Policy Price

The number of uninsured hospital admissions in Hamilton County more than doubled between 2004 and 2008, leaving local hospitals with barely three in 10 patients who have private insurance to pay for their care, according to a new report on health in the Chattanooga region.

The loss of commercially insured patients, whose insurance payments are significantly higher than those of government-sponsored insurance for the same services and treatments, has contributed to hospitals’ staggering losses to charity care.

In Hamilton County, hospital charity care losses totaled nearly million in 2008, compared to million in 2004.

More than million of the losses that year were absorbed by Erlanger Health System, Chattanooga’s safety net hospital.

Hospitals have felt the pain of providing more and more uncompensated care, said Craig Becker, president of the Tennessee Hospital Association.

But the pain doesn’t stop there. Employers and individual consumers are feeling it in the wallet, too.

As providers are forced to cost-shift their losses from uninsured patients to commercially insured patients, private insurers have raised their monthly rates to customers, contributing to more employers and individuals being unable to afford private insurance, Becker said.

“The big problem we’ve seen is nobody wants to pay for health insurance,” he said. “It’s kind of a death spiral of, the more people dropped (from insurance), the higher the commercial rates go, the more people dropped.”

Even as total hospital admissions declined by a few percentage points, uninsured admissions grew 123 percent between 2004 and 2008, driven by both cuts to TennCare and recent losses in employer-sponsored health care due to the economic recession, according to the report compiled by the Ochs Center for Metropolitan Studies and released today.

The annual Ochs report focuses on health in the six-county metro region including Hamilton, Marion and Sequatchie counties in Tennessee, and Catoosa, Dade and Walker counties in Georgia.

The 2010 report provides a sobering overview of local health statistics, from high smoking and obesity rates, to an age-adjusted death rate that exceeds the national average, and one of the state’s highest infant mortality rates, in Hamilton County.

“We tend to focus on those areas where it appears Chattanooga and Hamilton County lag, because from our perspective that means there’s an opportunity” for improvement, said David Eichenthal, president and CEO of the Ochs Center.

The report gives a detailed picture of the local health care system on the eve of the implementation of federal reforms, and on the heels of a severe economic downturn. A breakdown of who is paying for hospital patients’ care shows patients’ heavy reliance on government-funded health insurance.

Nearly two-thirds of 2008 hospital admissions were covered by government-sponsored health care: either TennCare, the state’s Medicaid program; Medicare, the federal program for the elderly; or Cover Tennessee, the report said.

Across the six-county metro region, 16.3 percent of people were enrolled in the state’s Medicaid program. One in four people in Sequatchie County get their health care through TennCare.

Emergency rooms locally also are experiencing a shift as the number of uninsured emergency department visits rose from 24,797 in 2004, to 40,140 in 2008, an increase of 61 percent. Visits from those with private coverage dropped from 70,534 to 67,605 in the same period.

Local emergency physician David Seaberg pointed out that total emergency room visits increased by 7.8 percent in that time period. However, the disproportionate rise in uninsured ER visitors could indicate that more uninsured people are skipping routine care and allowing illnesses to worsen into true emergencies, he said.

“You’re seeing the uninsured are often probably sicker when they go in, because they don’t have insurance and they do wait” to see a doctor, said Seaberg, who is dean of the University of Tennessee College of Medicine in Chattanooga.

The hospital industry supported the health care legislation passed into law in March, which is expected to bring millions of people into the private or public insurance marketplace, Becker said. But even if more people get covered, hospitals are still worried about low reimbursement rates from public programs like TennCare, which already play a major role in community hospitals’ budgets, he said. Today TennCare only pays 64 percent of a hospitals’ costs to provide care, he said.

“While it’s coverage, it’s problematic in terms of we still would have to do cost shifting,” he said.

DEATH TRENDS

Many of the major killers in the county are related to lifestyle factors, such as smoking and maintaining an unhealthy body-mass index. Of the 3,239 Hamilton County

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