University of New Mexico Hospital is the state’s largest public hospital and most important safety net. As such, UNMH is entrusted with significant local tax revenue each year to meet health care needs that no one else will meet.
In May 2017, hospital administrators implemented a policy that essentially denies medically necessary surgery to uninsured low-income residents of Bernalillo County by requiring them to pay 50 percent of the cost of surgery up front before the operation can be scheduled. If a surgery is medically “urgent,” patients must appeal to the Chief Medical Officer in order to receive care. It is unclear how patients would know this new appeals process exists or that it represents such a drastic change from the previous policy.
This new requirement is in direct conflict with UNMH payment policies established in 2009 and updated in October 2015, which call for a reasonable down payment of $25 for patients in poverty and allows for people to make payment plans to pay off the balance after surgery.
The new 50 percent up front policy singles out surgery patients who have already gone through the UNMH financial screening process, have proven that their income is low, and who cannot qualify for any assistance. They are not asking for free care – only the opportunity to get necessary health care first and worry about paying for it afterward, when they can work again.
This policy was created without input from or knowledge of the UNM Hospital Board of Trustees, the hospital’s medical providers, or the public. UNM Hospital quietly initiated this new policy while in the middle of prolonged, closed-door negotiations with Bernalillo County, UNM Board of Regents and the Indian Health Service about how $96 million in property taxes that voters approved in November should be used.
The draft contract among these parties addresses UNMH’s long-established responsibility for providing necessary health care to Bernalillo County indigents and to Native Americans residing in New Mexico in exchange for taxpayer support and no-cost leases for county and native land.
This May 2017 policy is familiar to our community. Before 2005, a similar 50 percent up front policy was blocking access to necessary care until it was successfully challenged by community health advocates who organized those most impacted. In 2005, then-Gov. Bill Richardson called a UNM Health Care Summit, attended by 400 people, which resulted in dismantling the 50 percent up front policy and other hospital policy improvements.
Reviving the old 50 percent up front policy has already had a significant impact on the lives of our hard-working residents. Patients have had surgeries cancelled for necessary cancer care and for surgical repair of multiple torn knee ligaments because they could not come up with 50 percent of the bill up front. One patient received a bill for over $17,000, to be paid before his knee surgery could be scheduled. His surgery is medically necessary if he wants to walk again.
The new 50 percent up front policy was discovered in June by well-trained community health workers who help patients apply for UNMH’s low-income discount and payment plans. Most patients affected by this policy do not have access to such advocates and are being denied necessary care by our state’s largest safety net hospital without recourse.
Hospital administrators made this change at a time of great national concern about the future of health care access. Our public hospital must inspire a different response to this uncertainty – instead of creating a two-tiered system where the poorest among us must pay 50 percent up front for surgery. This is a policy that is neither humane nor economically sound. UNMH has seen a nearly 50 percent decrease in uncompensated care since the Affordable Care Act and Medicaid expansion, and has amassed cash reserves of more than $230 million. We ask that UNMH immediately reverse this 50 percent up front policy for indigent patients, reinstate the affordable co-pays for necessary surgery, and commit to transparency and accountability to the county and to the community that it serves.