Saturday, December 14, 2013

Serving vs. advocating for the uninsured

Brazilian Bishop Camara famously said, "When I give food to the poor, they call me a saint. When I ask why they are poor, I’m called a communist,” a colorful way of saying that while helping the poor earns praise, questioning the policies that keep them poor is not so welcomed.
Recently the trustees at Cheyenne Regional Medical Center voted 5-4 to require full co-payments from insured patients before receiving medical services. Uninsured patients are now required to pay a minimum of $180 when initially seen and $120 for follow-up visits.

After this column objected, CRMC responded with op-eds and letters-to-the-editor making good points about what the hospital is doing to help low-income and uninsured people obtain care. But, their PR machine should be used to persuade Governor Mead, not me. It’s Mead whose decision to forego Medicaid expansion makes the CRMC programs necessary even as his partisan decision forces CRMC to provide millions of dollars in uncompensated care.

CRMC invited me to learn more about their good works. I did and am impressed. I toured the hospital’s new Emergency Room and was assured no one would be turned away for inability to pay. If that happens to you, let me know.

I also spent time at the Cheyenne Health and Wellness Center, largely funded by CRMC, as is its pharmacy. Both are vital safety nets for low-income folks. This year the pharmacy will provide over 6.1 million dollars in prescription drugs to those who would not otherwise receive them. CRMC provides 80% of their operating costs.

The clinic will treat more than 6300 people this year, averaging $231 while an ER visit costs $754. It doesn’t take many ER diversions to save millions of your tax dollars. Equally impressive is the level of preventive care CHWC provides.

CRMC is to be commended for these programs and others, which are part of the maze of state and local programs, created to help the uninsured get care. However commendable those efforts, CRMC’s advocates miss the point. Tim Thorson, whose work with Circles demonstrates his concern for those in poverty, serves on the CRMC community benefits committee. His letter-to-the-editor argued it’s “a mistake to confuse the larger issues around Medicaid with what is a reasonable and necessary change in collecting payments at the hospital.”

Actually the two issues are inextricably intertwined. If the governor and the legislature expand Medicaid coverage, CRMC’s new collection policy wouldn’t be necessary. Those targeted by the policy would have insurance.

Consider the cost of not expanding Medicaid. Last year CRMC spent more than two million dollars funding healthcare programs for the uninsured. They wrote off $23 million in uncompensated care. Hospitals around Wyoming wrote off more than 200 million dollars. Yes, Medicaid is expensive but what we’re doing now isn’t free.

Without adequate insurance, low-income families are now required to bring large cash payments with them before they can walk through CRMC’s doors. Is that a problem? Four of the nine CRMC trustees thought so when they voted against the new policy. My column simply shared some the same concerns they voiced.

Trustee chairman Joe Evans voted “no” saying, "My concern is that we don't want people not to be seen because of the policy," Evans’ concern is valid. The bottom line is these fees will mean fewer people have access to care in Laramie County.  The Center for Advancing Health researchers found that one in five U.S. adults do not get needed medical care because they were worried about the cost or their health insurance would not pay for treatment.

CRMC is doing yeoman work meeting important community health needs. But where is their voice when the governor says he will not expand Medicaid? Where are the op-eds and letters-to-the-editor? CRMC’s PR apparatus would be more productive challenging Governor Mead’s partisan decision to deny Medicaid coverage to the uninsured rather than questioning efforts to challenge their payment policy.
Maybe they could invite the governor to witness the problems his choices have caused.

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