short list to be Obama's secretary of health and human services.

Dean soon came around to the administration's thinking, but says the fight is not over. "The current law is not perfect. We need to fix the elements that people have had difficulties with." In particular, costs. "Although the act begins to bend the cost curve, we have to address how we're going to pay for what we are planning to deliver," he said.

"We have to find a way to deliver quality health care services in a cost-effective manner. That means people only be admitted to hospitals who really need to be in a hospital. That there is more focus on preventative care, that chronic conditions get treated early, before they become acute."

Dignity Health (formerly Catholic Healthcare West), headquartered in San Francisco, is the fifth-largest hospital chain in the country, with 40 full-service hospitals in California, Arizona and Nevada, and 150 ancillary clinics. It's one of 26 hospitals nationwide chosen byMedicare for a pilot program, funded by the Patient Protection and Affordable Care Act, to try to reduce the high rate of health complications and hospital readmissions (and high costs) among elderly patients.

While profitable, the company, which recorded $10.6 billion in revenue last year, is "burdened" by low reimbursements from a large number of Medicaid patients, and the low-cost or free medical services it provides, according to a Standard and Poor's report.

Reductions in Medicare reimbursements to hospitals, as provided in the act, might not make life any easier. Still, said Dean, "we supported this legislation, even though it reduces payments to hospitals, because the new delivery model it creates focuses on reducing costs by increasing the quality of care."

But, he said, "it doesn't get us off the agenda of being a more cost effective, higher quality provider of service."

"Hopefully," he added, referring to the Supreme Court's ruling, "we have enough stability and momentum to address the issues that need to be fixed."

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Moody’s: Ending health reform would hurt for-profit hospitals

The bond rating agency says recent investments, including physician hiring and practice purchases, could be for naught if the health reform law is struck down.

For-profit hospital chains like Tenet Healthcare and Hospital Corp. of America could be the hardest-hit parts of the health care system if the U.S. Supreme Court overturns the Patient Protection and Affordable Care Act, according to an April report by credit rating agency Moody’s Investors Service.

The report’s authors said the cost of caring for uninsured patients probably would rise without a mandate to buy coverage under health reform, a problem that would affect physicians and nonprofit hospitals as well. But for-profit hospitals have spent a lot of money in the past few years preparing for a “post-reform environment,” the report said. They have hired physicians, bought medical practices and upgraded technology. If the health system reform law is repealed, “it’s unclear whether operators will benefit from all the investments they’ve made.”

The court is expected to announce in June whether it will to repeal the health reform bill in whole or in part. If the court eliminates an individual requirement to buy health insurance and expand Medicaid eligibility, an estimated 49.9 million people would remain uninsured rather than gain coverage in 2014.

“Uninsured patients enter the health care system through the emergency room and often wind up admitted and accumulating bills they don’t have the means to pay,” the report said. “The continued rise in uncompensated care costs would limit operators’ revenue growth and profit margins and constrain cash flow.”

Specialty hospital chains like HealthSouth, Kindred Healthcare and Acadia Healthcare would be less affected by the growing cost of caring for the uninsured, because they see fewer uninsured patients, the report said.

For-profit hospitals aren’t alone in facing uncertainty. Moody’s has downgraded credit ratings for many nonprofit hospitals during the last two years as hospital revenue dropped, states cut Medicaid budgets and commercial insurers tightened their payment rates.

Moody’s past reports noted that nonprofit hospitals were seeing lower margins because of spending on such items as physician hiring and electronic health records so they could prepare for health reform. As of yet, Moody’s has not produced a report assessing how nonprofit hospitals would be affected if the Supreme Court overturns health reform.

In an amicus brief filed in the Supreme Court case in support of keeping the health reform law in place, the American Hospital Assn. and five other hospital organizations argued that the burden of caring for the uninsured hurts interstate commerce.

The brief noted that of the $86 billion in care received by the uninsured in 2008, hospitals, doctors and health systems wrote off $56 billion in uncompensated care.

“Although hospitals do what they can to assist patients, burdens on uninsured individuals remain heavy,” the brief said. “The legislation extends coverage to millions more Americans. To undo it now would be to maintain an unacceptable status quo — a result that is neither prudent nor compelled by the Constitution.”

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ANALYSIS: Another Family’s Tragic Tale Of Unaffordable Health Care

Plight of uninsured Alabama girl illustrates need for reform

“It shouldn’t be this way,” read the subject line of an email I received Friday morning from a conservative friend and fellow Southerner. “People shouldn’t have to beg for money to pay for medical care.”

At first, I thought he was referring to my column last week in which I wrote about the fundraising effort to cover the bills, totaling hundreds of thousands of dollars, that the husband of Canadian skier Sarah Burke is now facing. Burke died on January 19, nine days after sustaining severe head injuries in a skiing accident in Park City, Utah. I noted that had the accident occurred in Burke’s native Canada, which has a system of universal coverage, the fundraiser would not have been necessary.

But my friend was not writing about Sarah Burke. He wanted to alert me to another fundraiser, this one on Alabama’s Gulf Coast, to help pay for the mounting medical expenses for a beautiful 13-year-old girl fighting for her life at USA Children’s & Women’s Hospital in Mobile, Ala.

In late November, Caroline Richmond was rushed to the hospital after collapsing on the way home from school. Doctors quickly determined she’d had a stroke and required immediate surgery. The bad news just kept coming. The stroke had been caused by leukemia.

In the weeks following brain surgery, Caroline had to undergo chemotherapy. She later became so ill that she was put on a ventilator and had to be fed through tubes. Although she is still listed in critical condition and faces a bone marrow transplant, Caroline has made progress. She was taken off the ventilator and tubes last week and is now eating solid food for the first time since the stroke.

As it turns out, Caroline is one of more than 50 million men, women and children who do not have health insurance in the United States, which is why her family is in the same predicament as Sarah Burke’s. Caroline’s father, Dallas, is self-employed and, like millions of other Americans who do not work for a company that offers health benefits, has not been able to find affordable coverage for his family.

A friend of the Richmonds, Robin Smith, told me Dallas is one of the hardest working people she’s ever met. She said he owns a coin-operated laundry and has “two or three” other jobs to make ends meet. “He works round the clock,” she said. “You never see him when he’s not working.”

Knowing that Dallas and his wife, Christy, are worried not only about their daughter but also about the real possibility they might be forced into bankruptcy and lose their home because of the medical bills, Smith has joined other friends of the family to raise money. Caroline’s classmates and teachers have put “Cups for Caroline” in all the homerooms at Fairhope Middle School, where Caroline is an eighth-grader. They’ve also held car washes.

Last night they were scheduled to host a bake sale and fish fry at the American Legion Post in Fairhope. It was that event, also posted on a Facebook support page, that my friend brought to my attention. Until then, I had never heard of Caroline Richmond. I suspect you hadn’t heard of her either. I am writing not only to spread the word, but also to ask that you think for a moment about walking in the Richmond family’s shoes.

It is important to understand that almost all of us who do have health coverage through the workplace are just a layoff or plant closing away from joining the Richmonds among the uninsured. Those of us who are self-employed like Dallas Richmond or who work for small businesses that can no longer pay for coverage are increasingly unlikely to find decent coverage that we can afford.

Hundreds of thousands of families file for bankruptcy and lose their homes every year nationwide because of medical debt. Many of those people actually have what they thought was adequate insurance, but find that they still have to pay far more out of their own pockets to cover thousands of dollars in bills than their budgets will allow.

My column on Sarah Burke provoked many comments, some from people who essentially wrote, “too bad, so sad.” In their opinion, Burke shouldn’t have been taking risks on the ski slopes in Utah in the first place. She should have bought coverage that would have protected her in the U.S.

Maybe so. But I wonder what those people, all of whom condemned “Obamacare,” will say about Caroline Richmond. When the reform law is fully implemented in a couple of years — assuming it goes forward — the Richmonds should be able to find coverage at an affordable price. That’s what reform was all about. To make sure that American families don’t have to lose their homes when someone gets sick and to make sure that insurance firms can no longer engage in practices that have swelled the ranks of the uninsured and underinsured.http://www.blogger.com/img/blank.gif

Caroline’s story is not unique. Tragedies like her’s occur so often, in fact, that they rarely make the news anymore. But it is precisely because they are an everyday occurrence that health care reform was so urgently needed. We have been led to believe by opponents of reform that our health care system is the best in the world. The reality, of course, is that, while we do indeed have some of the world’s best doctors and hospitals, the system in which they operate has become increasingly dysfunctional and unnecessarily expensive. This is why the reform law, despite its flaws, must go forward.

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Interactive Uninsured Mapping

SAHIE has provided an interactive map of health insurance coverage estimates for the United States. Selections of income and race are available and can be mapped by state or county. Data can be viewed for 2008 or 2009.

Click map for full size

Click for Interactive Mapping

Health Insurance Coverage in the US - 2008-9 Census

The U.S. Census Bureau today released 2008 and 2009 estimates of health insurance coverage for each of the nation's roughly 3,140 countieshttp://www.blogger.com/img/blank.gif. Area Health Insurance Estimates (SAHIE) are currently the only source for estimates of health insurance coverage status for every county in the nation.

2009 Health Insurance Coverage Status for States (% Uninsured)


Also available by county

Three-Quarters of U.S. Jobless Can't Afford Health Care: Report

Affordable Care Act will give newly unemployed more choices for coverage in 2014, authors contend

Nearly three-quarters of jobless Americans say they can't afford needed health care or prescription drugs, and about half say they're struggling with medical bills or medical debt, a new report reveals.

Sixty percent of working Americans rely on employer-based health insurance, so when 15 million working-age adults lost their jobs between 2008 and 2010, an estimated 9 million also lost their health insurance, according to the Commonwealth Fund report.

The authors of the report also concluded that when the major provisions of the Obama Administration's health care reform law are implemented in 2014, newly unemployed people will have many more health insurance choices.

But the current lack of options have led to a health and financial crisis for many Americans who lose their health insurance benefits along with their jobs.

For the new report, researchers analyzed data from the 2010 Commonwealth Fund Biennial Health Insurance Survey. Of the respondents who lost their health insurance when they lost their jobs:

- 72 percent said they couldn't afford to: fill a prescription; get a recommended test, treatment or follow-up; go to a doctor or clinic for a medical problem, or get specialist care.

- 72 percent said they had problems with medical bills, including: an inability to pay; having to make payments over time to clear up medical debt; being contacted by collections agencies over unpaid bills; and changing their way of life to pay medical bills.

- 40 percent said medical bills forced them into difficult financial tradeoffs in the past year, such as: 32 percent had used up all their savings; 27 percent couldn't pay for basic necessities such as food, heat or rent; 14 percent accumulated credit card debt; and 9 percent took out a home loan.

"It's clear from this report that losing a job and health insurance simultaneously is a serious threat to a family's health and financial stability," Commonwealth Fund President Karen Davis said in a fund news release.

But she added that "the Affordable Care Act will assure that families already struggling with the devastation of unemployment will still be able to get the health care they need and will be protected if they become seriously ill."

In 2014, Medicaid will be expanded to cover single adults earning up to $14,484 a year and families of four making up to $29,726 a year. There will also be sliding scale premium tax credits for single adults earning up to $43,560 a year and families of four making up to $89,400 a year to obtain private policies through new state insurance exchanges.

People who buy health insurance through the exchanges will be protected against high premiums and won't be able to get turned down due to existing health issues, the authors of the report pointed out in the news release.

The Commonwealth Fund is a private foundation supporting independent research on health policy reform and a high performance health system.

More information

The U.S. Department of Labor outlines health insurance options for people who've lost their jobs.

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Economy drives ER visit influx

Local hospital officials say use of their emergency rooms has risen. The reason could be that more people put off primary care doctor visits because they don’t have health insurance or they can’t afford them.

Increasing ER visits is a national trend, West Valley Medical Center CEO Julie Taylor said. ER visits from patients without health insurance lead to a shift in costs to people with insurance — helping drive up the overall cost of health care.

“People that aren’t insured that come in and use the service are using a more expensive type of care,” Saint Alphonsus Medical Center-Nampa CEO Karl Keeler said, “which only increases the burden of the insured.”

The struggling economy likely causes more people to rely on ERs for medical treatment because those departments must treat all patients.

West Valley Medical Center has seen a 7 percent increase in emergency room visits compared to last year and Saint Alphonsus-Nampa a 5 percent increase. Those hospitals also have experienced an influx in the number of patients who are uninsured and/or qualify for charity.

When people put off medical care because they can’t afford it or don’t want to pay for it, often their health problems become worse and more expensive to treat. ER visits, even for nonserious medical conditions, cost more than visits to primary care doctors’ offices.

“People are calling 911 because the cold that they had has now settled in the chest, and it’s full-blown pneumonia,” Caldwell Fire Chief Mark Wendelsdorf said. “They’re pushed to the end where they feel like that’s their only recourse.”

The Caldwell Fire Department had about a 5 percent increase in medical calls last year, Wendelsdorf said. He expects about the same this year.

Wendelsdorf also said he thinks more people have accidents requiring emergency medical service when they take on home repair or maintenance jobs that they may have paid professionals to do in the past.

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Steep Cuts Pushed for Hospitals; Trims From Medically Needy, Medicaid Spending plan OK'd by Fla. Senate trims from Medically Needy, Medicaid.

POLK FACILITIES WOULD LOSE $43.2 MIL.

LAKELAND FL | Polk County hospitals would lose just less than $43.2 million in Medicaid and Medically Needy payments, with Lakeland Regional Medical Center taking more than half of that hit, under the budget approved Thursday by the Florida Senate.

LRMC's loss in funding — from lower Medicaid payments, elimination of adult hospital services through the Medically Needy program and elimination of Medicaid for the Aged and Disabled – would be $23.7 million.

Winter Haven Hospital stands to lose $9.4 million; followed by $6.5 million for Heart of Florida Regional Medical Center, $2 million for Lake Wales Medical Center and $1.6 million for Bartow Regional Medical Center.

The Safety Net Hospital Alliance of Florida released that hospital-by-hospital analysis Thursday. Elimination of the medically needy and the aged-disabled Medicaid programs wouldn't occur until April 2012, but the figures are annualized to show a year's impact.

Both the Florida Senate and the Florida House are proposing cuts to deal with a multibillion-dollar state budget deficit, but the Senate's budget takes more from hospitals and from programs for people who need treatment for substance abuse and severe mental illnesses.

Officials at local hospitals are alarmed at the extent of the Senate cuts.

"That would drastically affect all hospitals' ability to care for the state's neediest," said Josh Putter, division director for Health Management Associates, which owns Heart of Florida and Bartow regionals.

"These proposed cuts are unprecedented and place a disproportionate burden on Florida's hospitals," said Elaine Thompson, president and chief executive officer of Lakeland Regional.

"Reductions of this magnitude will have a significant impact on the provision of services to the most vulnerable members of our population – our sick and elderly — as well as have a ripple effect on our economy as health care jobs will be lost."

Putter also mentioned the effect of reduced hospital income on the economy.

"It will definitely have a negative impact on the number of people we are able to hire," he said.

Scott Smith, chief executive officer at Lake Wales Medical Center, said hospitals will need to look for new ways to reduce expenses while continuing to serve their patients and communities.

"Hospital emergency departments will face increased pressures as they are often the safety net for service gaps in the larger community," he said.

Despite cuts, Thompson said, "the need for care and our obligation to provide it will not be reduced."

Statewide, cuts proposed by the Senate would eliminate $1.6 billion to hospitals, the alliance said.

"Hospitals are one of Florida's leading economic drivers," said Tony Carvalho, alliance president. "To force hospitals to carry a disproportionate amount of cuts is totally unrealistic."

The proposed House budget would cut hospitals by a more modest $297.7 million. The five Polk hospitals' combined loss under the proposed Florida House budget would be $6.8 million, which is $36.4 million less than the Senate budget would cut, according to the safety-net alliance.

Under the Senate proposal, some of its members would lose more than Lakeland Regional's $23.7 million.

For example, Jackson Health Systems in Miami faces $177.5 million in proposed cuts. Orlando Health would lose $75.6 million and Tampa General Hospital's loss is $62.5 million.

Hospitals' emergency departments also are likely to have a great influx of patients in mental health crises if Senate cuts to mental health and substance abuse programs statewide are in the final budget agreement reached by the House and Senate.

The Senate cuts would "dismantle local adult mental health and substance abuse treatment systems that have taken decades to develop, leaving in place only emergency crisis services," according to an email Thursday from Tri-County Human Services in Polk County.

The Senate proposal would take about $186 million from adulthttp://www.blogger.com/img/blank.gif mental health services, eliminating their capacity to serve more than 180,000 adults. Adult substance abuse treatment services will be cut $43 million, leaving 35,660 adults without access to services, said Adam O'Connor, Circuit 10 adult transformation specialist, using statistics from the Florida Council for Community Mental Health and the Florida Alcohol and Drug Abuse Association.

They said as many as 12,000 people in those treatment areas would lose their jobs if the Senate cuts took place.

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Baucus stands by health care reform despite criticism

The one-year-old Affordable Care Act will prove over time to be a "major benefit to Montanans and it will be appreciated," but it will take time, said Sen. Max Baucus, as objections to the law continue to make state and national headlines.

Montana lawmakers have tried to repeal the law, Rep. Denny Rehberg always refers to it as "Obamacare" and during a speech in Helena last month, Republican presidential hopeful Michelle Bachmann said a top priority for Republicans nationally is to repeal the federal health care overhaul.

But Consumers Union, the nonprofit organization that publishes Consumer Reports, said the law is "a bold move toward better access, affordability and reliability."

The legislation established health insurance as a right and a responsibility for every American and is on pace to reduce the rate of health care costs for individuals and businesses, Baucus said.

So, why the criticism?

"They don't understand it," Baucus said in a telephone interview. "People are confused. People really don't know what this bill does. Most of the benefits won't accrue immediately. ... There's a lot of misinformation about it."

Baucus, a lead architect of the law, remains a supporter, despite his plummeting approval ratings. In a recent Lee Newspapers State Bureau poll, Montanans gave Baucus a 38 percent job approval rating. His performance rating dropped from 67 percent in the last Lee poll in May 2009, when he led the pack of politicians scored.

Polls by other groups also have shown Baucus' job performance scores have dropped since his role in passage of the law.

Baucus called the results "interesting" but doesn't waver in his support.

"It's confusing," Baucus said. "There's just a lot here, and in the meantime, we need to keep working on it to make it better. It was appropriate legislation. It was the right thing to do. Of course, it's not perfect and, of course, we'll keep working on it to make it even better. We need to keep talking about it and keep listening."

Polls show that one in eight people believe they have been helped by the law, long before it fully takes effect in 2014.

***

Kim Wombolt, 52, of Laurel has had bone marrow cancer for five years and has received two stem cell transplants. The first was $85,000; the second, $125,000.

Throughout her illness, she has been hospitalized at least 100 days. She remains in the care of physicians and fills eight prescriptions a month.

The Wombolts were quickly reaching - and fearful of surpassing - the $1 million cap on Wombolt's husband Leonard's insurance.

Kim contemplated leaving her husband of 34 years. She thought it was the only solution to keep the hospitals, physicians and bill collectors from seizing their assets once they maxed out their coverage. She also thought that as a single woman she might be eligible for Medicare.

"I didn't think he deserved to lose everything he's worked so hard for because I got sick," Kim said.

On Jan. 1, the Affordable Care Act banned insurance companies from imposing lifetime dollar limits on health benefits.

"If it were not for health reform, I would most certainly die," Kim said.

***

Kelli and Steve Carlson's baby was born on May 21 - five weeks premature. Baby Rowan had respiratory distress and was treated for pneumonia. She was in neonatal intensive care for 21 days, accruing bills exceeding $85,000.

Though Kelli, 31, and Steve, 32, had insurance through her job at Colstrip Public Schools, they had not added their infant to their coverage within 31 days, and claims for her care were denied.

"At no point as she was fighting for her little life did I think, ‘Oh, I need to read our insurance booklet and enroll her in our insurance plan,'" Kelli said. "These insurance companies should not be allowed to treat us like that. It was probably the worst summer of my life, having the stress of all that looming over your head. I was scared we would have to sell the house."

Because of a provision in the Affordable Care Act, the Montana Insurance Commissioner's office intervened, enrolled Rowan and got the insurance company to pay.

***

John Tooke, a certified public accountant in Miles City, employs two people. When President Barack Obama signed the Affordable Care Act, small businesses became eligible for tax credits up to 35 percent of their premium contributions for employee coverage, making insurance more affordable.

Tooke said offering employees health care is one of biggest benefits employers can offer, yet he knows many small businesses that have been forced to drop it because of cost.

"Hopefully there will be a much wider array of businesses offering health care insurance because the costs will be mitigated," Tooke said. "It hasn't directly helped me yet because I haven't taken full advantage of it in my office, but it will. This whole issue is the first shot across the bow. Yes, there are some things that need to be fixed ... but at least now we're talking and arguing about it."

By 2014, small businesses with up to 100 employees will have access to state-based Small Business Health Options Program exchanges, where they may purchase affordable, quality insurance and may qualify for tax credits up to 50 percent of employer premium contributions.

***

Sue Bailey of Billings said her family has benefited from the law.

Bailey's 27-year-old daughter, whose employer does not provide health insurance for part-time workers, has been able to secure health coverage from the expanded "high-risk" insurance pool from Montana Comprehensive Health Association using money provided by the Affordable Care Act.

Bailey said her family no longer will face the possibility of losing its health insurance because they have maxed out their "lifetime limits."

***

One of the biggest misconceptions about the bill, Baucus said, is that it is costing taxpayers money when they can least afford it.

"This bill does not cost one thin dime," Baucus said. "It's all paid for. It does not put additional burden on Montana businesses or taxpayers."

The Congressional Budget Office reported that health reform will reduce the federal budget deficit by about $210 billion in the next decade and more than $1 trillion over the next 20 years.

"No legislation that Congress has passed in modern times will have such a dramatic effect on lowering the federal budget deficit than the health care legislation that was passed," Baucus said. "That is not recognized and, of course, people have a hard time seeing that, but it's a fact."

***

Some critics fear the Affordable Care Act will cost jobs.

The fact is that the national unemployment rate has gone down since health care reform became law. Nationwide, more than 1 million private-sector jobs have been created since the health care law was enacted and 243,000 have been in health care. The independent chief actuary at the Centers for Medicare and Medicaid Services and the Congressional Budget Office said the health care law strengthens the economy by lowering the rate of health care costs and reducing the deficit.

The Congressional Budget Office, the independent Joint Committee on Taxation and other economists agree that lower health care costs would free up resources for employers and result in higher wages for workers. Lower costs also mean more money to hire workers.

Before the law, Medicare was forecast to be bankrupt in seven years, according to a Senate hearing with U.S. Secretary of Health and Human Services Kathleen Sebelius earlier this month. According to the Centers for Medicare and Medicaid Services, the law extends the life of Medicare for 12 more years.http://www.blogger.com/img/blank.gif

The major purpose of the law is to reduce health care costs, Baucus said. Americans spend about 53 percent more per person on health care than the next most expensive country and we're not 53 percent per person healthier.

The United States spends $7,290 per person per year, or 16 percent of the gross domestic product on health care. The next-closest is Norway, which spends $4,763 per person, accounting for only 8.9 percent of its GDP, according to the Organization for Economic Cooperation and Development.

"We can't go on like that," Baucus said.

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