Negotiating our care in a broken system

Mission Health System, the largest hospital and the largest employer here in the Asheville region, has announced it may leave the Blue Cross Blue Shield of North Carolina network in October.

That has a lot of people in a panic, since Mission is our only option here and BCBS is pretty much the only insurer in the state — three-quarters of all people with health insurance here have it through them.

Leaving the network would mean closing the hospital. It couldn’t survive because it wouldn’t be able to collect the money it’s owed by patients whose insurance only covers half the cost of their bills.

On the other hand, this dramatic announcement allows Mission to tell the public how desperate things are becoming here.

Here’s why: Our state’s legislature has rejected the billions in federal dollars to expand Medicaid.

Before the Affordable Care Act, the federal government reimbursed hospitals and clinics for the money they spent caring for people who couldn’t pay. The ACA’s provision for expanding Medicaid was meant to replace this money, but the Supreme Court ruled that Medicaid expansion couldn’t be mandatory, so mostly Republican states, mostly in the South, decided to shoot themselves in the foot and not expand.

Now, we’re still paying our full share into the Medicaid expansion pot, but not a penny of that money is coming back into North Carolina. Instead, it’s going to states like Arizona that have expanded Medicaid, and North Carolina’s hospitals are losing billions of dollars a year.

What’s worse is that about five people in this state die every single day — up to 2,000 a year — from lack of access to care.

Instead of lobbying the legislature to expand Medicaid, BCBS is insisting this is not its problem, and Mission is left to try and survive by cutting services.

Already, several small hospitals in the state have either closed or been bought up by larger hospital systems like Mission that can weather the storm longer than they can.

But this can’t continue. Eventually, even the wealthiest people here won’t have access to services because they won’t be available.

I know this tactic of brinksmanship. I saw it as a reporter. I would get press releases from the hospital claiming the insurance company wanted to reduce rates to the point where the hospital wouldn’t be able to survive. On the other hand, I got press releases from the insurance companies saying the hospital was guilty of gross inefficiency.

Once the contracts were signed, usually within days of the deadline, everyone was buddy-buddy again.

One year, the CEO of BCBS came to Asheville for a Chamber of Commerce event and praised Mission as one of the most efficient hospitals in the nation. This was just four months after a press release with the same CEO saying Mission was one of the worst.

So, with press release in hand, I approached him after his speech and asked if he had any thoughts on Mission’s dramatic turnaround in just four months.

He had no comment.

This is a game — a dangerous game with human beings as pawns, but a game nevertheless.

The hospital needs higher reimbursements to cover the losses from the state legislature’s recalcitrant position. The insurance company can’t keep paying more without some serious rate hikes.

Everyone involved here is guilty of greed or of trying to make a political point at the expense of human life.

It is all deeply, deeply immoral, but I think people need to understand who’s at fault here and what could happen.

The Affordable Care Act isn’t perfect, but it’s better than what we had before. The rate of people with insurance are at an historic high in the country right now. If all the states expanded Medicaid, insured rates would be over 90 percent.

In states that have expanded Medicaid, insurance rates are rising far more slowly and health care expenses are leveling off. In states like this one, health care costs continue to spiral out of control and people continue to die.

So, who’s pro-life now?


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