Within two years, the percent of uninsured patients at the hospital had dropped from more than a half to about a third, almost entirely driven by increased Medicaid coverage, hospital data show. And for the first time in the hospital’s history, a majority of the patients it treated had coverage.
A third of the new Medicaid enrollees treated at Cook County were patients new to the system. And, hospital administrators say, those with chronic diseases such as diabetes, who used to be frequent emergency room visitors, now have personal physicians to help them manage their conditions.
In the fiscal year ending in November 2014, uncompensated charity care dropped to $342 million from $500 million the year before. Funding from Medicaid nearly doubled the health system’s operating revenues, a major reason that, after ending 2013 with a net loss of $67.6 million, Cook County Health finished its most recent fiscal year in the black.
Now, the provider, like other safety-net hospitals, has a new challenge: holding onto old clients.
“For the first time in our history, we need to compete for our patients,” said Shannon. “A world of improved access is also a world of choice.”
At Grady Health System in Atlanta, meanwhile, the number of patients covered by insurance increased by less than 2 percent last year. Bad debt from unpaid bills has continued to climb, to $396 million from $269 million in 2013. And the percentage of patients covered by Medicaid didn’t change.
“We’ve seen no difference from the Affordable Care Act,” said John Haupert, Grady’s chief executive. Many patients “are still coming to us as a safety-net provider and falling under our charity care.”
Georgia is one of 20 states, disproportionately clustered in the South, that didn’t expand Medicaid. About 89 percent of those left out of the new Medicaid coverage, because their states chose not to expand the program, live in the South, Kaiser Family Foundation found.
Grady has a better financial outlook than many hospitals in states that didn’t expand Medicaid, thanks to a philanthropic campaign that has raised $350 million since 2008 to fund new infrastructure and expand clinical services. But, unlike Cook County, which has reduced some dependence on local government support with the help of Medicaid expansion dollars, Grady remains reliant on $57 million in tax support from two local counties. Without the local funding, Grady would be running a deficit.
“From a global perspective, it seems like the ACA is working,” said Kevin Holloran, senior director at Standard & Poor’s. But in non-expansion states, like Georgia, “it’s really a neutral. It’s just the status quo.”