Charity Care Policy Improving, Not There Yet

Vote Health's research and advocacy on fees for so-called 'charity care' patients (those earning 200% or more above the federal poverty level guidelines) was acknowledged by ACMC's Board of Trustees at their Oct. 25 meeting. Back in July we presented a survey of nearby counties ( San Francisco ,Santa Clara , and Contra Costa counties) whose charity care policies were much more reasonable than the proposal implemented by ACMC last April. ACMC planned to charge $60-100 deposits for each outpatient visit, and 25-50% of the balance of total charges, with no pharmacy coverage at all. A family of four with a monthly gross income of $3142 would be charged $100 for each ER visit, and 25% of the balance!

Vote Health argued strenuously against the concept of charging percentages of medical costs since they have no relationship to a patient's ability to pay. There is no cap with such a fee schedule, and the deposits themselves were prohibitive. Many national studies have demonstrated that higher co-pays and share of cost have significantly reduced access to medical care. The other systems we studied encouraged preventive health care and allowed patients to know their total liability in advance of seeking medical care .

In light of our research and objections from other parties, the BOT asked their internal taskforce on the subject to revise the current policy. Their draft for the October Board meeting reflects some of our concerns. First of all, they have extended the schedule of discounted fees to patients up to 500% of the federal poverty level, rather than the original 300%. They now cover pharmacy costs at Highland , where the waits are finally getting shorter. The outpatient deposit has been reduced to $20 per visit, with no deposit for ER visits. But the percentage concept is still there, although much reduced - 10% of total charges for outpatient visits and the ER, with the inpatient liability ranging from 5-10% of actual charges, based on patient income.

Vote Health acknowledges the progress made with the new draft but continues to insist that the percentage approach be dropped in favor of capped, finite fees that patients can know in advance. 5% of actual charges for an inpatient stay of several days might be unaffordable for a family at 201% of the federal poverty level. Santa Clara County would charge this family a flat fee of $300 for an inpatient stay; San Francisco $250. Surely ACMC can come up with something similar! Fortunately, members of the Board of Trustees also expressed concern at the lack of a cap on medical costs in the draft. We hope to see more progress at the Nov. 29 Board meeting.

Vote Health Members Set Priorities

At our October membership meeting we agreed to focus our energies and resources this coming year on a set of issues in hopes of being more proactive than reactive. The chronic crisis of the medical center has absorbed us so completely that we haven't often stepped back to evaluate our activity or determine whether we might work more effectively.

Looking at the medical center, we will focus on Measure A oversight (making sure the funds are spent according to the ballot language), "debt" repayment to the County, and charity care. More broadly, we want to research how the County's healthcare leadership has resulted in the constant crisis at ACMC, including the history of decision-making with respect to new buildings. These problems precede the current governance model of the quasi-independent hospital board of trustees.

We plan to better integrate into our general work our support for the current single payer bill in the California legislature, SB921. This is particularly important given the Nov. 2 defeat of Prop. 72, which would have provided 1 million uninsured working families with employer-paid health insurance. Most of the health care problems we identify at the local and state level would be significantly addressed by the passage of SB921!

Our internal priorities include updating our Vote Health brochure, fielding a VH membership survey, making our annual fundraising appeal, and preparing for our elections early next year. We also hope to schedule more guest speakers to broaden our vision of health care advocacy at the local, state and national level [see November meeting announcement].

We need your help! Give us a call, send us an email, or attend a meeting to help Vote Health function more effectively. We have already made a difference with the passage of Measure A and getting SB921 as far as it has in the state legislature, but there is so much work yet to be done!

Vote Health Elections Coming Up

Nominations for Vote Health's Officers and Executive Committee will take place at our January 24, 2005 general membership meeting, with the election itself scheduled for February 28, 2005 . A candidate must be a dues-paying member for three continuous months prior to nomination, or by Oct. 24, 2004 . However, anyone may join "at the door" or pay full back dues and participate in the vote itself (annual dues are $35, $10 low income).

The Executive Committee consists of three officers and eight at-large members who serve two-year terms. An Elections Committee will be appointed at the January meeting to conduct the election and count the ballots. All members are encouraged to participate, including nominating themselves! Please volunteer!

Life Goes On...

Despite the defeat of Prop. 72, along with many other progressive causes, Anthony Wright of Health Access sent out an upbeat assessment Nov. 4 that this campaign for health insurance created significant momentum for future reforms. After all, nearly half of the California electorate (49%) voted for health care reform, compared to the 27% that supported Prop. 186 in the early '90's. 72 had a well-funded opposition which included our popular governor late in the campaign, and the ballot was very crowded with a number of hot items.

In describing the diverse coalition that came together to support Prop. 72, Wright notes that "for the first time...health reform was supported by all elements of the health care community: doctors, nurses, consumers, hospitals, and even some health plans." He predicts that when "we finally win quality, affordable health care for all in California and the nation, the vote on Proposition 72 will be seen as an historic moment, when people and policymakers realized that health care reform is possible and achievable."

Let's use this momentum to push SB 921 through its next stage in Sacramento!

Newsletter committee:
Kay Eisenhower and Mary Barnaby.
Our thanks to California Nurses Association for its help in producing this newsletter.