Federal Help Needed, Group Says : Catholic Health Assn. Urges Better Care of Poor

Catholic health professionals Monday released a set of sweeping recommendations to extend health care to the growing numbers of the poor, calling for an overhaul of the Medicaid program, taxing affluent hospitals to pay for services to the indigent, and encouraging greater involvement at the parish level to identify the health care needs of the underprivileged.

The recommendations--released as part of a report by the Catholic Health Assn. of the United States, which is meeting in San Diego--assert that adequate health care for the poor can be delivered only through federally mandated universal health insurance. But members of the task force acknowledged Monday that the current “political environment” is not right for such a plan, and envisioned that recommendation as a “long-range goal.”

Instead, the report--compiled over the last year by the CHA’s Task Force on Health Care for the Poor--recommended immediate and short-term measures that would be implemented by the nation’s 621 Catholic hospitals, state and federal governments and local Catholic agencies, including dioceses and parishes. In addition to representing Catholic hospitals, the organization also speaks for other church-affiliated clinics throughout the United States.

Although the report emphasized the Catholic hospitals’ commitment to serving the poor’s health needs, the task force also stressed the church’s belief that the federal government has the “ultimate responsibility” to see that this obligation is met.

“In particular, the government has a specific obligation to assist the poor, the disadvantaged, the handicapped, the unemployed and others who lack the means to care for themselves,” the report said.

However, government health care services to the poor, the report charges, are diluted by holes in what President Reagan calls the “safety net” for the nation’s disadvantaged, who rely on federal programs. Overall, the report charges that the Reagan Administration’s funding for health care programs “disproportionately” favors those who are better off financially.

As an example, the report said that, while the federal government will pay $25 billion this year for Medicaid programs for welfare recipients, it will spend almost that much--$20 billion--on health care for Defense Department employees, their dependents and veterans.

Recommendations in the report include:

- A proposal to tax affluent hospitals and private insurance premiums, using the revenue to pay for health care for the poor offered by Catholic and public hospitals that treat a disproportionate number of patients who cannot afford to pay for services. The tax on hospitals could be an assessment per bed or a flat fee, said task force members, who pointed to similar plans already in effect in New Jersey, Massachusetts and Florida.

“We’re asking the for-profit institutions to carry their fair share (of services to the poor),” said Sister Jane Frances Brady, chief administrator at St. Joseph’s Hospital and Medical Center in Paterson, N.J., and a task force member.

- Raising physician reimbursement rates in states where low payments discourage doctors from treating Medicaid patients.

- A call for all states to raise their poverty levels to the federal level to make more poor people eligible for Medicaid. Varying poverty levels are a result of a 1981 federal law that allows states greater flexibility in the management of their Medicaid programs, the report said.

- An easing of Medicaid eligibility requirements to make poor single persons, two-parent intact families and childless couples eligible for Medicaid.

Recommendations relating to the Catholic health care community include:

- Each Catholic hospital or clinic should include care of the poor as a specific item in its annual budget and provide free care or care at a reduced cost to the needy.

- Ways must be found of keeping open a Catholic health facility that serves a poor area when a lack of revenue threatens its closure.

- Catholic health care facilities should collaborate with other institutions, including non-Catholic ones, to establish or expand health care programs for the poor.

- All Catholics should serve as advocates for the poor by lobbying federal and state governments for increased services to establish better health care for the needy.

According to the report, Medicaid covers only 31% of the country’s poor population, and of this number, one-third are covered only part of the time. The report criticizes as burdensome and expensive the patchwork health care system serving the poor and advocates a universal health insurance program.

Brady charged that current Medicaid regulations encourage waste. As an example, she said that Medicaid will not cover a patient’s visit to a doctor for symptoms of a sore throat. However, if the same patient walks into an emergency room, Medicaid will pay for the visit.

“It ends up costing Medicaid $100 more for something that is clearly not an emergency and which could be treated in a physician’s office,” Brady said. “But the physician won’t take him because the (Medicaid) reimbursements are so low.”

The number of poor people going without adequate medical coverage increased sharply between 1981 and 1985, when, because of tightened eligibility standards, more than 1 million people were dropped from the Medicaid rolls, the report said. Federal and state governments have also aggravated the problem by limiting their commitments to health care programs, the task force said.

According to the report, in 1982 California dropped 270,000 adults from the state Medi-Cal program. The report called these the working poor, with incomes of $250 to $500 per month, but who were not eligible for welfare.

Brady and Sister Mary Caritas Geary, president of Mercy Hospital in Springfield, Mass., and a task force member, charged that most Catholic hospitals serve as dumping grounds for for-profit hospitals that do not care for patients who cannot afford to pay for health care.

The report warns that unless for-profit hospitals are forced to begin treating more poor patients, Catholic hospitals will be crushed by the financial burden that comes from continuously treating people who cannot afford to pay.

“Catholic hospitals appear to have less financial resiliency than the median U.S. hospital,” the report said. “The difference does not seem to be significant, but it does imply that in the future, Catholic hospitals may fail at a slightly higher rate than average.”