Harris Health, which runs the historic Ben Taub Hospital, as well as two other hospitals and dozens of outpatient clinics, is now facing a $14 million dollar deficit. Within three years, the deficit could be as high as $142 million, if nothing changes.
The board of managers is considering a proposal to cut financial aid to uninsured patients as a way to encourage them to enroll in private insurance plans through the Affordable Care Act. Most of them would qualify for subsidies to pay for the plans, and could continue to see doctors at Harris Health.
Patients under the federal poverty level (an income of $12,000 a year for an individual) would be unaffected by the proposed changes.
But other uninsured people, whose incomes are above the poverty level, would no longer pay for healthcare under the system's current fee scales, known as Plans 2, 3 and 4.
Currently, a clinic visit at Harris Health might cost a patient $10, $38, or $76, depending on his or her income and plan eligibility. The system had more than 1.9 million outpatient visits last year, and 55,000 people admitted to its hospitals.
"These people are the working poor," said Ken Janda, CEO of Community Health Choice. CHC is a non-profit health insurer closely allied with Harris Health.
Janda hopes the fee change will help convince thousands of Harris Health patients to enroll in his insurance plans, which are heavily subsided by the Affordable Care Act.
Although federal subsidies would reduce the monthly premium for many new buyers, even bring it down to zero in some cases, the plans haven't always been attractive for patients, Janda said, especially when compared to the Harris Health fees.
"They might have, right now, a $10 copayment to see a specialist and it might be $20 copayment in our plan instead," Janda explained.
But if Harris Health ends its current sliding-scale fees, it could encourage up to 53,000 eligible patients to shop for insurance through the Affordable Care Act.
The move might initially be disruptive and scary for long-time patients in Harris Health, according to James Huggins, a resident of southeast Houston and a current Harris Health patient. (He is disabled and on Medicaid, so would be unaffected by the proposed change.)
"I'm not opposing it, I'm not saying it's definitely the right thing," Huggins said. "Will it affect some people badly? Yes. But if we do nothing...Harris Health will run out of money, bottom line.”
Huggins said he understands that Harris Health is being financially squeezed and needs help.
"The federal government is handing out huge amounts of healthcare, but you have to sign up,” he said. “And if you don't sign up, you just go drawing on the county. Well, the county doesn't have that much to give."
Board members may vote on the fee overhaul at its next meeting September 24.