May 27, 2014
USA Today (5/27, Galewitz) carries a Kaiser Health News report on how the Affordable Care Act is helping safety-net hospitals, which currently “treat a disproportionate share of poor and uninsured people and therefore face billions of dollars in unpaid bills.” The article explains that these hospitals “had expected to see a drop in uninsured patients seeking treatment, but the change has been faster and deeper than most anticipated.”
However, the Athens (GA) Banner-Herald (5/26, Burkhart) reports that local free-clinics are seeing more patients without insurance “despite [the] promise of ACA.”
Hospital systems cut aid to some to push them onto exchanges. On its front page Monday, the New York Times (5/26, A1, Goodnough, Subscription Publication) reported that “hospital systems” are cutting back on aid to “lower- and middle-income people without health insurance, hoping to push them into signing up” in the ACA’s insurance exchanges. The ACA’s cuts in “federal aid to hospitals” for such aid is also “creating an additional pressure on some to restrict charity care.” The hospitals defend their decision by pointing out that the ACA offers subsidized insurance and that it’s goal is to bring people into the insurance market. So as Henry Ford Health System CEO Nancy M. Schlichting, said, offering aid to those who could get insurance in the exchanges “defeats the purpose of what the Affordable Care Act has put in place.” Critics argue that some “found the plans too expensive, even with subsidies.” Generally the aid cutbacks are being applied to those with incomes from 200 to 400 percent of the poverty level. Some are also charging a co-payment to every patient, without respect to income.
Hospital systems increasingly offering insurance plans. Austin Frakt, a health economist, wrote in the New York Times(5/26, Frakt, Subscription Publication) “The Upshot” blog, on the “trend” of hospital systems offering insurance policies, sometimes purchasing insurance companies to do that. He explained that some reasons for this are “to better design incentives for higher-quality care;” or to “cut costs;” or “to adapt to — and make more money from — new Medicare payment models in the Affordable Care Act.” He views the trend as an effort to reduce competition, laying the groundwork for price increases. He cites a study he conducted that found that such insurers charge more but do not have superior policies, though consumers tend to rate them more highly. He notes that data is difficult to get and that his study focused on Medicare Advantage plans because data was readily available in that sector. It also covered a single year.
article courtesy American Medical Association
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