The Affordable Care Act has provided a much-needed boost to public providers like the Cook County Health and Hospitals System, the two-hospital public system that serves Chicago and its surrounding communities.
Now that the system has more insured patients than uninsured, its bad debt and charity obligations fell 46% to $191.4 million during the first year in which the ACA's individual insurance mandate was in effect. The system reported a total surplus of $14.1 million in the fiscal year ended Nov. 30, 2014, according to audited results, up dramatically from a $93.1 million total deficit the year before.
The push to insure Americans also brought new enrollees to CountyCare, Cook County's new Medicaid managed-care program. In 2014, CCHHS received $656 million in reimbursements for CountyCare, up from $117.5 million the year before.
More money from CountyCare left the system with $1.3 billion in revenue in 2014, up 78% from $709.5 million the year before.
The system still suffered an operating loss of $213.7 million because of increased costs from serving more patients, but that loss was nearly half of the $394.4 million operating loss it suffered the year before. That left CCHHS with a -16.9% operating margin, compared to a -56% margin the year before.
“(Public hospitals) have a greater amount of patients arriving with insurance cards, and that has helped pay bills that were previously unpaid or paid by other public entities,” said Peter Butler, associate professor and chairman in the department of health systems management at Rush University.
Cook County is a better example of success than most public hospitals, Butler said. The new CountyCare membership means it will be better able to monitor patient populations instead of just dealing with acute patients, but the system will also have to compete with other hospitals that will be able to treat patients who previously would have been reimbursed as charity care, he said.
“Public hospitals will have to improve their service to retain the newly insured patients,” Butler said. “If they can do that, they should be in much better shape than they previously would have been.”