Thread by @kschorsch

.@CookCtyHealth is the region’s medical safety net, known for treating everyone whether they can pay or not. But how much free health care can it provide? The estimated tab this year: about half a billion dollars. Here’s why. Read/listen @WBEZ (1/16) >> tinyurl.com/ydfzefjd

2 big reasons: 1) @CookCtyHealth’s share of free care is growing, while other hospitals in #CookCounty provide less 2) #CookCounty health system’s ability to bill & get paid. (2/16) @cookcountygov

First, about that growing amount of free care. We’re starting to see the ripple effect of a 2012 Illinois law. It aimed to settle how much free care non-profit hospitals in the state must provide to keep what can be very lucrative property tax breaks. (3/16) @KHNews @hamiltonproj

The compromise: IL hospitals don’t need to provide free care at all. Training doctors & conducting research counts. So does treating expensive trauma patients who are shot or hurt in car crashes. (4/16)

John Colombo, a retired @Illinois_Alma law professor, sums it up: “Why would you devote more money to (free) care if you don’t have to?” (5/16)

So @CookCtyHealth believes other hospitals are sending uninsured patients the county’s way. (6/16) @CIMPAR

Esperanza Villalobos is one of these patients. She was a week away from breast cancer surgery when she lost her insurance. 3 hospitals turned her away. She ended up at #StrogerHospital, @CookCtyHealth's flagship. @AdrianaCardMag helped me tell Esperanza's story. (7/16) @TRPistas

What one longtime #StrogerHospital ER doc sees: 'I think now a lot of places have a way of discharging their patients, giving them a follow up (appointment), but knowing that the patient can’t possibly afford that. So what’s the patient to do, but to come to county.” (8/16)

Some numbers to help explain. There are 68 hospitals in #CookCounty. In 2016, @CookCtyHealth's 2 hospitals provided nearly half of all the free care in the county, totaling about $266 million. #StrogerHospital shouldered the bulk of it. (9/16)

5 years earlier, other hospitals picked up more of the slack. @CookCtyHealth provided about 40% of all the free care. (10/16)

Back to 2016: @NorthwesternMed’s #NorthwesternMemorialHospital, one of the richest in Chicago, provided the 2nd highest amount of free care in #CookCounty. It was almost 7 times less than #StrogerHospital. (11/16)

And #StrogerHospital's neighbors a few blocks away? @UIHealth (state-funded) provided about $8 million; @RushMedical’s #RushUniversityMedicalCenter, about $20 million. Both hospitals said they help patients or their communities financially in other ways. (12/16)

Circling back to the other reason @CookCtyHealth is providing so much free care: billing. It’s gotten a lot more complicated, partly fueled by @GovRauner largely privatizing #Medicaid. (13/16) @KaiserFamFound

But it’s hard to know who is more to blame for @CookCtyHealth's pile of unpaid bills: the system, or #Medicaid insurers denying lots of their claims. There’s lots of missing information I’m still trying to gather. (14/16)

Here’s the bottom line: #CookCounty can’t keep providing so much free care. At some point, patients could wait longer to see their docs, or need to go somewhere else. They could wind up at the same hospitals now turning them away. (15/16) @CivicFederation

There’s lots more to this story. Read up & listen @WBEZ (16/16) >> tinyurl.com/ydfzefjd