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Hospital lease only part of health debate

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Our periodic row over the role of the University of New Mexico Hospital officially kicks off tonight before the Bernalillo County Commission, which is expected to discuss terms of a new lease agreement with the hospital. The last time UNMH indigent care got a lot of people angry was in 2008 when voters had to reauthorize the mill levy that supports the hospital.

The UNMH administrative policies manual says the hospital “is operated pursuant to a lease agreement between the Regents of the University of New Mexico and Bernalillo County” that “requires Bernalillo County to provide certain revenues to UNMH for its continued operation and maintenance.” Those funds come from property taxes voters agree to impose on themselves. In exchange, UNM “provides care to indigent residents of Bernalillo County, contingent on availability of resources and funds. Patients who do not meet the eligibility criteria for financial assistance and have no third-party payor source are classified as self-pay.”

Audited financial statements for the most recent fiscal year show UNMH lost $88.3 million on operations, which essentially is providing care to patients of all kinds, including those who are indigent, who have private insurance, Medicare, Medicaid etc.

It cost $130.8 million to provide charity care to 26,500 people under the UNM Care program, available to Bernalillo County residents with incomes 300 percent of the federal poverty level or less. This does not include patients who receive Medicaid benefits.

A family of four is at 300 percent of the poverty level if it makes $70,650 a year.

UNMH expects to eat another $102.2 million owed by “patients who are either uninsured or underinsured and who do not meet the criteria for financial assistance.” Immigrants in the country illegally are not eligible to receive public assistance.

UNMH is hardly destitute. At the end of fiscal 2013, the hospital had $102 million in cash and cash equivalents and it finished $6 million in the black, thanks to the county mill levy of $78.5 million, a state appropriation of $5.2 million, $13.7 million in investment income and a variety of grants, donations and the like. Those revenues are not counted as part of the operation, because they are not obtained through the delivery of care.

Some critics of UNMH say that county indigent funds go into a black hole. Because they are lumped into the hospital’s general fund, there is no telling whether a given indigent patient received the benefit of the voters’ generosity.

The lease agreement does not require UNMH to set up some special account for indigent dollars to be spent only on the indigent.

A more realistic concern is that even when the federal Affordable Care Act is fully implemented, when all of the adults who are newly eligible for Medicaid get benefits, when all qualified individuals receive subsidies when they buy insurance on exchanges, there will still be 30,000 low-income residents in the county without coverage, according to Youth Development Inc. CEO Chris Baca, who wrote an op-ed piece published in Monday’s Journal. Some who do get subsidies will discover that even though they have purchased coverage, copayments and deductibles will be more than they can afford, he said.

That will lead to a costly and immoral inequality and disparity of care unless UNMH is compelled by the lease agreement to assure care will be delivered to all, Baca wrote.

Baca doesn’t say so, but at least some of those 30,000 residents are likely in the country illegally and don’t qualify for Medicaid, insurance exchange subsidies or Medicare.

One major criticism has been leveled at UNMH for years. Baca put it this way: “This is the moment for commissioners to put families first. Not acting means letting UNM Hospital unilaterally decide how our taxpayer dollars are used.”

Put another way: What is UNMH for?

UNMH and the Health Sciences Center have been working for years to establish some world-class medical programs, for cancer and stroke treatment, among other things. That kind of operation attracts great researchers, great health professions teachers and better students. It attracts more customers with good insurance. It creates significant new revenue streams.

Many people, including some UNMH physicians and residents, say that as the county’s safety net provider, the hospital should spend no money on anything except primary care clinics, pediatric clinics, Indian health services and services for the indigent and the working poor until the basic health needs of everyone in the county are met, regardless of ability to pay.

It’s a debate worth having, but it is an inadequate debate. If we are to build a real health care system, we’ll need a way to make rational use of all resources, from first responders at the Fire Department to the county’s large private hospital systems to the First Choice and First Nations clinic systems to school nutrition programs to private practitioners to insurance companies to caseworkers and beyond.

Unfortunately, the Bernalillo County Commission is not empowered to do anything but negotiate a new lease. Solving the real problem will have to wait.

UpFront is a daily front-page news and opinion column. Comment directly to Winthrop Quigley at 823-3896 or wquigley@abqjournal.com. Go to www.abqjournal.com/letters/new to submit a letter to the editor.

 

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