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The cost of health care for local hospitals

Bannock Commissioners worried about unpaid medical expenses

POCATELLO, Idaho - Some county commissioners say they are feeling the impacts of the Affordable Care Act, because the state isn't accepting Medicaid expansion. it may be trouble for local hospitals.

On Wednesday, representatives from the Portneuf Medical Center approached the Bannock County Commissioners to seek reimbursements from medical bills that have been piling up from people seeking the hospital's medical services who don't have insurance to pay for their bills.

"We've done a lot internally to provide options for people: explaining the exchange, setting up relationships with brokers so they can get on to the state exchange and get insurance, etc., but at the end of the day it's a personal choice whether you decide to get insurance or not and there's a lot of people choosing not to do it," PMC's Chief Financial Officer John Abreu said.

The problem is that some people living above the 130 percent poverty line are choosing to not jump onto the exchange. So, they are not poor enough to qualify for those insurance plans, yet some of them can't afford to jump onto their own plan. So, many of them have to bite the bullet and pay the penalty.

However, now local hospitals, such as Portneuf, are eating the cost.

The county commissioners said their hands are tied, and can only pay the medical bills of those who are living below the 130 percent poverty line. 

The state allows counties to pay up to $11,000 of indigent medical bills for people who can't pay them for up to five years, before the state picks up the rest of the cost. That comes out to about $55 million in taxpayer dollars on medical bills every year.

However, Commissioner Howard Manwaring said the new ACA laws now take over as the law of the land and interferes with how they used to do business.

"We have a choice: do we follow the Affordable Care Act rules, or do we just pay the bills anyway and not let the system work?" Manwaring told the group. "If you're over 130 percent above the poverty level and you choose to not buy insurance, you're taking a gamble with your health because you can't come to the county and ask us to pay (your) bills just because you choose not to do what the law says."

Representative Kelley Packer said in a phone interview the commissioners still have the option to pay for the bills uninsured patients fail to pay through the indigent fund. However, the commissioners feel taxpayers shouldn't have to pay for that.

Manwaring said he spoke with other counties across the state who share the same sentiment.

"Many counties have expressed concerns this (problem) will put some hospitals out of business because they will not be able to provide services for people and get paid for them," he added.

Abreu said Portneuf is already starting to take a hit, but with the hospital being a powerhouse in the medical field, he doesn't see it shutting its doors anytime soon.

Or, ever.

In fact, Abreu said the county has always had a good, working relationship with the county commissioners and feels confident the two entities will work something out before they have to take the issue before the court system.

House Bill 535, which aims to nix the indigent and catastrophic fund programs was killed in the senate this past week. If it passed, the CAT fund would save about $35-40 million in savings, but the counties would end up putting in another $30-40 million in property taxes.

Manwaring said expanding Medicaid into the state would be helpful, but until then, those unpaid bills for those who fall below the poverty level will still come from the indigent fund.

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