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There is a solution for this

Yet it manages to go completely unmentioned in this story.

The Harris County Hospital District has begun turning away uninsured patients from other counties who show up in its facilities and do not need urgent care, unless they pay cash up front.

The policy is one of several strategies the district is pursuing to prevent “cataclysmic” effects on patients as the state considers cuts that could take nearly 10 percent of the district’s budget, president and CEO David Lopez said.

If a patient enters a hospital or clinic with a medical emergency, federal law mandates treatment. Many people, however, visit emergency rooms with routine illnesses, said Dr. Shkelzen Hoxhaj, chief of emergency medicine at Ben Taub General Hospital, the district’s flagship facility.

It cost the hospital district about $3.9 million to treat uninsured, out-of-county, non-emergency patients during the fiscal year that ended Feb. 28, said district chief financial officer Mike Norby. About $200,000 of that will be collected, he said.

In a $1.06 billion budget, the loss is a fraction of 1 percent. No savings is too small when state cuts could cost the district as much as $110 million, Norby said.

“We need to just hold the line and say, ‘Folks, we need cash up front.’ It’s the principle of the thing,” Lopez said. “We knew we were going to have to start doing things differently. This is not going to solve our problem, but there’s no one single strategy to addressing our loss of revenue.”

It’s true that there’s only so much that the hospital district itself can do about this, and all of their solutions are going to be of the every-little-bit-helps variety. The underlying problem, however, is that there are too many people in Texas who lack health insurance, and thus must rely on emergency rooms for their care. Fortunately, we now have a way to deal with that problem. It’s called the Affordable Care Act, and it will greatly reduce the number of uninsured residents in Texas, which will make life a lot easier for county hospital districts. I don’t know why this wasn’t discussed in the story, especially since we have a new County Commissioner who ran on a platform of fighting against the implementation of the Affordable Care Act, but I’m pretty sure it will have a bigger effect than anything the HCHD can do. Not that they shouldn’t take whatever reasonable steps they can to control their costs – every little bit does help – it’s just that there’s more to it than their own efforts.

A related matter is discussed in this Houston Politics post, namely why are there all of these out-of-county indigent people coming to Harris County for treatment?

Most surrounding counties use the minimum standard allowed by law — 21 percent of the federal poverty guideline — to decide who qualifies as “indigent” to receive free or discounted health care.

Under these rules, a family of four earning $4,632 per year or more is not eligible for discounted care.

“If a family is making $7,000 a year for a family of four and they show up in your clinic or your facility, you know they’re indigent,” [HCHD CEO David] Lopez said. “They don’t have $150, $200 to pay. So we’re going to have to tell those people, ‘We’re sorry, we can’t see you, because you don’t qualify for care in our community and you don’t qualify for indigent care in your community.’ So what happens to them? … Is that right? That makes it somewhat difficult.”

In Harris County, that same family of four earning up to $55,875 in annual income could receive discounted care. Its care could be free if its annual income is less than $22,350.


Commissioner Steve Radack, a frequent critic of the hospital district, found himself in the same foxhole with Lopez on this topic.

“Harris County government, and the Harris County Hospital District, as well, needs to send a strong message to other counties: ‘Stop shirking your responsibility of taking care of your indigent patients and trying to send them to the the Harris County Hospital District,'” Radack said. “These counties probably set (their poverty levels) that way so that, ‘Hey, these people are going to go somewhere else.’ They can’t just get it done in that county. They don’t have the money to pay for it.”

“It’s a way to literally push people into the Harris County hospital system who aren’t qualified to be in it.”

I agree, and it should start with Harris County officials calling out the free riders by name. There should also be a concerted push by Harris and other big urban counties to get the Lege to put an end to this nonsense, as this kind of mooching exists elsewhere in the state as well. It’s time for every county to be responsible for its own residents.

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