By: Health Insurance
Submitted: 2010-02-02 11:52:51 | Word Count: 891
A proposal by Arizona Gov. Jan Brewer to cut 300,000 people from the health care plan for the poor will likely "increase the misery index," a Prescott doctor said.
Dr. Joseph Goldberger, chief medical officer for the Yavapai Regional Medical Center and a rheumatologist with a private practice, said about 15 to 20 percent of the patients he sees at his rheumatology consulting practice are insured by the Arizona Health Care Cost Containment System, the Arizona equivalent of Medicaid. Already, AHCCCS fees to doctors have been frozen, he said.
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"The untold story is patients with or without insurance continue to get the care," Goldberger said. "They get the most expensive care of all: ER care. Everybody else ends up paying for that through higher premiums. It has a significant impact."Many of his arthritis patients need "very expensive" medications and "without insurance, they can't afford them at all. The bigger problem is the access to medications."
While that may not be life threatening in all situations, it certainly increases pain levels for arthritis patients.
In some situations, such as with a lupus patient who has kidney disease and can't get access to chemotherapy, it could be life threatening, he said.
While Goldberger understands that the state is having budget problems and that education and health care are candidates for cost cuts, there are consequences, such as the loss of federal matching funds.
Health providers face a total cut of $67.7 million in state and federal money, according to the Arizona Hospital and Healthcare Association. The association protested the plan to transfer AHCCCS's remaining graduate medical education money and nearly all private disproportionate hospital dollars to other uses. Arizona's hospitals have seen $278 million in state funding cuts since 2008, trade group officials said.
Reduction in payments for training doctors - the graduate medical education money - is particularly egregious, said John Rivers, the hospital association president and CEO.
The state and federal government traditionally reimburse hospitals that train doctors who typically go through a residency in a specific area of medicine after they complete their medical training and internships, Rivers said. However, if the state doesn't put up the money for that training, then the federal government won't contribute its share, Rivers said.
"If we're not training doctors, I don't see how that is good for the people of Arizona," Rivers said. "One of the important by-products of training doctors here is this is where they end up practicing. If they get training somewhere else, they stay there. It's a horrible outcome for the people of Arizona."
Already the state has only 219 doctors for every 100,000 people, while the national average is 293 physicians for every 100,000.
It's also shortsighted economically to cut into hospital budgets as hospitals create jobs, he said. And the cuts will shrink the state's economy by $48.8 million in federal Medicaid matching dollars that will now go to other states.
Hospitals in Arizona employ 73,300 people and contribute $11.5 billion to its gross economic product, according to an Arizona State University study.
While the Yavapai Regional Medical Center is not a teaching hospital and is not affected by the graduate medical aspect of the budget cuts, said Brian Hoefle, the chief financial officer, the lack of disproportionate care money from the state would result in a loss of several hundred thousand dollars.
"Gov. Jan Brewer is talking about eliminating some of those programs," said Hoefle. "It would be up to the Legislature to decide on cuts to AHCCCS. Just because the state isn't covering certain populations anymore doesn't mean they won't get sick and end up in our ER. If there's no payment for them, it shifts the costs to the paying customers."
The state will lose $2 from the federal government for every dollar it cuts from AHCCCS, according to Hoefle.
"That's very frustrating," he said.
About 15 percent of patients who use YRMC are AHCCCS clients.
Meanwhile, the hospital has already seen large increases in bad debts and charity care over the past two years, Hoefle said. Charity care - wherein patients provide their financial information and are deemed unable to pay - has doubled from 2008 through 2009. While bad debtors - those who are unable or unwilling to pay but are not working with the hospital - have increased by 18 percent over the last two years.
"If the AHCCCS program is not going to pay hospitals, it's going to fall back on hospitals to pay," Hoefle said. People are "going to come to the hospital and we're going to eat it. It ultimately affects commercial insurance. We raise our rates to insurance companies and those people who can pay will ultimately pay for the state's lack of coverage. They're talking about the hidden tax. Whoever is paying their hospital bills is paying for those who are not paying their hospital bills. Otherwise the hospital goes out of business."
