A battle over health care is playing out in Olympia, but not in the Legislative Building.
It’s a true sign of a sick health care system when even health care workers struggle for affordable health care coverage.
Workers at Thurston County’s two hospitals — nonprofit Providence St. Peter, the county’s largest private employer, and for-profit Capital Medical Center — are similarly challenged in collective bargaining.
Both employers want to pare workers’ health care coverage. In the case of St. Peter, that would occur through forcing workers into high-deductible health savings accounts (HSAs). The high deductibles and matching out-of-pocket maximums — $3,000 for an individual and $6,000 for a family — would represent almost one-tenth of the median worker’s annual income. Workers are fighting back, enlisting community and faith leaders, and a strike may result over the impasse.
HSAs can work for those in the “young invincible” category of health risk who just need basic coverage. But even that risk group gets burned. One St. Peter’s worker opting into a HSA did so without realizing she would get pregnant last year. Because the baby is due this year, she is on the hook for two separate $3,000 payments. Surprise!
It’s ironic that this battle over health care costs is playing out in health care settings. Hospitals gain significantly under the Affordable Care Act (ACA). Presently they eat much of the more than $1 billion in annual uncompensated care for more than one million uninsured Washingtonians.
If the Legislature authorizes Medicaid expansion, one report estimated 328,000 likely to be newly-covered through Medicaid, while more uninsured residents will purchase, with federal tax credits, private insurance through the Washington health-plan-finder “Exchange.”
The report on Medicaid expansion estimated it alone would account for 199,000 new hospital days of care in Washington — perhaps cutting in half uncompensated care.
In a piece in support of the ACA, the American Hospital Association writes, “The AHA is most supportive of the ACA’s individual mandate” and “supports health insurance market reform, particularly the efforts to improve access to affordable health insurance in the private sector.” (Emphasis added).
Yet a 2008 study by the Kaiser Family Foundation found relatively few uninsured households have enough assets to cover the cost-sharing in HSAs, and those households met the low and moderate-income demographic many hospital workers fit into. So why are hospitals electing to push coverage that, were it the private sector norm, would leave hospitals with unpaid bills?
Further, it is not as if hospitals are going broke without the ACA. While not spared lamentable state cuts, Providence has maintained a healthy operating margin in ways visible beyond executives whose salaries are in the millions. The company cleared over $239 million in profit in 2011 according to its financials. Meanwhile, Tennessee-based Capella Healthcare — which owns Capital Medical Center — has used soaring revenue to buy hospitals.
As we approach 2014, when the ACA comes fully online, it would be a sad irony if its promise of affordable health care was broken by those most enthusiastic to enact it. For labor, this is a line in the sand that cannot be crossed if our employer-based health care system is to have a future.
Around four decades ago I received a tonsillectomy at St. Peter; almost 11 years ago my son was born there. As a legislator, I fought to give Capital Medical Center the right to perform a cardiac procedure its competitor sought to deny it.
I do not begrudge hospitals’ financial health. Yet that health should be shared by the workers. Surely we must care first for those who provide care to us all.
Brendan Williams is a former State Representative from the 22nd Legislative District.