Hospitals’ Uninsured Patients Rising Again

Remember how Obamacare was supposed to reduce the burden of so-called “uncompensated care” from uninsured patients that was driving hospitals bankrupt? Well, two years into Obamacare it hasn’t worked out that way:

Hospital operator HCA Holdings Inc on Tuesday said more patients are coming through its doors who have lost their health insurance, most likely because they stopped paying for it.

The largest U.S. for-profit hospital chain said it admitted more uninsured patients in the third quarter who had previously registered with health insurance, compared with a year ago. They included people who bought coverage from marketplaces set up under President Barack Obama’s Affordable Care Act, but then dropped it.

“We believe this is likely due to non-payment of premiums,” HCA Chief Financial Officer Bill Rutherford said on the company’s earnings call.

Overall, the company admitted 13.6 percent more uninsured patients in the third quarter. It was the second straight quarterly increase in uninsured admissions, reversing a downward trend since the insurance exchanges opened for business in early 2014

(Susan Kelly, “HCA says some patients dropping their new insurance coverage,” Reuters. October 27, 2015.)

Protecting hospitals’ revenues by increasing the number of insured Americans was never actually a legitimately important goal of health reform, although hospitals are very successful at making that case. Now, it looks like Obamacare doesn’t even do that.

Comments (8)

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  1. Jimbino says:

    Aren’t non-profit hospitals still required to provide charity to justify their gummint subsidies and tax breaks?

    • Wanda J. Jones says:

      Yes, they are. One of the gaps in Obamacare’s prep was to deal with the possibility of so much success that there would no longer be enough true charity cases to justify tax exemptions. Don’t have to worry about that anymore, do we? Of course, the average percent charity cases overall was in the range of 1.5%. This early indicator, that coverage is being dropped because of high premiums, is just what should have been expected, as the largest uptake in ACA coverage was among people with the least income. Guess they would rather eat.

      Wanda Jones
      San Francisco

  2. Bob Hertz says:

    Most hospitals do have a program to reduce or even forgive a patient’s bill if the patient has no insurance and a low income. The patient must be persistent to use this kind of program, because the hospitals understandably do not advertise it.

    The ACA brought in millions of individuals who make from 150 to 250 per cent of the poverty line. This comes to $15,000 to $25,000 a year for a single person. At those incomes, people are living paycheck to paycheck, and a car repair or layoff can destroy even a careful budget. The New York Times had a poignant article about a woman whose subsidized premium was only $50 a month, but she stopped paying it when she had to replace a stove and help out a daughter.

    Medicaid and Medicare have almost no lapse rate, and workplace insurance rarely lapses because the corporate bookkeeper pays the bill. The individual market will always have this problem however.

  3. Ron Greiner says:

    Bob, get real. These hospitals have a target on the back of poor Americans who have no insurance. This just out:

    “According to a new research performed by Health Affairs, a healthcare journal focused on policy issues and affordability, there are at least 50 hospitals in the United States charging uninsured patients more than 10 times the cost allowed by Medicare. Florida’s hospitals come in number one for highest markups and account for 40% of this list.”

    You make it sound like the hospitals care Bob, come on.

    These hospitals will make a child spend the night so they don’t get sued then mark up the expense of $1,200 to $12,000 and it’s all legal. These hospitals are worse than the Mafia and some of these CEOs should be behind bars.

  4. Bob Hertz says:

    I do not at all question the fact that ‘the hospitals overcharged vulnerable patients…’

    What I say that sometimes hospitals do not try very hard to collect that they have charged.

    • Ron Greiner says:

      Bob, the hospitals sell their debt to collection agencies who make the poor go bankrupt. Is that what you mean when you say they don’t try and collect? It is more likely an accounting thing where the hospitals would rather write off $100,000 in fake charges than $10,000 in real charges. But the hospitals should be stripped of their non-profit status and charged with discrimination in pricing and some of these hospital CEOs should be in prison.

      Saying that the hospitals don’t try and collect their debt is a goofy statement.

    • They certainly do not succeed in collecting what the have charged. But that is not the point. The point is to take the (inflated) unpaid claims to the government and ask for the taxpayers to pay.

  5. Barry Carol says:

    My understanding is that most hospitals calculate their charity care based on chargemaster rates and it’s still a pretty small percentage of revenue. If they calculated it based on Medicare rates or even 125% of Medicare, it would probably be a pittance in the scheme of things except in the case of the inner city safety net hospitals.

    I think hospitals have a lot to answer for regarding issues from the lack of price transparency to their grossly excessive bills they send to uninsured and out-of-network patients. I’m surprised that there haven’t been class action lawsuits charging them with dealing in bad faith. I wonder how the geniuses that developed this system would like to be on the receiving end of these bills and the follow-on harassment from collection agencies. Obviously, they wouldn’t like it but they have no problem subjecting others to this abuse.