CHARITY CARE: Increasing Burden Cripples Safety Net
With 7.3 million California residents uninsured, the state's charity care network is becoming increasingly strained and "may soon snap," the Alameda Times-Star reports. Many of the insured are employed but earn too much to qualify for Medi-Cal or too little to finance private coverage. Others who qualify either "don't know they do -- or can't stomach the forms required" to enroll. As the cost for indigent care spreads throughout the state, reimbursements from donors and the county governments are running out. For example, Alameda County Medical Center spent $46.4 million on charity care in 1998, but only received $21.3 million in reimbursements and donations, leaving a $25 million shortfall.
In addition to the ballooning costs of charity services, health providers are also concerned about "the threat to overall public health created by legions of people who don't visit a doctor until they absolutely must." Dr. Roger Peeks at Highland Hospital said that he is seeing more people waiting "months to get an appointment and spend[ing] hours in his waiting rooms, or ... wait[ing] until disaster strikes and show[ing] up in the emergency room." He said, "You're in a situation now where the people who need to get the care, can't get the care. If you can't get care until you're at an emergent level, then the safety net is not working."
While some are looking to the state's tobacco settlement and projected budget surplus to combat the charity care problem, others are calling upon private, not-for-profit hospitals to step up their services. But Michael Mahoney, president of St. Rose Hospital, said, "Demanding that private non-profits eat more of the cost of charity care might sound good ... but it is an unrealistically simplistic solution to a complex problem." Currently, lawmakers in Sacramento are trying to address the problem with a handful of legislative measures. Assemblyman Gil Cedillo (D-Los Angeles) is proposing a bill that requires hospitals that provide charity care to be eligible for discount bond financing. Other proposals expand Medi-Cal and Healthy Families and tax credits for private and employer-based insurance. The state Legislature also is looking at a universal health care plan and has commissioned a task force to examine the idea. The results are expected in 2001 (Stannard, 5/8).