Monthly Archives: May 2015

05.05.15
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Minnesota nurses oppose MNCare repeal

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By Mathew Keller, RN JD, MNA Nurse Policy Specialist

When cuts are made to public insurance programs, we all end up paying more.  Just the other day I heard the story of Mary*, a young woman who found some unusual lumps in her breast.  Having already had her preventive care exam for the year, she could not afford the high cost of following up with her physician.  When she was finally able to get her next annual exam, Mary got the heartwrenching news that she had Stage 4 breast cancer.

MinnesotaCare, a public health insurance program for the working poor, is under threat from state legislators in the House of Representatives. In the long run, gutting MinnesotaCare is a losing proposition for our patients, our hospitals, and our state.

MinnesotaCare is a program for those who earn between 133 percent and 200 percent of the Federal Poverty Line (FPL), which is $11,770 for an individual and $24,250 for a family of four this year. MinnesotaCare currently serves 105,000 individuals and families who work hard and yet don’t have employer-provided insurance and can’t afford coverage on the open market.  The program requires enrollees to pay premiums of $15-$50, depending upon income, and to share in some of the costs of coverage.

If MinnesotaCare is repealed, its current enrollees will be forced to enroll in a private insurance plan, which will cost more and deliver less. For example, a 2015 silver plan would cost an individual earning $16,243 annually a $46 monthly premium, while only covering 70 percent of medical costs. That same individual would pay a monthly premium of $15 while receiving 98 percent coverage under MinnesotaCare. For the working poor, this is a huge difference.

As nurses, we know that the high price of healthcare is often a barrier to the working poor receiving adequate care. According to a Harvard study, unpaid healthcare costs cause more than 60 percent of  bankruptcies in America, and one in five American adults struggle to pay their medical bills.  The rate of unpaid medical bills is even higher among working poor earning between 133 percent to 200 percent of the FPL.

Consider, for example, the price of an emergency appendectomy. Assuming the patient gets to the emergency room before the appendix ruptures, the procedure costs upwards of $20,000. For a working-class individual earning $16,243 annually on a silver-level private insurance plan (with 70 percent coverage), the out-of-pocket cost is still an unmanageable $6,000. When that individual is unable to pay the $6,000, the hospital absorbs the cost under “charitable care,” but the hospital has to raise prices on every other patient to balance the books.  Rather than cut healthcare costs, eliminating MinnesotaCare actually raises costs for all Minnesotans.  It’s a gimmick that budgeters try to make it look like they’re doing a good job.

When individuals and families are afraid to go to the doctor because of what it might cost them in the long run, they put off necessary treatment.  This harms our patients’ health while costing them, the hospital, and all Minnesotans more in the long run. Mary didn’t make it; let’s make sure the 105,000 working-class Minnesotans who use MinnesotaCare don’t need to face the same choices she did.

*Name changed to protect confidentiality

05.04.15
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Patients Not Hurt When Their Hospitals Close, Study Finds

A hospital closure can send tremors through a city or town, leaving residents fearful about how they will be cared for in emergencies and serious illnesses. A study released Monday offers some comfort, finding that when hospitals shut down, death rates and other markers of quality generally do not worsen.

Researchers at the Harvard School of Public Health examined 195 hospital closures between 2003 and 2011, looking at health experiences in the year before and the year after the hospital went out of business. Their paper, published in the journal Health Affairs, found that changes in death rates of people on Medicare — both those who had been in the hospital and among the broader populace — were no different than those for people in similar places where no hospital had closed.

While the researchers noted that some people might be inconvenienced by having to travel further for care, they found no significant changes in how often Medicare beneficiaries were admitted to hospitals, how long they stayed or how much their care cost.

The closed hospitals tended to be financially troubled, with revenues averaging 13 percent less than the cost of running the institutions. “It’s possible that we didn’t see any change in outcomes because patients instead went to nearby hospitals that had better finances and may have had more resources to provide care,” said Dr. Karen Joynt, the lead researcher on the study.

She cautioned that the study looked at the average experience of a hospital closure and should not be interpreted to mean that every hospital loss is harmless. “I would be shocked if you couldn’t find an example where access is really threatened,” she said.

One of the study’s surprises was that 70 percent of the hospital closures were in urban areas rather than in rural regions, where hospitals have had trouble staying afloat for decades. Rural closures can be devastating when the hospital is the only one in the region. Medicare pays isolated hospitals more generously to help them keep going. Since 2010, 50 rural hospitals have closed, 16 of them last year, according to the N.C. Rural Health Research Program.

A less surprising finding from the study was that a third of the closed institutions were safety net hospitals that treated large numbers of the poor and uninsured. Joynt said the researchers had no way of examining whether the health of low-income and uninsured people suffered from the closures, so it was possible those closures did have deleterious effects. The paper looked at Medicare patients because their records are easiest to analyze and compare.

Nancy Foster, a quality expert at the American Hospital Association, called the paper “an important first indication that nothing untoward has befallen patients thus far, but we’ve got to continue to monitor this.”

She said that with hospital admissions declining overall, many are building outpatient clinics and stand-alone emergency rooms, to ensure patients aren’t abandoned.

The Harvard study did find a few changes when hospitals closed. Readmission rates dropped by more than 6 percent, and patients were more likely to go out of their health care market when they needed to be admitted to hospital. On average in places where hospitals closed, the percentage of Medicare patients leaving the area for inpatient hospital care increased from 43 percent before the hospital closed to 54 percent afterward.

“On average, people are going a little further, but it clearly has no negative effect on their outcomes and on their health,” said Dr. Ashish Jha, another author of the study.

He said that while hospitals are often coveted because they are large employers, from a health perspective, fewer admissions can be a good sign. “If we do our job well and keep people healthy, many hospitals will become unnecessary,” Jha said.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.