Published by: Brigette Scott on 5/13/2011 12:14:02 PM
On Tuesday, I had the pleasure of being interviewed by MSNBC news anchor Tamron Hall during her program, NewsNation, regarding an issue that all American’s should care deeply about – closing of our nation’s safety net hospitals. In the last two decades, nearly 700 hospitals have closed across the country – of those more than half were considered safety net or public hospitals. Public hospitals face the daunting challenge of caring for all citizens, regardless of their ability to pay – including the un- and underinsured.
Safety net hospital systems function as our nation’s “default” national health insurance system. The pressure on safety net hospitals continues to grow rapidly. Saving lives and protecting the fabric of communities has been our mission since day one. Our troubled economy and the rising rates of unemployment are forcing more and more people into the ranks of the uninsured. For most Americans, the loss of a job also means the loss of employer-sponsored health insurance coverage. As the current economic crisis continues to threaten the financial viability and health security of families throughout the country, Americans have turned to safety net health systems in increasing numbers.
Astoundingly, there are some who believe that with the Affordable Care Act (ACA), the need for safety net hospitals and health systems will decrease — however, arguably nothing could be farther from the truth. While the ACA promises heath coverage to 30 million Americans, there will be many people who will fall through the cracks, and remain uninsured. We also know that coverage does not automatically equal access to care. As demonstrated after Massachusetts health reform was fully implemented in the state, low-income, diverse patients disproportionately continue to rely on safety net health systems for care even when they have coverage.
Further, the Urban Institute published a report in March 2011 indicating that 23 million people in this country will remain uninsured after the ACA is fully implemented. About one in four will be undocumented immigrants, a group that has relied on safety net hospitals and health systems for much of their health care throughout our nation’s history.
So why are so many of our nation’s safety net hospitals closing? It’s simple economics – public hospitals are dependent on Medicaid, and the Federal Medicaid disproportionate share hospital funding which provides coverage for their unreimbursed care. Public hospitals also receive some state and local subsidies for unreimbursed care. However, reliance on public funds creates challenges when the Federal, State, and local governments are looking to cut budgets. According to a February 2011report released by the Center on Budget and Policy Priorities–An Update on State Budget Cuts, “at least 31 states have implemented cuts that will restrict eligibility for insurance programs and/or access to health care services.” The lesson – reduction in government program spending makes it difficult for public hospitals to remain open and maintain current levels of care.
And when a public hospital does close in a community, the impact is monumental. Safety net health systems are coordinated systems of care—managing the care for people with multiple chronic conditions. In 2009, NAPH members provided more than 50 million non-emergency outpatient visits, both for primary and specialty care. Public hospital closures equal reduced access to care for patients. Researchers found that public hospital closures in Los Angeles County resulted in patients traveling longer distances to receive care. Longer distances equals increased time required transporting patients to the hospital and therefore attribute to an increased number of deaths. Preventive services that are more likely to occur in hospital settings such as colon cancer screening are likely decreased.
Moreover, local economies suffer when public hospitals close. Public hospitals are often one of the largest employers in their community. Through direct employment, vendors, and training programs, NAPH members yield more than 1 million jobs, nearly $60 billion in wages and more than $133 billion in total economic output nationwide.
Most importantly, essential services— those community-wide services provided by safety net hospitals and health systems that all American’s rely on (e.g., trauma and emergency care, emergency preparedness, mental health services, burn and neonatal care and care to the homeless)—are vital for care delivery in communities across the nation and in some cases the only place where certain specialty care is available and delivered. In short, when a public hospital closes, we all pay. Let’s work to keep the doors of America’s safety net hospitals open – if we don’t, EVERYONE suffers in the end.