[Schneed10]

Today at work we started looking into the effects the current health care bill, as written, will have on our hospitals. This was a narrow view of course, our job is to look out for ourselves. But hospitals in similar situations to us (in poor neighborhoods with high concentrations of underinsured) all throughout the country would feel the same effects.

As discussed in the opening post in this thread, reimbursement from state medicaid programs on behalf of Medicaid patients is terrible. We lose 25 cents on the dollar on this reimbursement alone. Currently, the healthcare system is set up such that hospitals with higher concentrations of Medicaid patients receive an extra lump sum payment from the government to help assuage the massive losses felt on Medicaid patients. This payment is referred to Disproportionate Share.

The current plan being discussed in congress would establish a universal healthcare program, allowing nearly everyone in the country to acquire affordable coverage. This of course is costly and to fund this the bill proposes to increase taxes on the wealthy. But that wouldn't even be enough. Also to help fund it, the bill proposes pulling the Disproportionate Share payments and reallocating the funds to Universal Healthcare. This is a detail overlooked by the media.

This will effectively rob my health system of approximately $80 million per year, that's how much we get in Disproportionate Share currently. Given that last year we lost $40 million on operations, even with receiving the $80 million from the government, this puts one of the biggest Medicaid hospital providers in the nation at risk of going out of business.

See, Universal Healthcare helps the working class. It does not help the poor. The poor don't have 2 cents to rub together. The working class could actually afford healthcare coverage of $150-$400 per month. But those currently on Medicaid will not suddenly be covered by a government plan, those currently on Medicaid can't afford ANY plan because frankly they can barely afford to eat.

Our hospitals will still have tons of Medicaid patients. Some of our working class patients will now get covered by Universal Healthcare, and we'll get reimbursed for them instead of writing the cost of their care off to charity. But the improvement in revenues from working class patients will nowhere near offset the losses in Disproportionate Share payments.

So the result:

- Money gets taken away from hospitals with the highest concentration of Medicaid patients.

- Those hospitals won't recoup those losses because they don't see enough working class patients who will gain coverage under the government plan.

- Hospitals in the poorest communities will be forced to shut down, creating a political nightmare. Meanwhile those patients will have to go somewhere, and nearby hospitals will be overcrowded thanks to shifting patient populations.

It's a horrible solution, and it's as if the bill's creators have absolutely no understanding of the current healthcare system. The bill's creators seem to have good intentions, to help make healthcare more affordable. However they have no idea how to do it, and left to their own devices they would leave the poorest and most vulnerable in the country without care at all. Lobbyists are fighting hard to get the hospitals in poorest areas carved out of the current proposal so they can continue to operate with Disproportionate Share payments.

I suspect we'll succeed in convincing Washington that they're morons.