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Costs of Caring for Uninsured People in Maine by Stephen Zuckerman, Randall R

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Costs of Caring for Uninsured People in Maine by Stephen Zuckerman, Randall R COSTS OF CARING FOR UNINSURED PEOPLE IN MAINE By Stephen Zuckerman, Randall R. Bovbjerg, Jack Hadley, and Dawn Miller Commissioned by the maine health access foundation MAY 2007 Strategic solutions for Maine’s health care needs MeHAF is Maine’s largest private health care foundation. Through its grant and program support, the Foundation advances strategic solutions to improve health and health care in Maine with a special emphasis on addressing the needs of people who are uninsured and medically underserved. The mission of the Maine Health Access Foundation (MeHAF) is to promote affordable and timely access to comprehensive, high quality health care, and improve the health of every Maine resident. COSTS OF CARING FOR UNINSURED PEOPLE IN MAINE Prepared by Stephen Zuckerman, Randall R. Bovbjerg, Jack Hadley, and Dawn Miller of The Urban Institute for the MAINE HEALTH ACCESS FOUNDATION Strategic solutions for Maine’s health care needs ABOUT THE AUTHORS stephen zuckerman, ph.d., is a Principal Research Associate in the Health Policy Center of The Urban Institute. He received his doctorate in economics from Columbia University in 1983 and has studied health economics for over 20 years. His current research interests are state health policy including coverage expansion for adults, racial and ethnic disparities, Medicare physician payment and Medicaid managed care. Dr. Zuckerman has also worked on research related to the health care safety net, hospital rate setting, health care price indices and health system reform. Prior to joining the Institute, he worked at the American Medical Association’s Center for Health Policy Research. randall r. bovbjerg, j.d., is a Principal Research Associ- ate at The Urban Institute. He has 30 years of experience in public THE URBAN INSTITUTE and private insurance; state and local health policy; medical injury, HEALTH POLICY CENTER liability, and patient safety; safety net issues; and state regulation. The Urban Institute is a nonprofit policy research organization Current research includes a planning grant to help the District of created in 1968 to sharpen thinking about America’s problems and Columbia expand insurance coverage and case studies of state medi- efforts to solve them, improve government decisions and their cal boards’ performance in physician discipline. implementation, and increase citizens’ awareness about important jack hadley, ph.d., is a Principal Research Associate at The Ur- public choices. Its research agenda includes national issues that ban Institute and a Senior Fellow at the Center for Studying Health reflect, respond to, and at times anticipate society’s changing needs. System Change. His research has emphasized statistical analysis of In recent years, Institute researchers have also begun analyzing various issues in health care organization and financing, including similar issues in developing countries, Eastern Europe, and the determinants of health insurance coverage, the consequences of lack Russian Federation. Researchers identify and measure social of health insurance, access to care, physician and hospital payment, problems, assess their solutions, spot trends, evaluate social and and the effects of managed care on health care delivery systems. economic programs and policy options, and offer technical assistance in policy and program development. dawn miller, ba, is a Research Assistant with The Urban Institute's Health Policy Center. Her work focuses on analyzing en- Within The Urban Institute, the Health Policy Center analyzes rollment and expenditures for the Medicaid program utilizing ad- trends and underlying causes of changes in health insurance ministrative data from the Medicaid Statistical Information System coverage, access to care, and use of health care services by the and the CMS Form 64. Recently, she has investigated public revenue entire U.S. population. Researchers address issues that arise from sources to fund care for the uninsured, and has been providing sup- the inevitable trade-offs among health care costs, access, and port to senior health policy researchers using data from the Current quality. The center’s focus has been on Medicare and Medicaid, Population Survey and the Medicare Current Beneficiary Survey. public insurance programs that were created to serve the elderly, the disabled, and low-income households. Institute researchers also have studied proposals to control costs, incentives built into public and private provider reimbursement mechanisms, reform alternatives for the long-term care system, and malpractice tort law and insurance. iv COSTS OF CARING FOR UNINSURED PEOPLE IN MAINE TABLE OF CONTENTS ABOUT THE AUTHORS iv ACKNOWLEDGEMENTS 2 EXECUTIVE SUMMARY 3 INTRODUCTION 5 UNCOMPENSATED CARE COSTS: PROVIDER AND PROGRAM DATA 6 UNCOMPENSATED CARE COSTS: HOUSEHOLD SURVEY DATA 12 SOURCES OF PUBLIC REVENUES TO SUPPORT UNCOMPENSATED CARE 17 CONCLUSION 24 APPENDIX A: COSTS OF UNCOMPENSATED CARE PROVIDED THROUGH THE 27 RYAN WHITE COMPREHENSIVE AIDS RESOURCES EMERGENCY (CARE) ACT APPENDIX B: METHODOLOGY FOR ESTIMATING MEDICAL CARE COSTS OF 28 UNINSURED PEOPLE APPENDIX C: COMPUTING PREDICTED EXPENDITURES, IF FULLY INSURED 31 END NOTES 44 COSTS OF CARING FOR UNINSURED PEOPLE IN MAINE 1 ACKNOWLEDGEMENTS The authors gratefully acknowledge the comments and advice provided by John Holahan and the research assistance provided by Joel Ruhter and Saad Ahmad. Thanks also for people who assisted with data collection: Katharine Addicott, Portland Community Free Clinic; Sarah Gagné Holmes, Maine Equal Justice Partners; Sophie Glidden, DHHS; Geoffrey Greene, DHHS; Patty Hamilton, City of Bangor; Nancy Kane, Harvard School of Public Health; Elizabeth Kilbreth, Muskie School of Public Service; Kala E. Ladenheim, National Conference of State Legislatures; Kevin Lewis, Maine Primary Care Association; Sue MacKenzie, Office of MaineCare services; Trish Riley, Govenor’s Office of Health Policy and Finance; Marianne Ringel, DHHS; Ellen Schneiter, Bureau of the Budget; Gordon Smith, Maine Medical How can Maine Association; Connie Warren, Office of MaineCare Services; David Wilson, DHHS; David Winslow, Maine Hospital Association; Charlotte Woodcock, Franklin Health Access; and Carol Zechman, cope with the costs of CarePartners. The Maine Health Access Foundation funded this study. Any views caring for uninsured expressed are those of the authors and do not represent those of the Foundation, The Urban Institute, its sponsors or Trustees. Mainers? One theme Additional copies of this report are available upon request at no charge. Please contact the Maine Health Access Foundation at 207-620-8266 or [email protected], or download the report emerged—“Maine through the Foundation’s website at www.mehaf.org. is small, so we all work together.” EXECUTIVE SUMMARY In this report, we provide estimates of the costs of uncompensated care that the 124,000 uninsured Maine residents received in 2005 and the revenues that may have been available to offset these costs. We use two alternative approaches to estimating uncompensated care costs of uninsured people. In the first approach, we draw on data reported by health care providers and public programs. 2005 costs of uncompensated care for The second approach uses household survey data on health care uninsured people in maine expenditures and, as such, develops estimates based on informa- tion reported directly by uninsured people. Prior to enumerating the sources of funds that offset the uncompensated costs of care $7.5 for uninsured patients, we provide some background on the recent $8.7 evolution of health policy and health care delivery in Maine. The information on the funding for uncompensated care is drawn from federal, state and local budget reports as well as from trade associa- tion materials and a series of interviews with key respondents. $33.0 $78.7 According to our analysis of provider/program data, hospitals are the largest provider of uncompensated care to uninsured Mainers, accounting for $78.7 million in 2005. Office-based physi- cians provided another $10.2 million in uncompensated care. $10.2 Among government programs and providers, the largest amount of uncompensated care to uninsured Mainers came through Veterans’ Affairs hospitals and clinics ($33.0 million). Other government providers included community health centers ($8.7 million) and the Indian Health Service (IHS) ($7.5 million). Across all providers total $138 million (all figures in millions) for which we had data, we estimate that uninsured people in Maine received about $138 million in uncompensated care in 2005. According to estimates based on household survey data collected maine hospitals by the Medical Expenditure Panel Survey (MEPS), uninsured office-based physicians adults received an average of $1,277 in care and uninsured children received $1,382 in care. Personal out-of-pocket spending is the veterans’ affairs hospitals & clinics largest source of payment for care received by uninsured people (37%). Since some uninsured people have coverage for a portion community health centers of the year, private insurance and Medicaid pay for 9% of their care. indian health service Workers’ compensation, an insurance system for paying the medical care costs of injured workers, pays for about 3% of care for uninsured people. The remaining catagories of reported spending represent uncompensated care and account for about 51% of the care received by uninsured Mainers. The first category of uncom- pensated care for uninsured Mainers is “other public sources”
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