My mother passed away just before Easter of this year. During her last five months, she made six trips to the emergency room. Her journey from failing health to death gave our family an opportunity to observe, first hand, the positives and negatives of our transitioning healthcare system. Essie Jackson was a frugal senior citizen who suffered from a rare form of blood cancer and expired from complications of that health challenge. Thankfully, she had my family and myself to help her navigate the last few months of life. Most of the poor or elderly would not have been able to travel 45 to 60 minutes (each way) to take advantage of the region’s best healthcare options.
Instead of the large, efficient hospitals where everything is state-of-the-art; the poorest and weakest citizens must use the clinics and hospitals that serve the patients that no one else wants. These Medicaid patients (whose reimbursements are much smaller than those of private insurance) and patients without insurance are on the lowest rung of the healthcare food chain. The institutions that serve them are struggling. Many such organizations initially welcomed ACA, believing that it would help their uninsured patients get covered. But ironically, these are the very institutions whose existence is now threatened.
Now that the ACA has been in effect for a few months, the unintended consequences of the law are becoming clearer. Initially, the obvious problem was that far more insurance plans were being canceled under the ACA’s regulations than were being selected in the exchanges. This seemed to defeat the ACA’s goal of expanding healthcare coverage. The higher premiums that younger healthier adults were being charged to subsidize the care of those who were older or who had preexisting health conditions also attracted a lot of attention. But not much has been made of the ACA’s effect on the segment of population it was supposed to help the most: the poor.
Little discussed in the thousands of pages of the ACA bill were its deep cuts to Disproportionate Share Hospital (DSH) payments. These were to begin this year, but last Fall were delayed by the Obama Administration until 2016. DSH payments go to hospitals that treat a large number of uninsured patients who are unable to pay their bills. Each year, there are about 130 million emergency room visits. The 1986 Emergency Medical Treatment and Active Labor Act (EMTALA) requires that hospitals provide emergency treatment to anyone, regardless of ability to pay. Naturally, the hospitals doing the most of this kind of charity care rely on the DSH payments to stay in business.
Bishop Harry Jackson is chairman of the High Impact Leadership Coalition and senior pastor of Hope Christian Church in Beltsville, MD, and co-authored, Personal Faith, Public Policy [FrontLine; March 2008] with Tony Perkins, president of the Family Research Council.