January 23, 2006

Care for All is not what you think

The recent article “U.S. health care is a national failure” by David Whitsett touts the success of Care for All, a program that encourages the uninsured to seek free health care from hospitals in the Advocate Health Care Network and the Resurrection Health Care system. According to Whitsett, Care for All forces these hospitals to live up to their obligation to provide charity care in return for tax breaks as charitable organizations. Whitsett claims that Care for All ensures that the poor receive emergency care and do not have to pay for other charity care to which they are entitled. Unfortunately, Care for All is based on a faulty understanding of the health care system and insincere motives that will ultimately harm the uninsured in the Chicago area.

The Care for All program will almost certainly not result in more health care for the poor and uninsured. First, there is little evidence that Advocate and Resurrection are not currently meeting their obligations as charitable organizations. As recently as 2003, the Cook County Board of Review affirmed that Resurrection qualified for tax exemption. Indeed, it agreed that Resurrection gave a third of its excess revenues in 2003 to charity care and held that the provision of charity care beyond emergency care is largely at the discretion of hospitals. Thus, Care for All has little leverage to compel hospitals to provide more free care. Second, the Emergency Medical Treatment and Active Labor Act (EMTALA) already requires that any hospital receiving Medicare funding provide emergency care to all regardless of ability to pay, so Care for All could only function to increase awareness of the provisions of the EMTALA among the uninsured.

Whitsett believes that increasing EMTALA and charity care awareness will have considerable impact because hospital systems like Advocate are currently obscuring their obligations so they can swindle the government out of tax revenues at the expense of the poor. Care for All claims that Advocate annually receives $70 million in tax breaks while only providing $20 million in charity care, effectively stealing $50 million. This claim is a distortion. Advocate’s independently prepared financial statements indicate that in 2004 Advocate spent $24 million on charity care. But, Advocate also spent $49 million on other uncompensated care and $162 million on the unpaid costs of government sponsored programs for the indigent. This sums to $235 million in unreimbursed care for the poor. If Advocate is trying to keep its charitable mission a secret, it is doing a terrible job.

What effects will Care for All have on health care in Chicago? It will probably send more uninsured patients to emergency rooms seeking care for nonurgent conditions. That the uninsured often have no other option is clearly a weakness of our health care system, but given that the average operating margin for hospitals in Illinois is 1.6 percent, shifting the cost of care for the uninsured to hospitals is not a viable solution. More troublingly, Care for All instructs the uninsured only to visit Advocate or Resurrection hospitals. As a result, patients needing urgent care may lose precious time traveling to a distant hospital. There are reports of a man suffering from chest pain driving 40 miles from his home past several closer hospitals to get to an Advocate emergency room because of advertising from Care for All. The encouragement of behavior like this will cost lives.

Why does Care for All support methods of such doubtful efficacy and peculiarly target only Advocate and Resurrection? The disheartening answer is that Care for All has little to do with providing health care for the uninsured and everything to do with labor disputes between the SEIU and Advocate and Resurrection. Care for All is part of a project started by the SEIU in 2003 after Advocate refused its offer to represent Advocate’s employees. Resurrection was targeted later after refusing a similar offer. The SEIU seeks to punish these hospital systems by increasing their costs and tarnishing their image. Whatever the SEIU’s labor claims may be, endangering the health of the neediest is not an acceptable negotiation tactic.