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Lawmakers review charity care as an alternative to Medicaid expansion

Published: Tuesday, Sept. 24 2013 6:53 p.m. MDT

Utah lawmakers and community advocates are exploring the option of a viable system of charity care. The idea would utilize Utah's large network of retired physicians to extend health care coverage to underserved populations.

Lynne Sladky, AP

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SALT LAKE CITY — The Green River Medical Center is the only option for health care on a 235-mile stretch of highway in eastern Utah.

Without it, "they would be in trouble here," said Mary Winters, executive director at the center. "We are considered frontier."

The 5,000-square-foot community health center — one of the three smallest of its kind in the country — is just one of 11 similarly located throughout the state that serve a high-need community, providing quality health care to patients for sometimes little or no payment.

"I think it is absolutely vital," Winters said, adding that about 43 percent of the population served by the clinic is either uninsured or underinsured. "They don't have the ability to pay — or pay much, for that matter," she said.

The small community of fewer than 1,000 residents depends on the federally funded network of care, but they're not the only ones in need. Community health centers throughout Utah served more than 112,000 patients last year.

Most patients are able to pay a nominal fee for treatment, but it rarely covers the cost of their care. There are also hundreds of providers outside the community health network that provide free or low-cost health care to their patients, also at a loss and in the name of charity.

"What we are finding is charity care is not free," said Pamela Atkinson, a local advocate for the homeless who serves as the head of the Charity Care Team, a work group created by Utah's Health Reform Task Force and the governor's Medicaid Expansion Options Community Workgroup.

The group has been studying the potential of a charity care network in Utah, which some lawmakers believe could help eliminate health problems for the uninsured.

Atkinson, who routinely seeks and provides assistance for Utah's underserved populations, said it is difficult to know how much care is provided without expectation of payment in the state. Many medical offices, clinics and even hospitals, she said, offer deep discounts or collect nothing for services rendered.

With a relatively selfless population in Utah, it's a market that Atkinson believes is largely untapped.

The idea to beef up charitable care was offered in the midst of heated debates about proposed Medicaid expansion during the most recent legislative session. Rep. Jacob Anderegg, R-Orem, said that when given a chance, Utahns would step up to help.

"We have the power to do this ourselves," Anderegg said during a floor debate on the Medicaid bill.

Utah Gov. Gary Herbert has yet decide to expand Medicaid, an option under the Affordable Care Act, that would extend coverage to more than 130,000 uninsured Utahns.

While the state is renowned for its charitable characteristics, Atkinson said it is difficult to quantify how much is available, how much is necessary and how to make sure quality care is being offered.

The group is surveying retired physicians to determine their willingness to return to the industry when called upon to give much-needed care.

"We really, truly can in Utah show the nation how it can be done," said Sen. Allen Christensen, R-Ogden.

A retired dentist, Christensen is chairman of the state's Health Care Reform Task Force and is also working on the committee to study charity care.

He said he expects a lot of physicians to come out of the woodwork to offer assistance.

The Sutherland Institute, a nonpartisan conservative public policy Utah think tank, has long backed charity care.

It has presented many opinions on the matter, hoping to "reverse the ever-growing burden on taxpayers from Medicaid and other state government-driven programs," according to a 2008 policy brief titled “Caring for Our Neighbors in Need and Strengthening Community in Utah."

On Tuesday, Stan Rasmussen, Sutherland's director of public affairs, told the task force that there are many challenges to providing adequate charity care, including that it isn't readily available everywhere in the state and patients often don't know where to find it.

Rasmussen said human beings "should be attentive to the needs of each other, and should not have to rely on mechanisms of government."

The federal government has promised to fund 100 percent of the Medicaid expansion in Utah for at least the first three years. After that, the state would be responsible for 10 percent of the cost to extend coverage to more people, and beyond that, financing is uncertain.

For people who rely on government-subsidized health care, such as those in Green River, there is no substitute.

"We render really good health care here," Winters said, adding that it couldn't be done without federal funding.

The center is required to meet and work on various performance measures, maintaining standards as good quality health care.

While residents heavily rely on the medical facility, it is also essential to the many visitors to nearby state parks and travelers on the highways that cut through town. Like many medical facilities, patients receive care at the center regardless of their ability to pay.

Treatment for specialty care is outsourced, if patients can travel, and holes in health care are expected in the small community, as it will never be large enough to warrant a hospital, Winters said.

Lawmakers on the task force also agree that as long as there are people to treat, there will always be a demand for charity care. It is a dilemma that Christensen said could use some creative thinking and long-term commitment.

Email: wleonard@deseretnews.com

Twitter: wendyleonards

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