Proposed Commission Would Work to Coordinate Indigent Care in St. Louis

The St. Louis Task Force on Indigent Care has proposed that a new regional health commission be established to help "bring together" the various players in the city's "fragmented" safety net for poor and uninsured residents, the St. Louis Post-Dispatch reports. Under the proposal, which will be reviewed by the St. Louis mayor, the county executive, and Missouri's governor, the 16-person commission would operate as a not-for-profit organization consisting of eight political appointees and eight private members, including two representatives each from the region's hospital systems and community health centers, one from its medical schools and three from the community at large. Supporters of the commission say that the current health care system for the city's poor is faltering because none of the entities involved in treating the indigent "has enough money to meet or identify all the unmet health needs of the shifting population of poor and uninsured people." Moreover, the Post-Dispatch reports that indigent care has suffered due to "institutional competition and fighting" among these "factions." Supporters believe that the commission could better coordinate care for the uninsured, identify current problems and offer solutions and information. There are currently 50,193 uninsured resident in the city of St. Louis and 122,950 in St. Louis County; providing health care for this population costs the St. Louis metropolitan area $348 million annually.

An Example of Those Factions
The Post-Dispatch reports that the problems at ConnectCare, the "largest community health clinic system in St. Louis," underline "how difficult" it would be for the new commission to bring the indigent care system together. Earlier this year, ConnectCare, which provides primary care at four clinics in "medically underserved areas" as well as "outpatient specialty medical care" and dialysis, began to "line up allies to support" its bid to become a federally funded health clinic, which would allow it to receive "significantly higher Medicare and Medicaid reimbursements for primary care services." However, that plan has been opposed by the city's existing four federally funded community health centers (operating 13 clinics), who "maintain they can provide primary care cheaper and more efficiently than ConnectCare" and believe that ConnectCare "should get out of the primary care business altogether." These clinics have said they could expand to "absorb" ConnectCare's patients, but ConnectCare says that the "poor health status of St. Louis points to a need for greater, not reduced, health care access" (Vandewater, St. Louis Post-Dispatch, 3/27).