New Hospital Report: “Politics, Posturing, Or What?”

Last week, a few CEOs from Arkansas hospitals testified before a state legislative subcommittee about the Obamacare “private” option. They explained that the PO has been a raving success — because, according to them, three months of data show that the number of uninsured visits to their hospitals has dropped since the program began in January. It was a nice effort to grab some good headlines (lord knows they needed some). But I think there’s plenty of reason to be skeptical of this data, and not only because I’m an ardent opponent of the program.
1. The only data provided is from the Arkansas Hospital Association, huge boosters of the PO, and the term “data” is generous in this context.
The AHA has been a huge booster of the PO. That’s fine — they represent Arkansas hospitals who will be the recipients of millions of taxpayer dollars, thanks to the “private” option. They are (in their estimation) looking out for their clients. However, given that context, it’s very curious that the AHA won’t release the full data they stake their “success” claims on.
In fact, all the AHA has released is this three-page report of indecipherable graphs that cites none other than themselves as the source of the data. The data itself, however, has not been released. All we have is this report that’s based on a survey that the AHA did. No dollar figures; no raw numbers of actual hospital visits, etc. (As an example of how this could be problematic: it’s possible that a hospital that saw 2 uninsured patients during the same time period in 2013 has now seen only 1 uninsured patient this year. Behold, a 50% reduction!)
Even worse, they haven’t even released the survey questions. They simply released some of their favorite “findings.” And yet, without hesitation, we are supposed to accept these “numbers” as “proof” that the PO is a success? Color me skeptical.
2. Why can’t we see the real data?
AHA lobbyist Jodianne Tritt has really taken to my tweets. Over the past several weeks, she’s bombarded my feed with declaratory statements like, “Actually, asked our hospitals in a survey-# of uncompensated care down 30%!” and “Look. Hospitals across AR are seeing patients who were previously uninsured and now have a payment source.” The only thing she forgot to add was “No more questions!”
But seriously: why can’t AHA or Tritt or anyone provide the actual data? Why do we have to take their word for it? If the results are so great, why aren’t they anxious to share it? Why must Arkansas taxpayers — the ones paying for this mess — be subjected to this data cherry-picking?
In response to my tweet of frustration that everyone claims to have the data but won’t share it, Tritt asked if I’d “asked an AR hospital?” Rep. John Burris also suggested that I “go to a hospital and ask like I did.” But later, Tritt said the information can’t be released due to “anti-trust laws” and Burris, after I asked him several times for the information, referred me to “Google,” informing me that he’s “not [my] messenger.” I don’t think both of them can be right: either the information is public or it isn’t.
I’m old-fashioned, I guess. When people make repeated public claims about all of the wonderful data they have, I expect them to actually have it, and be able and willing to share it. I would particularly expect someone like Rep. Burris, who has been a big supporter of the “private” option, to be eager to share all of these good numbers. So far, I haven’t seen anything.
(And I have also spoken to Senator David Sanders, who promised that the data would be “released soon.” That was about three weeks ago and, despite his commitment to call me back for further discussion, I haven’t heard from Sanders.)
3. Reducing the number of “uninsured visits” is not the same thing as reducing uncompensated care costs.
In its own way, the slipperiness of the messaging of pro-PO crowd is impressive. However, the promise of the “private” option wasn’t that it would reduce the number of uninsured people; the promise was that it would reduce uncompensated care costs for taxpayers and improve the financial outlook for hospitals. At this point, it’s too soon to make a judgment on that goal one way or the other. But it’s far from accurate to conflate the dollars of uncompensated care and the numbers of uninsured visits.
If I go to the doctor and pay cash for my care, I’m an “uninsured” visit, but I’m not an uncompensated care visit — I paid for my care. So, if I enrolled in the PO and obtained insurance, I would now be an insured patient, but my care would still be paid for, just as before. The needle hasn’t moved in regards to actual uncompensated care costs.
Relatedly, whether I obtain insurance or not, if I don’t go to the doctor, this would also be seen in the numbers as a “reduction in uninsured visits.” In other words, a reduction in uninsured visits could simply be a reduction in visits overall; people could be going to the doctor less.
It’s possible that AHA accounted for all of these variables in some way in their survey but, because they won’t release any actual data, we have no idea what behavioral changes in patients are really occurring or what is causing the changes. Maybe I’m too cynical, but it looks like the AHA is attempting to move the goalposts for PO “success” while keeping the scoreboard under wraps.
I rarely agree with Senator Stephanie Flowers, but I think she hit the nail on the head when she told attendees of the hearing, “I don’t know if this is politics, posturing or what…I want our committee to get the truth and have the opportunity to evaluate and review facts and not just take somebody’s word.” I look forward to the opportunity to receive and evaluate transparent data from Arkansas hospitals about uncompensated care — right now, unfortunately, all we have from them is bombastic, self-congratulatory statements whose connection to reality is uncertain.

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