I have authored many comments in regard to Medicaid in this space. As we know, one of the pillars of the Affordable Care Act upon conception was to first, provide health insurance to all Americans, the so called “individual mandate.” For the indigent population, states were to expand Medicaid to accommodate this disenfranchised sector of society with coverage. The Supreme Court struck down these all too very important pieces. The repercussion of that legal decision was that achievement of the healthcare Triple Aim as expressed by Dr. Berwick and his colleagues became moot.
This week the acclaimed Cleveland Clinic reported that their Charity expense or write off for providing care to the indigent population without health insurance was down from to $171 million in 2013 to $101 million in 2014. They attribute this success to Ohio’s decision to expand Medicaid, thus enrolling the millions who, here to for, have not had health insurance in past.
In Texas, unfortunately, this phenomenon is reversed. Also a part of the Affordable Care Act was the directive from CMS to scale back the disproportionate share or DSH (Dish) reimbursement to hospitals who treated larger amounts of charity patients. So, Texas hospitals can no longer count on DSH payments and Texas did not expand Medicaid, so charity care is increasing as Texas also has the largest proportion of uninsured per capita in the country (26.2%).
Texas did apply for and get approved a Medicaid 1115 Waiver, which in theory was to reduce Medicaid spending in the Lone Star State. Unfortunately, any net savings are not being recognized as there is no long term solution for the uninsured. Texas should look closely at the Cleveland Clinic data and ponder what could have been.