Before ACA, taxpayers were already obligated to provide indigent care

Published 2:00 am Sunday, March 26, 2017

Perhaps the most frustrating fallout from the ongoing national struggle over “repealing and replacing” the Affordable Care Act has been the suggestion that any outcome is going to somehow relieve taxpayers of the responsibility for funding indigent and/or uncompensated health care. Wrong.

So much of the bile being spewed on social media is couched in the language of “us” or “them” and cheers the notion that there is an outcome on Capitol Hill that makes the issue of health care for the poor and those who can’t take care of themselves magically go away.

There is no such outcome. Much in the vein of the Biblical admonition that “the poor will always be with us” it’s equally certain that the provision of health care for the poor, the elderly, the disabled and children will continue and that in some form, taxpayers will pick up most of the tab.

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The questions in the current health care reform debate are more accurately what taxing authority – local, state, federal, or some combination of all three – will bear what percentages of that burden.

Even more to the point, how will these proposed changes impact the availability and accessibility of health care in rural and/or underserved areas? For Mississippians, that’s a key question.

Some 39 Mississippi government-owned community hospitals that serve – in whole or in part – rural areas of Mississippi – are in particularly peril should the federal government undertake even more wholesale changes in the nation’s approach to funding health care than were made under so-called “Obamacare.”

There’s a fascinating, white paper on the topic available at that focuses on Mississippi’s government-owned hospitals authored by a group of healthcare executives and attorneys, one of whom is Andy Taggart, the former Madison County supervisor and former chief of staff to the late Gov. Kirk Fordice.

The paper focuses on challenges to maintaining accessible health care facilities in local communities – something that becomes harder by the day.

I asked Taggart to summarize the findings of his group’s study and he offered this except: “Standalone hospitals in general, and particularly government-owned hospitals in regional and rural areas with declining populations, are structurally unable to cope with the scale and pace of change the hospital sector is experiencing. Unless fundamentally reorganized from the ground-up and combined with a larger sustainable delivery system, we believe that the vast majority of these hospitals and their associated healthcare services will ultimately become financially unsustainable and unable to meet an acceptable standard of care…government-owned hospital boards and counties that respond quickly to these rapidly changing market forces will experience the best outcome for the residents of their communities.”

The white paper looks at local availability of quality health care, efficiencies to deliver higher quality care at lower costs, to maintain jobs from existing health care facilities, to protect prior taxpayer investment in local hospitals, and to transition from direct taxpayer support to a more self-sustaining health care delivery model.

So, what happens if the national health care reforms being contemplated make it impossible for hospitals like, for instance, Sharkey-Issaquena Community Hospital or Claiborne County Hospital to remain financially viable? What about the health care needs of the people in those areas?

After you’ve had your heart attack, how far away should the cardiac care unit be – or even a basic emergency room? The political chattering class has made national public health care reform a simplistic exercise. It isn’t. There are consequences, winners and losers.

Many of the 39 government-owned community hospitals in Mississippi were funded through the federal Hill-Burton Act, which originally gave hospitals built with federal dollars a 20-year post-construction mandate to provide to provide free or subsidized care to a portion of their indigent patients. In 1975, Congress enacted an amendment to the Hill-Burton Program, Title XVI of the Public Health Service Act. Facilities assisted under Title XVI were required to provide uncompensated services in perpetuity.

Public health care reform is advanced civics and involves heavy lifting on the part of Congress, the White House, and state and local governments all working in concert. Political types who suggest otherwise haven’t read the fine print.

Sid Salter is a syndicated columnist. Contact him at