Guess what, when people have insurance, care gets paid for. Amazing concept.
Kaiser on the Cleveland Clinic:
The Cleveland Clinic, one of the largest hospitals in the country, has cut its charity care spending — or the cost of free care provided to patients who can’t afford to pay — to $101 million in 2014 compared with $171 million in 2013…..
The economy got slightly better in 2014 then 2013, but the big driver here is the Affordable Care Act. Medicaid expansion in Ohio was supported by the Republican governor and as projected by anyone who can count to eleven with their shoes on, unpaid care decreased significantly because quite a few poor people who had no health insurance in 2013 now had health insurance in 2014. The Exchanges most likely played a secondary role in reducing charity care as most hospitals have charity care programs up to 200% or 300% Federal Poverty Line, and subsidized Exchange policies are now avaialable to people who make too much for Medicaid but could not get affordable insurance previously and therefore relied on some charity care.
The counterbalance is that most hospitals are seeing some of their charity care cost reductions being balanced by an increase in deductible debts. The high deductible plan design mania to keep premium costs low means that a person hit by a car or diagnosed with cancer may not be able to come up with $4,000 on the spot, and some of that debt will never be paid. However, in the diagnosed with cancer scenario, the hospital might be out $4,000 but collect $25,000 from the insurer instead of eating the entire cost on charity care so it is still a massive net win.
This basic dynamic is why so many analysts (myself included) had thought that Southern and Great Plain state hospital associations would go to war with the Teabaggers to get Medicaid expansion passed as there is way too much money on the table. So far most of the hospital associations have not funded primaries or (gasp) Democrats against Teabaggers, but that is the way forward for most of the remaining hold out states to get Medicaid expansion. I think the incentive to go to the mattresses will increase as Disproportionate Share Hospital payments begin to get cut in the near future. That won’t on net hurt hospitals in Medicaid expansion states, but it will kill rural hospitals in the sadist states.