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Uncompensated Care Costs Rise at PA Hospitals

12:39 pm in Uncategorized by ThirdandState

By Chris Lilienthal, Third and State

More than a year ago, the Corbett administration decided to end the state’s adultBasic program, which provided affordable health insurance to about 40,000 low-income Pennsylvanians who were unable to obtain coverage from an employer or through other programs.

We worried at the time that many of those newly uninsured would delay treatments until a health condition snowballed into a more serious and costly problem, sending more people to the emergency rooms of our community hospitals.

The Pennsylvania Health Care Cost Containment Council released a report this week showing that uncompensated care costs at hospitals did in fact rise in the 2010-11 fiscal year, when adultBasic ended. Uncompensated care totaled $990 million — an 11% increase over the prior year.

Dave Wenner at the Harrisburg Patriot-News has more:

[Hospitals'] average operating margin was 5.58 percent, up from 4.37 percent the previous year. That means the average hospital had a profit of $5.58 for every $100 in revenue…

“We see the number of hospitals that lost money dropping,” said Joe Martin, the executive director of the cost containment council. “We see the margins rising to a healthy level. That’s all good news.

“The news that’s a little concerning is the spike in the uncompensated care. And there are still a lot of hospitals, particularly the small- to medium-sized hospitals, that are struggling financially. So there is really two sides to the story.”

But the Hospital & Healthsystem Association of Pennsylvania painted a much darker picture, saying the recent numbers “mask” a bleak long-term reality of hospitals struggling against state and federal budget cuts, while straining to provide a safety net for uninsured and under-insured patients.

Local hospitals told the Patriot that the loss of jobs and health insurance in the tough economy, as well as high deductibles and other tactics to shift more health care costs onto patients, played a role in rising uncompensated care costs.

And so did adultBasic’s end, as Sharon Ward of the Pennsylvania Budget and Policy Center noted in the story:

The loss of coverage, Ward said, forces people to wait until they are sick, when they need a maximum level of care and obtain it in the most expensive setting. Then their costs get shifted to people with insurance and government programs, said Ward, who is an advocate for government programs to provide insurance for people who can’t afford coverage.

PA Must Reads: Government Spending, Top Incomes and adultBasic

11:49 am in Uncategorized by ThirdandState

A blog post by Mark Price, originally published at Third and State.

Paul Krugman this morning caps off a series of blog posts over the last week with a column comparing government spending in the recovery following the deep 1981 recession and government spending in the recovery following the 2007 recession. The bottom line: the employment situation now would have been much better if the federal government had done more to provide aid to state and local governments.

One way to dramatize just how severe our de facto austerity has been is to compare government employment and spending during the Obama-era economic expansion, which began in June 2009, with their tracks during the Reagan-era expansion, which began in November 1982.

Start with government employment (which is mainly at the state and local level, with about half the jobs in education). By this stage in the Reagan recovery, government employment had risen by 3.1 percent; this time around, it’s down by 2.7 percent.

Next, look at government purchases of goods and services (as distinct from transfers to individuals, like unemployment benefits). Adjusted for inflation, by this stage of the Reagan recovery, such purchases had risen by 11.6 percent; this time, they’re down by 2.6 percent.

And the gap persists even when you do include transfers, some of which have stayed high precisely because unemployment is still so high. Adjusted for inflation, Reagan-era spending rose 10.2 percent in the first 10 quarters of recovery, Obama-era spending only 2.6 percent.

Why did government spending rise so much under Reagan, with his small-government rhetoric, while shrinking under the president so many Republicans insist is a secret socialist? In Reagan’s case, it’s partly about the arms race, but mainly about state and local governments doing what they are supposed to do: educate a growing population of children, invest in infrastructure for a growing economy.

Economist Emmanuel Saez has updated his time series (PDF) on top incomes with new data for 2010, which has just been released by the IRS. Mike Konczal walks you through the new data. The most shocking figure in the new data is the following from Saez:

The top 1% captured 93% of the income gains in the first year of recovery.

The Delaware County Daily Times this morning explores the impact of the end of Pennsylvania’s adultBasic program a little over a year ago.

One year after 42,000 working Pennsylvanians lost adultBasic, a state program designed to provide low-cost health insurance for low-income residents ages 19 through 64, many are still struggling to get health care, according to health care access advocates.

“Unfortunately I have heard countless stories over the last year from people across the state unable to gain access to the care they need. It’s been especially troubling for people with chronic conditions,” said Athena Ford, spokesperson for the Pennsylvania Health Access Network.

More than 1,700 Delaware County residents relied on adultBasic before the program ran out of money Feb. 28, 2011 and more than 17,400 Delaware County residents were on the waiting list for the low-cost health insurance.

The figure above comes from a new report by John Schmitt, Health-insurance Coverage for Low-wage Workers, 1979-2010 and Beyond (PDF):

The last three decades have seen substantial erosion in employer-provided coverage across workers at all pay levels. Low-wage workers saw the biggest decline in own-employer coverage – about 17.0 percentage points between 1979 and 2010. But, coverage losses were almost as large for workers in the second quintile (down 13.8 percentage points) and the top quintile (down 13.3 percentage points).

adultBasic: A Year of Struggle for Many Working Pennsylvanians

3:06 pm in Uncategorized by ThirdandState

A blog post by Chris Lilienthal, originally published at Third and State.

One year after Pennsylvania’s adultBasic program came to an end, many working Pennsylvanians are still struggling with the lose of this critical lifeline. Anxiety and financial pressures are common, and many are allowing chronic health conditions to go untreated.

That was the message delivered by health care providers, advocates and former adultBasic enrollees during a media conference call hosted by the Pennsylvania Health Access Network (PHAN) Wednesday.

adultBasic was created more than a decade ago to provide affordable health coverage to low-income working Pennsylvanians who either lacked job-based coverage or were denied outright because of pre-existing health conditions.

But when a funding agreement between the commonwealth and Pennsylvania’s four Blue Cross/Blue Shield plans expired, Governor Corbett opted to end the program rather than renegotiate the agreement. The adultBasic program shut down one year ago today.

Rick Mossinghoff, a part-time worker from Robinson Township, Allegheny County, was one of the Pennsylvanians who suddenly found himself without health coverage. He opted to enroll in Special Care – a plan for low-income people offered by the Blues and touted by the Corbett administration as an alternative. His new premiums were five times the cost of adultBasic.

“When I had adultBasic, I was able to have physical therapy to combat the arthritic degeneration in my hip,” Mossinghoff said during the conference call. “That all ended, when I lost my coverage – because Special Care doesn’t cover any rehabilitative or physical therapy care.”

He later added: “Special Care has been a nightmare for me. We are limited to just four doctor visits a year. Here we are, barely into the new year, and I’ve used up four of my visits trying to get my hip straightened out. My doctors told me that if I didn’t have physical therapy, I’d walk with a limp the rest of my life.”

Mossinghoff ended up shopping around for physical therapy, took the lowest bidder and is paying out of pocket.

And he’s probably doing better than many other former adultBasic enrollees. As the Pennsylvania Budget and Policy Center showed in a fall report, fewer than 40% of those who lost adultBasic coverage enrolled in Special Care or the state’s Medical Assistance Program. The other 60% have simply fallen through the cracks.

The Blues’ plans, meanwhile, continued to do quite well despite the recession. Reports show the plans had a combined surplus of $6.4 billion in 2010.

The only light at the end of the tunnel for those who lost adultBasic is the Affordable Care Act, which calls for new insurance marketplaces to buy affordable health coverage to be up and running by 2014. Only then will Pennsylvania families be able to access the kind of choices and security that are lacking in our current health insurance market.

Third and State This Week: Record Poverty, Public-Sector Job Losses, and Ending Loser Liberalism

12:00 pm in Uncategorized by ThirdandState

This week we blogged about new data on poverty in America, public-sector job losses putting a drag on the economy, and a new book by economist Dean Baker explaining how we can put an end to “loser liberalism.”


  • On poverty, Michael Wood blogged about new Census data showing the American poverty rate has risen to its highest level since 1993 and that the number of people living in poverty is at a record high. Christopher Lilienthal shared charts from the Center on Budget and Policy Priorities interpretting the Census data and linked to another Center analysis showing that by several measures poverty is worse than it has been in decades.
  • On health care, Sharon Ward highlighted a recent policy brief from the Pennsylvania Budget and Policy Center showing that on the six-month anniversary of adultBasic’s end, few former enrollees have signed on to the alternative insurance options offered to them.
  • On jobs and the economy, Mark Price commented on the increase in Pennsylvania’s unemployment rate last month and how declining public-sector employment is continuing to be a drag on the economy.
  • Finally, Stephen Herzenberg blogged about a new book by economist Dean Baker with the provocative title The End of Loser Liberalism: Making Markets Progressive and an online discussion of the book planned for Sunday from 5-7 p.m.

More blog posts next week. Keep us bookmarked and join the conversation!