January 8, 2014—U.S. hospitals provided a record-high $45.9 billion in unreimbursed care to indigent and underinsured patients in 2012, an 11.7 percent increase over 2011, according to a new American Hospital Association (AHA) report. [ms-protect-content id=”2799″]Hospitals in the 340B drug discount program supply 66 percent of all uncompensated hospital care in America, AHA reported separately in December.
In another new study, the Kaiser Family Foundation reports that an estimated one-third of Americans have trouble paying medical bills. Among those with health insurance, cost-sharing is a primary reason, it said.
The new AHA and Kaiser research comes amid concerns that, even with expanded availability of health coverage through the new insurance exchanges and Medicaid expansion, uncompensated care will remain a big problem for safety-net hospitals due to the growing prevalence of health plans with high co-pays and deductibles. Last June, for example, Citi Enterprise Payments, a division of Citigroup, reported that the patient financial responsibility portion of high-deductible health plans is approaching the 15 to 20 percent range and continues to grow.
The 2012 data on hospitals’ unreimbursed care come from AHA’s latest Annual Survey of Hospitals. The uncompensated care total includes charity care and bad debt but excludes Medicaid and Medicare underpayment. Hospitals have provided $347.7 billion in unreimbursed care since 2003, AHA says. Bad debt and charity care accounted for 6.1 percent of total hospital expenses in 2012, the highest such percentage in a decade.
Hospital unreimbursed care has risen from $14.7 billion in 1992, the year that 340B was established, to $45.9 billion in 2012. Total U.S. spending on prescription drugs increased during the same period from $47 billion to $326 billion, but has begun leveling off in recent years, mainly due to a wave of blockbuster drugs coming off patent and their generic substitutes coming to market.
The Kaiser study of medical debt among Americans with health insurance was based on case studies of nearly two dozen people who recently experienced such problems.
The study found that many people can’t afford even relatively modest cost-sharing requirements because expenses are often unexpected and most Americans have less than $3,000 on hand to cover such costs. “In light of the limited assets many people have, the problem of medical debt is likely to persist” even in spite of Affordable Car Act reforms, Kaiser concludes. [/ms-protect-content]