May 1, 2013

Sister Judith Ann Karam delivers testimony to Ohio Senate Medicaid Finance Subcommittee

Today in Columbus, Ohio, Sister Judith Ann Karam, CSA, president and CEO of the Sisters of Charity Health System, delivered the following testimony to the Ohio Senate Medicaid Finance Subcommittee:

Chairman Burke, Vice Chairwoman Jones, Ranking Member Cafaro and members of the Medicaid Finance Subcommittee.  I am Sister Judith Ann Karam and I am the president and CEO of the Sisters of Charity Health System. We oversee the ministries of the Sisters of Charity of St. Augustine, a congregation of sisters who in 1851 came from France to Cleveland and began an enduring legacy of service to the community.

The Sisters of Charity Health System is among the four major health systems in Northeast Ohio.  In Ohio, our system includes three acute care Catholic hospitals; two skilled nursing and assisted living facilities; and other health, education and human services ministries.  Our system also has hospitals and other faith-based organizations in South Carolina.  In 2012, our family of ministries provided $60.7 million in community benefit, including $26.3 million in charity care at cost and $21.5 million in unpaid costs of Medicaid.

Together, our mission is to extend the healing ministry of Jesus to all of God’s people.

Today, I testify on an important policy decision before you. In the biennium budget, the Senate may include legislation that would dramatically close the health care coverage gap with an extension of the Medicaid program.  I strongly urge you to do so.

The Sisters of Charity of St. Augustine, my religious community, and those who join us each day in ministry, have never done this work alone.  Motivated by our faith tradition, we believe that solutions to systemic challenges are found when we come together as community. In health care, the public sector has a role in offering coverage for lower-income residents, seniors and others without access. The legacy and mission of the Sisters is one that has never turned to government first to address our societal challenges, and we have decades of works to prove this, including establishing: homes for orphan children, schools of nursing, hospitals, elder care for our seniors, transitional housing for homeless men and more. We do not ask government first, but because of our belief in community, we do not fail to include government in furthering the common good. Members of the subcommittee, this coverage extension furthers the common good.

We firmly believe that families and communities are stronger when everyone has access to quality, affordable health care. Across the nation, studies have shown that Medicaid coverage improves health care outcomes and a person’s ability to return to work, compared to being uninsured. We know that Medicaid coverage saves lives.

From a point-of-view of those who deliver care, like St. Vincent Charity Medical Center in Cleveland, Mercy Medical Center in Canton and St. John Medical Center in Westlake, hospitals are major anchors and employers in the communities, and in today’s climate, live with real fiscal challenges.  Federal and state governments must support adequate financing to ensure the ability of health care providers -- including hospitals -- to maintain quality and compassionate care.  With an extension of coverage through the Medicaid program, Ohio’s families will be healthier and hospitals like ours will have improved sustainability and more financial predictability. 

We can agree that the current health care delivery system is not sustainable. The care is fragmented. With the Affordable Care Act (ACA), there is a policy foundation upon which to build.  It is not a perfect law, and hospitals and others had issues with it during the debate.  In the end, many, including my system, supported its passage because it offered nearly 32 million Americans the dignity of health coverage. The provider community, policymakers including Ohio’s lawmakers, and stakeholders are now working to achieve health reform, to chart a new vision for health care that includes delivery system reforms that will improve quality of care and patient outcomes.    

But, the ACA had to be paid for.  With its enactment, hospitals and other providers are already experiencing reimbursement reductions and will continue to do so.  In Ohio alone, the Sisters of Charity Health System’s three hospitals will take $120 million in Medicare reimbursement cuts over ten years because of the ACA.  

Additionally, we will experience Medicaid (disproportionate share) DSH funding reductions. Medicaid DSH has traditionally been used to help partially offset the cost of caring for uninsured patients who could not afford to pay for their own care. With DSH funding significantly cut, and those who would have been covered by Medicaid extension still uninsured, hospitals like ours will face significant financial challenges.  For example, St. Vincent Charity is a high-DSH hospital, with Medicaid insurance representing 21 percent of its patient payer mix and uninsured patients representing seven percent of its payer mix in 2012. Cuts to Medicaid DSH on top of the ACA Medicare cuts will negatively impact this hospital and all our SCHS hospitals.

If Ohio chooses not to extend coverage, the monies hospitals have already sent (and will continue to send) out-of-state will stay out-of-state, and Ohioans and Ohio’s hospitals will be worse off.

Today, the Medicaid insurance program does have gaps in coverage. It is not available to every lower-income resident. In our state, the majority of uninsured adults have no regular source of health care, forcing them to delay or forego needed care when they are sick. This dramatically limits their access to preventive services, reduces productivity and threatens their health.

Without access to coverage, many uninsured Ohioans will continue to seek care in hospital emergency departments.

Uninsured persons come to our emergency departments in a more acute state than they would with access to earlier intervention or prevention.  We see patients who have no insurance and cannot manage their chronic illnesses like diabetes because they do not have a regular doctor; or cannot pay for their prescription drugs for their hypertension or COPD (chronic obstructive pulmonary disease) and become sick.  So often, we admit patients when hospitalization may have been prevented if they had had their medications covered by insurance or had primary care options.  Regular physician visits would enable people to manage their care. 

This uncompensated care is costly to the whole system, is fragmented, does not offer patient-centered care, and was a major factor behind efforts to reform the health system in the first place.

I call on you to take action, to extend the current Medicaid program. I beg you to set aside political views to focus on the persons you and I have been called to serve.  Health care cannot only be treated as a commodity to be bought and sold.  It is integral to human dignity. The vast majority of people who would benefit are not “deadbeat” health care consumers. They are hard-working family members who are striving hard to escape the cycle of poverty.

Lastly, I strongly urge you to extend this health coverage in the biennium budget. The timing matters. We can debate this forever, but from a practical perspective, the major tenets of the Affordable Care Act come online January 1, 2014.  Community organizations, faith leaders, hospitals and others are preparing mightily to be able to help enroll newly eligible persons in the federally run health exchanges or marketplaces that will be available October 1.  Having this extended coverage in place will make the process more coordinated. These enrollment systems cannot be turned on overnight.  And, if the state does not expand, the 275,000 Ohioans projected to be enrollees into Medicaid extension will have no coverage options, leaving the most vulnerable (those under 138 percent of poverty) out in the cold.  Persons up to 400 percent of poverty will be able to be covered through the federal exchange. 

In closing, the Sisters of Charity Health System supports protecting human dignity by expanding coverage. We do not ask you to do this work alone; we are with you. Government does have a role to play.  As our elected leaders, we urge you to further the common good.

May God bless you in your public service. 

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From its Cleveland headquarters, the Sisters of Charity Health System provides oversight, leadership and strategic direction to more than 20 organizations responding to community needs in Canton and Cleveland, Ohio, and South Carolina.

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