Local hospital chiefs wait, worry over health care

By Craig Schneider

The Atlanta Journal-Constitution

Metro Atlanta hospital chiefs have a lot of hope riding on health care reform in Washington — and a lot of fear.

As Congress reconvenes Tuesday, the fate of health care reform remains controversial and uncertain. A major sticking point is whether legislation should include a public option, which would create a government-run competitor to private insurers.

Several metro Atlanta leaders said they hope reform will provide health insurance to those who can’t afford such coverage and those who have lost it because of pre-existing conditions or joblessness. But there are also concerns that hospitals could end up being shortchanged, hampering everyone’s access to care.

Expanded coverage could greatly help safety net medical centers such as Grady Memorial Hospital, where about one-third of patients pay nothing and have no government medical assistance.

“We support more people having insurance,” said Grady CEO Michael Young. “We’re eating more than our share” of the costs of providing health care.

Like some other hospital leaders, he was wary of taking a stand on specific proposals, asserting that there are still too many variables.

But numerous metro hospital leaders worry insuring everyone might simply be too expensive.

Emory chancellor Dr. Mike Johns said he is concerned about the government “public option.” There is discussion that the government would pay Medicare-like reimbursement rates to hospitals — that is, roughly 95 percent of a hospital’s costs to provide care. “Those rates may not pay our expenses,” Johns said. “We worry that the impact of this could cost [Emory] millions of dollars.”

Some ugly moments

Congress returns to Washington following a summer of intense public debate at town hall meetings and rallies sponsored by both sides of the issue.

Metro Atlanta seemed a bit more civil in its public discussions than some places in the nation, where angry disagreements sometimes led to shoving, violence and arrests.

Still, there were some ugly moments here. U.S. Rep. David Scott’s YouTube confrontation with a health care protester during an August town hall drew national attention. Days later, a swastika was painted outside Scott’s office.

Many hospital officials spent the summer analyzing the proposals and making their concerns known to Georgia’s congressional delegation.

A group of Republican state senators on Thursday said they want to amend the state constitution to prevent Democrats in Washington from enforcing health care reform in Georgia. Sens. Judson Hill (R-Marietta) and Chip Rogers (R-Marietta) and about half a dozen colleagues unveiled that plan at the Capitol, just an hour before hundreds of Georgians who support the Democrat-led reforms gathered for a rally outside.

President Barack Obama plans to address a joint session of Congress Wednesday on health care reform. White House officials say Obama remains committed to the public option, which he believes will help insure all Americans and foster competition.

The Georgia Hospital Association, the voice of many hospitals in the state, opposes the House proposal for a government-run, public option on health insurance, said spokesman Kevin Bloye.

The association fears the proposal could lead many insured people to switch to the government option, which the association believes would not pay hospitals enough to provide care, he said.

Bloye said the association would support a public option only if it is limited to insuring those people who have no health insurance. Hospital leaders say the issue of uninsured people looms large in metro Atlanta.

Lost job, lost coverage

The troubled economy has driven unemployment in metro Atlanta higher than the national average. Many of these unemployed people also have joined the ranks of the uninsured, leading them to postpone health care or to seek care through hospital emergency rooms.

“Hospital emergency rooms are flooding across the state as people lose jobs and lose their health care coverage,” said Bloye of the Georgia Hospital Association.

Grady’s CEO Young said the hospital is on track to provide $30 million more in unpaid care this year than last year’s figure of $270 million.

William Moore, the head of Atlanta Medical Center, hopes that any plan to cover more people will “even the playing field” for urban hospitals that serve many uninsured. About 12 percent of Atlanta Medical’s patients are uninsured.

But he said he would not support such a plan unless it addresses the underlying problems that contribute to health care costs, such as obesity and diabetes. Without addressing those problems, the government could not afford the health insurance program. That could lead to it being underfunded, with less money going to health care providers, he said.

Moore sees that scenario spiraling into more problems, such as fewer people pursuing health care careers, prompting a shortage of health care workers. That, in turn, could hamper access to care and lead to its rationing, he said.

Lost insurers?

Many doctors also fear that a government-run public option would drive other insurers out of the market, said Dr. Todd Williamson, president of the Medical Association of Georgia. His organization, which represents 6,000 physicians in the state, opposes the public option.

Medical leaders raised concerns about other health care reform plans, such as one to have the government perform “comparative effectiveness” research to determine the most effective treatments.

Supporters of the research hope it will eventually save money by discouraging the use of costly, ineffective treatments.

But Moore of Atlanta Medical Center fears the efforts will favor treatments that save money.

Metro Atlanta hospital officials are also concerned about a proposal in the House bill that would cut the government payment rates to hospitals where patients are treated and then readmitted for the same problem shortly thereafter.

Proponents say the policy would hold hospitals more accountable.

But Bloye said the proposal assigns all the blame of a readmission on the hospital, when the cause could be that the patient is not taking prescribed medicine or following other instructions.