As the state begins controlling Medicaid costs through managed care, hospitals are dealing with an influx of Kentuckians who have no health coverage at all.
That's not surprising, considering how many people lost their insurance along with their jobs in the economic downturn.
Some of the unemployed and their children are swelling the rolls of Medicaid, the federal-state program that now covers more than 800,000 Kentuckians.
Those who don't qualify for Medicaid and have no employer-provided insurance will probably have a hard time affording individual insurance.
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University Hospital, Louisville's medical provider of last resort, has been forced to turn away some uninsured patients from outside Jefferson County because the increase in patients with no insurance has produced a $20 million shortfall. Roughly one in three of the hospital's uninsured patients live outside Jefferson County, including many from Southern and Western Kentucky, reports the Courier-Journal.
University of Kentucky Healthcare, which treats uninsured Kentuckians statewide, provided $139 million in charity care in the last fiscal year — an increase of $13 million.
Call it charity, but someone has to pay. Kentuckians who have insurance, and their employers, pay higher premiums and out-of-pocket expenses to cover the unavoidable costs of caring for the uninsured. Kentuckians who lack insurance pay by delaying or going without medical care.
Health care will remain an unfair, deadly game of cost shifting until this country achieves something approaching universal coverage, which is why a recent ruling from the U.S. Court of Appeals in Cincinnati is so encouraging.
The ruling upheld the Patient Protection and Affordable Care Act, the law signed by President Barack Obama, which, among other reforms, provides subsidies to help people afford health insurance.
This is the first time a Republican-appointed judge has ruled that the law's individual mandate to maintain health insurance is a proper regulation of interstate commerce.
Judge Jeffrey Sutton, a respected conservative who was appointed by President George W. Bush, rejected arguments that Congress has no power to regulate economic inactivity, including a decision to go without health insurance, because health care is unique.
He wrote: "Regulating how citizens pay for what they already receive (health care), never quite know when they will need, and in the case of severe illnesses or emergencies generally will not be able to afford, has few (if any) parallels in modern life."
The U.S. doesn't have to remain the only advanced economy in which medical costs bankrupt families, but state and federal governments will have to innovate and push for reform. Kentucky's on the right track with managed care Medicaid. And, as imperfect as the national reforms may be, they're also a step in the right direction.