A new report from the state Insurance Commissioner shows several counties in the Mid-Columbia have the highest rates of uninsured residents in the state.
And that leads to area hospitals losing more and more of their bottom line to charity care and bad debt -- and costs being shifted to people who are insured.
Franklin, Adams, Grant and Yakima counties made up four of the five counties with the highest percentage of uninsured residents in the report released Tuesday by Insurance Commissioner Mike Kreidler's office.
The report tracks trends in the number of uninsured from 2008 to 2010 -- the year the state as a whole hit the 1 million uninsured mark.
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The ranks of the uninsured grew by 180,000 people during a three-year period, the report shows.
"This is a grim milestone for the state, and we believe the situation will remain bleak for two more years," Kreidler said in a statement. "But it's important for people to know that there is hope on the horizon."
That hope comes in the form of the Affordable Care Act passed by Congress and signed by President Obama in 2010, which Kreidler said should result in 800,000 Washingtonians becoming eligible for Medicaid coverage or subsidies to buy health insurance.
But that still leaves hospitals struggling with how to absorb costs as more patients are unable to pay.
Statewide, the amount of charity care -- essentially health care provided to low-income people for which they are not billed -- rose by 36 percent from 2008 to 2010. When unpaid medical bills are added to the mix, about $1 billion a year goes uncollected by hospitals and doctors' offices.
Tri-City hospitals provided$53.1 million in unpaid health care in 2010 when both charity care and bad debt are tallied. That's an increase from $35.5 million in 2008 -- or almost a 50 percent increase in three years.
Lane Savitch, president of Kadlec Regional Medical Center in Richland, said his hospital saw a 40 percent increase from 2010-11 in charity care alone. Kadlec provided $19 million in charity care in 2010 and estimates it will have provided about $26 million by the end of this year.
The hospital carries another $3 million in bad debt, he said.
"We are hoping and budgeting for charity care to remain at about that level for next year, but I think that is incredibly optimistic given the rate of increase over the last few years," Savitch said.
Kennewick General Hospital officials said their charity care has risen from $5.5 million in 2009 to an estimated $8.1 million in 2011, or about a 47 percent increase. Bad debt grew from $4.9 million to$7 million, a 43 percent increase, during the same period.
"We've been able to absorb those increases because our volume of patients is increasing," said KGH spokeswoman Liz Syer. "However, reductions in reimbursement will definitely not help us, and we would have to offset reductions with continued volume increases, cost reductions or potential elimination of unprofitable services. Patients with Medicaid coverage also continue to grow, and we are paid less than our costs to provide those services."
Only combined charity care and bad debt numbers were available for Lourdes Medical Center in Pasco on Tuesday, and those showed a smaller increase in the percentage of unpaid health care provided, from $9.7 million in 2008 to $13.2 million in 2010, or about a 36.1 percent increase.
Savitch said that with rising amounts of unpaid health care being provided, hospitals traditionally pass those costs on to insurers, who pass them on to employers in the forms of higher insurance premiums.
But employers are pushing back, which leads to insurers drawing the line on increases in hospital fees, Savitch said.
"The responsibility is falling onto hospitals to find more and more efficient ways of providing care," he said. "That's a pretty big challenge when we have this number of uninsured."
As a percentage of population, Franklin County's number of uninsured stayed relatively stable from 2008-10, with 14,300 people, or20.4 percent, uninsured in 2008 and 16,110 people, or 20.6 percent, in 2010.
But despite that relative stability, Franklin County outpaced the state average of 11.6 percent of the population uninsured in 2008, and 14.5 percent in 2010.
Yakima County saw an explosion in the number of uninsured, from 46,457 people, or 19.7 percent, in 2008 to 66,956 people, or 27.5 percent, in 2010.
In the Mid-Columbia, Adams and Grant counties also saw significant increases in the number of uninsured residents. Adams County had 2,904 uninsured, or 16.3 percent, in 2008 compared to 4,003 people or 21.4 percent in 2010.
Grant County's number rose from 14,682 uninsured, or 17.4 percent, in 2008 to 20,386 people, or 22.9 percent, in 2010.
Benton County's number of uninsured stayed on pace with the state average, but showed a rising number of people without health coverage. In 2008, 18,970 Benton County residents, or 11.5 percent, were uninsured compared to 25,391 people, or 14.5 percent, in 2010.
Savitch said the system as it exists is unsustainable, and broad changes must be made in how Americans think about health care to fix the problems -- namely a shift toward individuals embracing behaviors that will prevent chronic diseases instead of expecting quick fix treatments when problems arise.
"Frankly, I think this is a multigenerational kind of process, but we absolutely have to get started right away," he said.
-- Michelle Dupler: 582-1543; firstname.lastname@example.org