One way or another, bills for the uninsured passed along

By Karen Auge
The Denver Post

Posted:  09/13/2009 01:00:00 AM MDT

A lot of people who didn't have insurance got sick last year, and taking care of them cost an estimated $116 billion, according to some estimates.
The uninsured themselves paid about a third of that. Another third was never paid for.

So, who paid the rest?
You did, mostly.

Charities picked up some. But the lion's share of the $30 billion remainder was paid with tax dollars and inflated charges to those with insurance.
There were an estimated 46 million people in the United States without insurance last year and evidence of their impact on the system is clear:

• Nationwide, nearly $43 billion in tax dollars went to cover health care for the uninsured last year, the Kaiser Commission on Medicaid and the Uninsured estimates. That's about 2 percent of total health care spending.

• Physicians donated $8 billion in care last year.

• Locally, Denver Health collected $67 million from private insurance last year. It received another $44 million from a federal fund that reimburses hospitals that care for large numbers of poor and uninsured patients.

The hospital also received nearly $28 million from the city to treat uninsured patients, an $11 million federal grant to treat uninsured people in outpatient clinics, and $5.4 million from the state for indigent care.

• That state fund, known as the Colorado Indigent Care Program, paid out $296 million in 2007-08. Over the next two years, though, nearly $42 million will be cut from the program.

• In 2007, Colorado hospitals provided just under $1.7 billion in care and treatment that they didn't get paid for, said Tom Nash, the Colorado Hospital Association's vice president of financial policy.

Of that, $670 million was bad debt and charity care, Nash said. The rest was the amount hospitals say that government reimbursements for Medicare and Medicaid patients fall short of the actual cost of treating those patients.

Hospitals aren't about to wave goodbye to that lost revenue without a fight. Often that means higher rates charged to private insurance companies.

"What insurance companies are paying on behalf of patients, a very good chunk of that is going to cover underpayment by the government and charity care," Nash said.

But as rates go up, the number of people with insurance drops, and the cycle continues.

The number of people with private insurance coverage began dropping at the beginning of this decade, said Karyn Schwartz, senior policy analyst with the Kaiser Family Foundation.

Between 2004 and 2007, the percentage of Americans under 65 with private health coverage dropped from 61.7 percent to 60.9 percent. At the same time, the rolls of the publicly funded government programs, Medicare and Medicaid, have been swelling.

The drop in private insurance comes mostly from small businesses, Schwartz said.

Families USA , a nonprofit group that advocates affordable health care for all Americans, estimates that the cost of caring for those without insurance bumped up insurance premiums for families by $1,017 last year. For individuals, it was $368.

The Agency for Health Care Research and Quality, an arm of the federal department of human services, follows tens of thousands of uninsured people to get an idea of how they cope when they get sick.

The agency found that when they first get sick, people without insurance treat themselves and hope they get better. If they don't, they often go to the one place they know they'll be seen: the emergency room. By federal law, hospitals can't turn anyone away from an emergency room.

But they only have to stabilize patients. They don't have to treat the underlying illness. That means that if a patient comes in having a heart attack, the hospital has to treat that heart attack. It doesn't mean the patient will get cholesterol or blood pressure drugs to potentially prevent more attacks.

That leaves some hospitals struggling to decide how much care they can donate, and worried that as ranks of the uninsured grow, tough economic times will mean fewer tax dollars available to help them out.

"Who pays for health care? It's ultimately the consumer, no matter how you slice it, whether it's your tax dollars or higher insurance," said Peg Burnette, Denver Health's chief financial officer. "So let's try to make it the most streamlined program we can."

Karen Auge: 303-954-1733 or