Charity hospital system not a substitute for health coverage

Charity hospital system not a substitute for health coverage

Instead of accepting federal dollars to help Louisiana’s poor buy private health insurance, Gov. Bobby Jindal has elected to double down on the state charity hospital system, transitioning the LSU-run system to a series of “public private partnerships.”

Our system is completely unique,” the governor wrote recently, explaining his rationale. “We have been operating a system of 10 state-owned charity hospitals that is now being transformed via public-private partnerships. We are closing two hospitals, providing services instead in local privately run hospitals, and transferring the operations of seven other hospitals to the private sector.

The governor defends this safety-net model of care by pointing to an Oregon study that, he claims, “at the very least raise(s) serious doubts” about the wisdom of expanding health coverage to low-income populations.

But the reality is that these safety-net hospitals often care for the uninsured after they are already sick, where individual coverage empowers people to obtain the preventive care that can improve their health in the long-run.

Moreover, the governor’s rhetoric is undermined by studies from, among others, his very own Department of Health and Hospitals.

According to a DHH report released last December, more than half of all uninsured Louisiana adults don’t have a regular primary care doctor, while only 14 percent of insured adults lack that important relationship. More than 47 percent of uninsured adults were unable to see a doctor due to cost in the last year. For the insured, that number was only 11 percent.

Those with insurance have better access to care.

The same report emphasizes that “routine and preventive care is an important factor in keeping Louisiana residents healthy. Two of the most important predictors of an individual going in for routine check-ups are health insurance coverage and access to a primary care provider.”  It goes onto say “the strongest predictor of lack of access to health care is health insurance status.”

The numbers bear that out.

Louisiana has some of the highest cancer mortality rates in the nation. Yet according to DHH statistics, uninsured Louisianans older than 50 are less likely to have had a colorectal cancer screening in the last two years than the insured (35 percent vs. 63 percent); uninsured women are less likely to have had a mammogram than insured women (57 percent vs. 80 percent); and uninsured men are less likely to have a prostate cancer test (29 percent vs. 58 percent). As too many Louisiana families know, early detection can mean the difference between life and death.

Similar disparities exist in the management of chronic diseases like diabetes. As the state’s report shows, uninsured diabetics are less likely to have their eyes and feet examined than their insured counterparts. Gaps in care like this can mean amputated feet and early blindness.

Having a large number of uninsured residents also acts as a drag on the state economy and weakens the workforce. Uninsured adults are more likely to miss work and other life activities due to poor health and untreated illness, cutting down on productivity and quality of life alike. And lack of access to preventive services means more expensive trips to the emergency room later on — often at taxpayer expense — and avoidable hospital stays. Better health management is the best way to keep people out of the emergency room, but that requires a commitment to coverage.

Fortunately, Louisiana has an unprecedented opportunity to expand health coverage to adults by using federal dollars to help them buy insurance coverage. Unfortunately, Gov. Jindal and many legislators have so far opposed such a plan, even though it would result in millions in state budget savings over the next decade — as much as $500 million in savings according to the Legislative Fiscal Office. DHH’s own cost analysis found that the state could save as much as $367.5 million over 10 years.

It’s questionable whether the new private partnerships constitute real reform, since the low-income uninsured would still not have coverage. But while it’s too early to tell how the partnerships will impact the state budget, by continuing to steer money to buildings – instead of patients – Louisiana is continuing the policies that have brought us to the bottom of nearly every health indicator.