A change in the way Idaho counties handle indigent medical costs could shift tens of millions of dollars in expenses from local taxpayers onto hospitals and other health care providers.
Counties have historically been the “payer of last resort” for people who need medical treatment but can’t otherwise afford it. They all charge an annual levy to cover these indigent costs.
As of Jan. 1, however, the Affordable Care Act, often called Obamacare, requires most people to buy health insurance, unless they qualify for Medicaid or are covered by an employer. Consequently, county officials are wondering why their taxpayers should continue to foot the bill.
“We’re taking the position that counties and the state ought not to have to pay,” said Dan Chadwick, executive director of the Idaho Association of Counties. If someone is obligated by the law to buy insurance, yet fails to do so, he said, “then in our opinion they aren’t indigent. If you’re legally obligated to do something and you don’t do it, you can’t expect someone else to pick up the tab.”
Some counties have already decided to go down this route, but most are still weighing their options, Chadwick said. He’s not aware of any that have decided not to make this change.
The implications are substantial, both for taxpayers and for the health care providers. Idaho’s 44 counties currently spend about $30 million per year on indigent health care, or a maximum of $11,000 per person. The state spends another $35 million, covering anything above the county cap. That’s $65 million in reimbursements for hospitals and other providers, who are legally obligated to provide treatment even if someone can’t pay.
Exactly how much of that would go away isn’t clear, Chadwick said, but it could be in the tens of millions. The new definition of “indigent” would likely exclude anyone who makes more than 100 percent of the federal poverty level, or about $11,500 per year for an individual and $19,500 for a family of three.
“If they make below 100 percent, they’ll end up in the system we have now,” he said.
Steven Millard with the Idaho Hospital Association could not immediately be reached for comment.
Mike Brassey, a lobbyist for St. Luke’s Health System, said this concept was batted around last summer, but he hadn’t seen a firm proposal. “Historically with these issues, the conversations over the summer are conceptual,” he said. “Once everyone gets back to Boise, then the discussion heats up.” Chadwick said the Association of Counties is still debating whether legislation is even needed, or if counties can just make the indigent determination themselves.
“For some counties, their comfort level is better if we have it specified in statute,” he said. “But the Legislature could make a different decision — and there could be litigation, either from (a patient) or from the providers, in which case the court would decide.”
The Catastrophic Health Care Board, which oversees the state’s portion of the indigent health care system, will present its fiscal 2015 budget request to the joint budget committee this morning. It’s requesting $38.5 million in general fund support, but that depends on a number of factors, including whether counties choose to redefine who qualifies as indigent.
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