The effect of uncompensated care
on hospital quality operates through its impact on hospital finances.
Jay Kaplan, president of the American College of Emergency Physicians, wrote in a letter sent to CMS in November that leaving the uncompensated care
burden out of new types of Medicare reimbursement arrangements could hurt some types of physicians more than others.
Federal officials deny the claim and have encouraged Texas to apply for additional safety-net funds, but they say they do not want to continue to pay for hospitals' uncompensated care
costs that would be covered under a Medicaid expansion.
Vanessa Santarelli, CEO of the Maine Primary Care Association, said the state's 20 community health centers have been hit through increased uncompensated care
costs as the LePage administration also tightened regular Medicaid eligibility requirements and had two rounds of cuts of 40,000 residents.
Noting that Medicaid has escaped the cutbacks experienced by other welfare programs, such as food stamps, they observe that "Given that hospitals are an important political force at all levels of government, the factors requiring hospitals to provide uncompensated care
may thus have unintentionally assured Medicaid's long-term political stability."
Put differently, if there was no Medicaid, this population would still receive some health care and would pay only a small share of its cost, likely due to the large amount of uncompensated care
provided by hospitals.
(1) A majority (ie, $5 billion) of this decrease in uncompensated care
was realized by hospitals in the 28 states and Washington, D.C., which expanded Medicaid under the Affordable Care Act (ACA).
It would only reimburse providers and hospitals for uncompensated care
rendered to patients who come to their emergency rooms.
In exchange for providing uncompensated care
to working poor, the destitute, the undocumented, and the homeless, safety net hospitals receive Disproportionate Share Hospital (DSH) payments from CMS, which amounts to billions of dollars over the next several years.
Expanded coverage reduces hospitals' uncompensated care
, lowers "cost shifting" to businesses that see higher health insurance premiums as some of the costs of caring for the uninsured are passed on to them and strengthens local economies, the report said.
"Also, while hospital spokesmen claim that they have to take everyone regardless of ability to pay, hospitals get paid even when they don't get paid through the uncompensated care