By John Williams
CEO Barton HealthCare System
It's frightening that California has more uninsured residents than any other state - 6.8 million men, women and children. That's more than the entire population of Massachusetts. Because they lack health coverage, many Californians forgo the routine care they need and their health conditions become worse. As a result many end up in hospital emergency rooms, which are increasingly becoming the medical office of first and last resort. For the South Shore, that means Barton Memorial Hospital's Emergency Department is their only choice.
Gov. Arnold Schwarzenegger embarked on a bold initiative to provide health care coverage to more Californians by reforming the current employer-based health care system. His vision is one that the rest of the nation and our national elected officials are watching closely.
At a time when the state's health care system is on the verge of a meltdown, everyone must share the responsibility for creating reforms that expand coverage to the uninsured, protect the long-term stability of community hospitals and safeguard patients' access to care.
California's hospitals are on the front lines in our health care system - operating around-the-clock emergency rooms and providing critical trauma care to anyone who needs treatment, regardless of their ability to pay. As a result, California's hospitals provided $8.6 billion worth of uncompensated care last year alone. Included in that figure is a $2.1 billion shortfall stemming from the Medi-Cal program.
The California Hospital Association (CHA) Board of Trustees took a leap of faith this month to support the governor's health reform proposal, which would impose a new four percent fee on hospitals. These fees would be matched by federal funds and then used to increase Medi-Cal payments to hospitals and expand coverage to the uninsured.
The assessment fee alone will not provide the protection necessary to ensure that California's community hospitals will be able to continue providing vital services. While CHA is pleased to have reached an agreement on a broad package of hospital financing reforms, hospitals must have some long-term financial protections, including:
• A guarantee that Medi-Cal payments will be increased on an annual basis to the maximum amount allowed by federal law. California ranks last when compared with Medicaid programs in other states. Yet, the costs of delivering hospital care continue to increase every year. If Medi-Cal payment rates don't keep pace with rising costs, then hospitals will quickly find themselves back in the same hole that exists today.
• An agreement that all of the funds generated by the hospital fee will be placed in a separate hospital trust account, apart from the state's general fund. A ballot proposition will be required to ensure that the money contributed by hospitals will be used only for the purposes intended - financing hospital services and expansion of coverage to the uninsured.
• A promise that the state's current general fund expenditures to hospitals will be continued and increased annually.
It is also important to understand that any new hospital fee is only one piece of the bigger health care reform picture. Other new sources of revenue are needed to fully expand coverage to all of California's uninsured residents. Employers, health plans, the government, other providers and individuals also must share the financial responsibility.
With these and other responsible reform guarantees, Californians can be assured that there will be more health care dollars generated to reduce the cost shift created by Medi-Cal payment shortfalls to hospitals and provide vital health care coverage to more Californians. It is essential that California's hospitals and emergency rooms remain financially stable and open to provide critical care services to our state's growing and aging population.
Our state's hospitals applaud the governor and the Legislature for their commitment to enact a comprehensive health care reform package. Great strides have been made. However, during the next few days and weeks of the special legislative session, there's a lot of work yet to do to achieve this important goal.