Under consideration is the legality of two-year-old Affordable Care Act’s individual mandate requiring people to buy insurance if they don’t already have it –- with subsidies if they cannot afford it. Regional Medical Center in Anniston pays millions of dollars each year in care for the uninsured, and administrators there suspect those costs will continue to rise if the individual mandate is overturned.
“Medicare is going bankrupt,” said RMC CEO David McCormack. “We’ve got to do something different than what we’re doing.”
The Supreme Court heard oral arguments on the issue in March and is expected to reach a decision next week. If left alone, the individual mandate portion of the federal law will not take effect until 2014.
Opponents argue the individual mandate violates the U.S. Constitution because it gives Congress the power to force people into economic activity. Supporters say that the health insurance market is different because, unlike other sectors of the economy, the lack of economic activity by the young and healthy shifts substantial costs to others. Proponents of the mandate also argue that everyone will eventually need health services.
“Personally, I’ve got to have insurance,” McCormack said. “If someone comes to this hospital, if they can afford it, (they) should pay for insurance.”
McCormack said the cost of uninsured care has placed a substantial financial burden on RMC. He said the recession has only made the situation worse. McCormack said RMC is projected to provide more than $60 million in uninsured care by the end of this fiscal year. Last year, the hospital covered about $58 million in uninsured care.
“We’re getting killed here … and the uninsured keeps growing,” McCormack said. “If everyone can pay something, that’ll help.”
According to statistics to from the Kaiser Family Foundation, a nonprofit, nonpartisan group that focuses on health care issues facing the country, more than 744,000 Alabamians are uninsured –- 16 percent of the state’s population.
McCormack noted that Medicare, Medicaid and Blue Cross Blue Shield provide some reimbursements for that uninsured care, but not enough to cover all the costs.
“We’re the state with the lowest reimbursements in the country,” McCormack said.
Jim Edmondson, CEO of Jacksonville Medical Center, agreed that uninsured care reimbursements are a problem in the state.
"It’s very difficult in this state to get reimbursements,” Edmondson said.
A Supreme Court reversal of the individual mandate may not be as challenging for Jacksonville Medical as it would be for RMC. Edmondson said Jacksonville Medical is a smaller facility, and so does not provide as much uncompensated care as the Anniston hospital. Jacksonville Medical’s uncompensated care currently accounts for just about 5 percent of the hospital’s total business.
“Our uncompensated care as a total business is declining because our use of Blue Cross Blue Shield and Medicare is growing,” Edmondson said. “The secret to success is volume.”
Attempts to reach officials of Stringfellow Memorial Hospital in Anniston for comment Monday were unsuccessful.
Rosemary Blackmon, president of the Alabama Hospital Association, said many hospitals around the state are concerned about the possible loss of the individual mandate. Blackmon said that the way the law is currently written, the loss of the mandate could increase costs for hospitals through fewer reimbursements.
“There are portions of the plan that won’t work without that part,” Blackmon said.
The law requires cuts to uninsured care reimbursements as more people are insured or placed in Medicaid and Medicare.
“If they do away with the individual mandate but not the cuts, that will put a burden on hospitals,” she said.
Still, RMC is prepared for whatever decision the Supreme Court makes, McCormack said.
“We’re already preparing for the worst,” McCormack said. “No matter what, we’ve still got to care for the sick.”
Staff writer Patrick McCreless: 256-235-3561. On Twitter @PMcCreless_Star.