U.S. Senator Dick Durbin (D–IL), speaks with Dr. Ginger Fewell, Washington County Hospital Board Member Dale Blohm, and WCH CEO and President Nancy Newby before a meeting at WCH on the morning of Friday, July 7.
By Alex Haglund
Illinois’ Senior United States Senator Dick Durbin (D–IL) paid a visit to Washington County Hospital on the morning of Friday, July 7, speaking with WCH administration, staff and board members about the challenges related to rural healthcare, particularly related to Medicaid.
While Durbin said that he has been to Nashville before, “this is my first time to the hospital to get a close look at how it’s doing.”
“Our hospital has been here for 60 years,” said Nancy Newby, WCH CEO and President. She described the capabilities and facilities of the hospital, including a 24/7 emergency room, saying, “it is vital to the health of our community.”
The challenges WCH is facing, Newby said, “are volume, the competition, and the money owed to us.” Right now, Newby said that WCH was owed $1.2 million in Medicaid payments and $500,000 in state medical workers payments.
Newby stated that WCH has had to cut services due to volume just being too low.
The American Health Care Act (AHCA), the bill which rolls back the Access To Care Act (ACA or colloquially, “Obamacare”), which has already passed the U.S. House of Representatives and will be voted on by the U.S. Senate next, enacts large scale cuts to Medicaid. Durbin supports reforming the ACA, rather than replacing it.
“If that bill becomes law,” Durbin said, “23-million people will lose their insurance, including 1-million in Illinois.”
Slow Pay/No Pay
Right now, Newby said that WCH does about 50-percent medicare inpatient and about 95-percent medicare outpatient. Charity care (Cases where payment is written off completely) at the hospital has decreased significantly due to increases in Medicaid brought about by the ACA, but that has it own issues, because the payment rate to Medicaid accounts in Illinois is, “the lowest in the nation,” Newby stated.
The non-payment of Medicaid accounts was brought up again by Washington County Ambulance Administrator John Felchlia, who said that while he has seen an increase in people covered by Medicaid, the actual money coming in to providers is down. “We can’t absorb all of that.”
Felchlia added that for non-emergency services from the ambulance department, like hospital transfers, if the patient is covered by Medicaid and they are not a Washington County resident, “we refuse them service.”
Medicaid coverage, “that’s 100-percent reimbursed by the federal government to the state of Illinois,” said Durbin, and the state is mandated to pay on a 15 day cycle. Simply put, the state of Illinois does not do this. At all.
Gaps In Rural Healthcare
Durbin stated that another problem with healthcare in this country was that pharmaceuticals were marketed directly to consumers, which drove drug costs up.
Locally, WCH Doctor Ginger Fewell told Durbin that she has seen patients who will receive a prescription for a name-brand or non-generic drugs who will later call back and ask for their prescription to be changed to something less expensive.
Fewell also stated that an issue with the ACA was that it mandated coverage include coverage for mental health services, which wasn’t a problem in and of itself, but in rural areas like this, “there’s just no services available.”
WCH Doctor Alfonso Urdanetta told Durbin that while his experience as a surgeon was not the same as Fewell’s as a general practitioner, he did see that there was an extreme need for mental health services.
“It seems to me, if we had some way to alleviate debt for medical students” Durbin said, “we could ask people for a few years of service in an underserved area in exchange for us taking on some of that debt.”
Fewell said that there were programs like this, and that was one of the reasons she was working in a rural area.
Another problem, one that was present across the U.S., but which is particularly prevalent in rural communities, is the opioid epidemic.
Felchlia said this was related to an unfunded mandate from the state, that all first responders carry narcan, a drug that can reverse narcotic overdoses.
Felchlia stated that he believed that if a patient received narcan treatment, they should be prevented from signing out of the hospital or emergency room AMA (Against Medical Advice) and should be required to enter some sort of treatment. Again, this circles back to a lack of mental health services.
“There are people with chronic, serious pain, that need that pain relief,” Durbin said, “but overall, the opioid problem is madness.”
Reforms To The ACA
Washington County Hospital Board President (and veteran paramedic) Matthew Bierman addressed the extreme cost of premiums for some under the ACA.
“What good is it to have everyone on insurance if the premiums are $12,00 to $15,000?” Bierman asked. “They’re still paying out of pocket, and they’re still not covered.”
“They’re not going to lose their home if it’s a $100,000 bill,” said Cathy Combs, an area citizen who was present at the meeting. “I used Obamacare, and I had a big bill, but at least I knew I wouldn’t lose my home.”
“People say, ‘you’re defending Obamacare! It needs to be fixed!’” said Durbin. “It does.”
Durbin said that he has heard of the out-of-hand premiums charged to some through the marketplace. “It’s true, it’s a problem, but it’s one that we can fix if we roll up our sleeves.”
Newby, for her part, said that she was concerned about the future of WCH, and other hospitals like it, if the repeal of the ACA goes forward in the form it is currently in.
Whatever is done, Newby stated, “it’s got to be something that we can all live with.”