Letters to the Editor is a periodic KHN feature. We welcome all comments and will publish a selection of those that are relevant. We will edit for space and require full names.
Our three-part series, Building Ambitions, which was done in collaboration with McClatchy, explored the big money world of children’s hospitals. It drew a number of comments. Here’s a sampling:
Jackson Bain, vice president of public affairs, National Association of Children’s Hospitals and Related Institutions, Washington, D.C.:
“The Kaiser Health News focus on children’s hospitals underscores children’s reliance on federal health programs such as Medicaid, not only for health coverage but for access to specialized health care services. The National Association of Children’s Hospitals is working with allied pediatric, health and hospital organizations to urge Congress and the president to protect the federal health programs that America’s children depend upon.”
Some readers specifically reacted to the series’ story about children’s hospital charity care:
Karen Roth, director of research, St. Louis Area Business Health Coalition, St. Louis:
“In St. Louis, we have two children’s hospitals that are part of larger health care systems – St. Louis Children’s Hospital (part of BJC HealthCare) and SSM Cardinal Glennon Hospital for Children (part of SSM Health Care). I have followed their economic fortunes for the past 15 years and both are very profitable within their respective hospital systems. In addition, they continue to amass millions in annual fund-raising activities. Unfortunately, they both provide very little in free care. This information is made available by my organization, the St. Louis Area Business Health Coalition. I was pleased that you provided information on the wealth of SSM Cardinal Glennon Hospital for Children. … It is a shame that similar information for St. Louis Children’s was not published. I think these are very important issues to bring to the national spotlight as we move forward with health reform. I would love to see a national discussion regarding the amount of wealth that sits in each institution’s fund balance. Is it fair that this wealth sits there and is never used? Could at least some of it be used to expand access to primary and preventive health care services for the underserved?”
Sarah Young, Washington, D.C.:
“I noticed in the news article about children’s hospitals you once again point to the issue of ‘cost shifting’ as an explanation for rising costs in the private market. I’d like to ask you to be a bit more critical of this idea and not simply accept it at face value. Basically, if the children’s hospitals could, in the current market, raise their rates to private insurers, why do they need the excuse of low Medicaid rates to do so? They ought to raise rates as high as the market will bear regardless of Medicaid payments. If the market would not allow rate increases it would not matter how low Medicaid rates are. The hospitals still would not be able to raise rates. Now you’re probably aware of these economic arguments against cost shifting. And I’m not saying that cost shifting doesn’t exist. … However, I think it is important to ask what is going on in these hospitals’ rate setting decisions. … It is another example of the strange ‘not-exactly-a-market’ state of health care in the U.S.?”
Jim McNiff, assistant vice president, Revolution Cycle, Bronx, N.Y.:
“Many children’s hospitals provide care to the uninsured at the time of service. However, the hospital does everything it can to get the child and family enrolled in Medicaid. Hospitals could have higher charity care write-offs but they would be doing a disservice to the patients by not spending resources to enroll them. By placing pressure on hospitals to write-off more charity cases, the trade-off could be less people enrolled in the Medicaid program. We would be actually be destructing our goal to improve the quality of health care in the long term.”
