Earlier this year when the legislature voted down Medicaid expansion, lawmakers realized that some hospitals were struggling to make up for the fact that some people cannot afford to pay their medical bills. So after a lot of discussion, they provided roughly three million dollars to be spread among the smaller rural hospitals. But some thought that was not enough, so two legislative committees are looking into what else can be done to help.
Before they crafted a solution lawmakers needed to know how much hospitals were on the hook for uncompensated care. Hospitals lose money if people access the emergency room instead of a standard provider like a doctor’s office or clinic, because the costs can be three to four times higher. During a recent legislative meeting in Casper, Gillette Representative Eric Barlow said that this is a big issue.
“In this rural state many of the entry points, especially in the smaller communities to health care is an emergency room…period. They don’t have the opportunities for walk-in clinics, they don’t have the opportunities for doctors’ offices, especially after hours.”
Hospitals in Wyoming also lose money if Medicare, Medicaid, or private insurance does not pay the amount they want to be reimbursed. They also lose money if people don’t have insurance and don’t pay their bill.
The lack of insurance is the biggest culprit. The legislative service office recently surveyed hospitals in the state and heard from roughly half of them. They said that in 2013 they lost almost 100 million dollars. This can be especially harmful to smaller hospitals in the state.
State Senator Charles Scott of Casper says he’s worried that this debt will one day force the closure of a small hospital.
“Some of those where they are isolated and away from other hospitals, they are the only one in a significant area of population, the state cannot afford to be without a facility there.”
So the committee is trying to find a way to work with counties and hospitals to find a solution. Barlow is proposing working with county commissioners, hospitals, and others to find ways to develop clinics or alternatives to hospital emergency rooms in rural places. He thinks providing them grants could work. Scott is a long believer that changing the habits of those who use Medicaid would help.
Rick Schroeder is the CEO of the North Big Horn Hospital, a 15-bed critical access facility that’s always struggling to make ends meet. Schroeder agrees that emergency room use is big, but he says the problem for small hospitals like his is hardly Medicaid patients. It’s people who don’t have coverage at all.
“Hospitals are in trouble and we are taking care of our community members and some of those community members don’t have the ability to pay. But we continue to care for them, it’s the right thing to do.”
Schroeder said his hospital takes care of a lot of people who fall through the cracks.
“We have a fairly high underemployed and unemployed community and I think that contributes to it.”
At Memorial Hospital in Converse County, things are much better. CEO Ryan Smith says the recent energy boom has helped as has the fact that the hospital took the unique approach of getting doctors in the area to work for the hospital.
“We pay the salaries of those physicians and have been successful in creating enough volume for those providers to make the whole system work well.”
Smith says a high volume of surgeries also helps pay their bills. But if the economy were to turn or something happens to the affordable care act, Smith says things could change. Smith has been watching legislators try to find ways to help hospitals. He says the solution is fairly simple.
“I think it would make a lot more sense to just pass Medicaid Expansion.”
That would mean an additional 500-thousand dollars to his hospital alone.
If the state did expand Medicaid, the federal government would pay Wyoming 100-million dollars, which would make up for the total hospital debt in the state. But that is currently a non-starter for most legislators. That’s why the committee is looking at other solutions. But House Appropriations Committee Chairman Steve Harshman notes that these approaches cost money.
“For us to step in and thing that we can throw ten, 20, 30 million dollars at it, I don’t think that’s the case. We don’t have that kind of budget.”
Harshman also strongly opposes Medicaid Expansion. So what should the state do? He says nothing.
“There’s just some problems state government just can’t solve.”
Lawmakers will continue working on the issue and Senator Charles Scott believes they will be able to provide some help. But time will tell.