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In 2012, I was proud to vote in favor of creating Obamacare — or ensuring nearly all Americans could get health insurance — because it meant that millions of people in this country would no longer be denied healthcare.
But even with this landmark legislation, getting access to doctors and hospitals is still challenging. Indeed, a 2022 report from the Kaiser Family Foundation found that about half of adults struggle with healthcare costs.
The Kaiser report also found that those Americans most challenged by a lack of care are seniors and minorities, primarily African-American and Hispanic patients. I was not surprised to read another new report from the American Hospital Association that found Medicare patients who receive outpatient care in a hospital setting are more likely to be low-income and minorities.
It makes sense that if you cannot afford to see a doctor, you may delay treatment and eventually the problem becomes acute. At that point, going to a medical clinic or a doctor’s office may be out of the question because the patient is panicked or in serious pain. For this patient, the hospital is the most obvious choice.
While this Medicare patient’s choice to visit a hospital makes sense — and the hospital did the right thing by treating the patient — the hospital is essentially punished by Medicare for providing that care. How so? Because the hospital is reimbursed by Medicare at an identical rate to a Medicare patient treated in a doctor’s office or a healthcare facility focused on providing same-day surgical care.
In other words, the hospital may lose money on caring for that Medicare patient because a hospital’s operating costs are significantly higher than a doctor’s office or a same-day surgical care facility. After all, a hospital is typically open 24/7, 365 and has standby emergency-care capacities for natural or manmade disasters.
Of course, there is a benefit for the taxpayer for Medicare patients to be treated in lower-cost medical facilities and not in hospitals. That should mean better educating patients to seek care in more appropriate settings. The government could find innovative tools to work with patients to encourage less costly medical visits. But even if that education took place, it’s understandable that the last thing a patient facing a medical issue would consider is how to save Medicare dollars by shopping around for a treatment center.
As someone who has spent nearly a lifetime advocating for medically under-served populations and poor and minority Americans, I know those groups often lack access to hospitals. And, if American hospitals are going to lose money treating large numbers of Medicare patients, it only stands to reason that hospitals in low-income and rural settings (where patients tend to be on Medicare) would close or go out of business.
In rural areas of America, hospital closures are a serious and growing concern. According to data from the Rural and Community Health Institute and the Episcopal Health Foundation, as of 2018, 35 Texas counties had no physician, 58 counties lacked a general surgeon, and 147 Texas counties had no obstetrician or gynecologist.
Keep this fact in mind: 53% to 68% of hospitals are losing money. This is unsustainable for our nation’s hospitals, already weakened by the terrible toll COVID-19 had on their ability to operate.
Medicare shouldn’t be compounding problems for hospitals by reimbursing them at an unfair and too low rate for medical procedures.
I urge the administration to look into this matter and fight for under-served and minority patients.
Silvestre Reyes, D-Texas, represented El Paso in Congress from 1997 to 2013. He wrote this for InsideSources.com.
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