A flyer posted throughout the 10-hospital Appalachian Regional Healthcare system provides an incorrect web address to sign up for federally mandated health coverage, falsely states uninsured patients won't receive non-emergency services after Jan. 1 and sets an arbitrary deadline to enroll for insurance through the Affordable Care Act.
And CEO Joe Grossman is OK with that.
"I know when you read the flyer it sounds like we are being real draconian and hatchet men," Grossman said.
The flyer states: "Attention Patients, Consistent with the Affordable Care Act: Appalachian Regional Healthcare, Inc. will no longer see patients for non-emergent services without insurance coverage effective Jan. 1, 2014. In order to ensure your coverage is effective January 1, 2014 you must enroll in a health plan by November 30, 2013. To enroll go to www.Kynect.com."
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Grossman dictated the strong tone of the flyer and selected the Nov. 30 deadline as a policy for ARH patients to get insurance effective Jan. 1, he said.
The dates don't match those mandated by the Affordable Care Act, the federal law also called Obamacare, which set a deadline of Dec. 23 for coverage starting Jan. 1. The deadline under the federal law for enrollment is March 31. The correct website is Kynect.Ky.Gov.
Grossman said the flyer reflects his rules for his $576 million-a-year nonprofit healthcare business. And, he said, "all my rules do is build a sense of urgency."
ARH hospitals in Kentucky and West Virginia serve some of the poorest areas of the country. Ten percent of ARH's patients are uninsured, and 67 percent received coverage through Medicaid or Medicare, Grossman said.
He created the flyer because he was hearing patients say they had no incentive to sign up for health insurance.
The ACA requires every American to sign up for health insurance by March 31 or face a penalty of less than $100 per person taken out of an individual's tax returns.
Many of the ARH patients who are uninsured "don't pay taxes," Grossman said, so they wouldn't face a fine. Therefore, he said, they have no reason to sign up for insurance if they believe they will continue to get health care through the emergency room.
And even if all the patients in the ARH system have coverage, Grossman believes the ACA will bankrupt his company.
Grossman said ARH provided more than $140 million in charitable care to uninsured patients last year. He expects that amount to go down under the ACA, which he predicts will eventually force his hospital system into bankruptcy. His flyer is at least a way to push patients into action, he said: "If we don't give people an incentive to change, they will not."
There is so much misinformation in the ARH flyer that Cara Stewart, an attorney with the Kentucky Equal Justice Center, a nonprofit advocacy group, first wondered if it was a scam designed to extract personal information from those thinking they were signing up for health insurance.
After ARH officials confirmed the flyer was real, Stewart said it's a good thing that the hospital is trying to encourage people to sign up for health insurance, but falsely claiming that turning away uninsured patients "is consistent with the Affordable Care Act" seems like "fear mongering."
Dr. Ryan Stanton, president of the Kentucky chapter of the American College of Emergency Physicians, said federal rules independent of the Affordable Care Act require patient screening at emergency rooms, and making a claim that patients won't be seen is "all bark and no bite."
But, he said, he understands ARH feeling an urgency to make sure people get insurance. There is fear that the ACA will cause some emergency rooms to close, Stanton explained. Some ERs have experimented with screening people, and if no emergency condition is found, stopping care and asking for immediate payment for services.
That model, he said, is not widespread and opens the potential for lawsuits if a patient who is turned away has a serious health issue that was overlooked.
But Stewart emphasized that there is nothing in the ACA denying care for uninsured people. In fact, there are specific federal funds set aside to pay for uninsured care through 2020, she said.
The ARH flyer is only part of an outreach effort that included a letter to 12,000 uninsured ARH patients seen in July, August and September, Grossman said. ARH has held community events, has an education campaign and has 40 counselors to help people sign up for health insurance. The letter includes the exact aggressive and misleading language as the flyer.
Grossman said he selected the Nov. 30 deadline for ARH patients because he feared that if people waited until the original federal deadline of Dec. 15 deadline, bureaucracy would fail them. "And that's what happened," he said, adding he's hearing of patients who thought they signed up for coverage well before the Dec. 23 deadline but aren't in the insurance system or have not received an insurance card.
When asked how many ARH patients he's encountered with those problems, he said about a dozen.
Grossman said Friday his company will continue to post the flyer, unaltered. He said other hospitals are using similar methods, although he couldn't provide an example. He stands behind the incorrect web address used in the flyer. His enrollment counselors, he said, have used that web address to sign people up.
Gwenda Bond, a spokesman for the state Cabinet For Health and Family Services, said the state never used or promoted Kynect.com, but that address now redirects to Kynect.Ky.Gov because the state purchased several domain names in order to prohibit scam sites.
Grossman doesn't know if his tactics are effective. ARH isn't keeping records of how many people their counselors are helping enroll in insurance.
"I probably should have tried to measure it, but I didn't," he said.