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Charity HealthCare Conundrum Brewing Among Providers

Christopher Cheney, for HealthLeaders Media, September 2, 2014

As millions of previously uninsured Americans gain access to affordable healthcare coverage, hospitals and health systems are reconsidering the generosity of their charity care policies.

Improved healthcare coverage access, mainly through Medicaid expansion and the new insurance exchanges, has raised a thorny question for hospitals and health systems: Should low-income people who refuse to obtain affordable coverage be eligible for charity care?

"When do we not look after patients? We don't have an answer for that question, but it's staring us right in the face," Peter Angood, MD, CEO of the Tampa, FL-based American College of Physician Executives, said last week.

While the proportions of responsibility for healthcare costs among patients, providers, and payers are changing, charity care is likely to be a flashpoint in the transformation process, he said. "It's going to get pretty contentious at times."

The future of charity healthcare as it approaches universal-access level is beginning to play out in states that have adopted some form of the prime accessibility mechanisms under the Patient Protection and Affordable Care Act: expansion of Medicaid to more adults and the new public insurance exchanges.

In New Hampshire, Southern New Hampshire Medical Center, a 188-bed, two-campus acute care facility in Nashua, has restricted its charity care policy based on patients' eligibility for health coverage, the Kaiser Family Foundation reported earlier this month.

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