Expanding Medicaid may be anathema to Texas political leaders. For hospitals, though, it would be a godsend.
Baylor University Medical Center lost $172.8 million on uncompensated care last year.
Texas Health Presbyterian Hospital Dallas reported uncompensated care of $86.5 million. Methodist Dallas Medical Center reported $154.7 million.
And Parkland Health and Hospital System reported $1.488 billion of uncompensated care.
The figures are from www.txpricepoint.org and the American Hospital Directory. They represent what hospitals report as losses based on what they’d normally charge patients. Patients insured by Medicare or Medicaid and with private insurance companies don’t pay anywhere near those top prices. Even the uninsured are offered discounts.
But once you strip away the difference between top and discount prices, Parkland still had losses last year of $359 million from treating uninsured patients and bad debt.
The Texas Hospital Association is trying to remedy that, at least in part. It wants to coax Governor-elect Greg Abbott and the Legislature to use federal funds available through the Affordable Care Act to expand Medicaid with a private insurance model.
This “Texas Way” approach, as the hospital association describes it (texasway.org), would seek out the uninsured not currently eligible for Medicaid but who can’t afford the insurance policies offered under the Affordable Care Act’s healthcare.gov site. That’s about 1.05 million Texans, the association estimates.
The Texas Way would likely involve a high-deductible health plan coupled with health savings accounts, said THA vice president Lance Lunsford, but the exact structure is purposely vague.
“We want the Legislature to make those decisions or leave that to staff,” Lunsford said.
The association has its eye on Medicaid expansion plans in other Republican-governed states.
The “Healthy Indiana Plan” is a particular focus of the Texas Hospital Association. Under this approach, Medicaid recipients have to put some of their earnings into a health savings account each month to be eligible.
Gov. Mike Pence is still negotiating with U.S. Health and Human Services Secretary Sylvia Burwell to gain federal approval. If they can reach agreement, the plan would extend coverage opportunities to hundreds of thousands of Indianans with incomes between 100 percent and 133 percent of the federal poverty level. Under the Affordable Care Act, the extension would be paid for with federal funds.
Federal poverty level includes individuals making $11,670 or less or a family of four making $23,850.
Texas hospitals say their state should take the same path. Those federal funds would be coming back to hospitals that have already forfeited large sums under the Affordable Care Act’s cuts in Medicare compensation, Lunsford said.
The cost of covering the uninsured now falls on insured Texans, as hospitals and physicians shift the burden to cover costs. As a result, an average family insurance policy costs $1,800 a year more in the state.
Gov. Rick Perry and others have said Texas is not interested in pouring more money into a broken system. One way health care providers agree that Medicaid is broken is in the meager amount this state-federal partnership program pays for care.
Hospitals say they lose money on every Medicaid patient they treat. The American Hospital Association calculates Medicaid paid only 93 cents of every dollar spent on Medicaid patient care in 2012.
It’s worse in Texas, but that’s no reason to do nothing, Lunsford said.
“Until we get that addressed, we at least have to take advantage of the situation by getting these people covered one way or another,” he said. “I don’t see the validity in saying, ‘I’ll take zero over 50 percent.