Last year, Rep. Louie Gohmert (R-TX) announced that he would voluntarily go without health insurance, saying in a statement:
“On January 1st, when millions of Americans will likely lose their employers’ contribution to their health insurance, I will refuse to receive that same subsidy. It also means I will have to pay a substantial penalty or ‘tax,’ but I cannot in good conscience accept the subsidy when so many Americans have lost their insurance altogether because of ObamaCare.”
Rep. Gohmert’s commitment to making sure that he does not get special treatment as a member of Congress is admirable, but his decision to voluntarily go without insurance – despite the fact that his $174,000 per year salary indicates he can afford it – is both misguided and dangerous.
Because we treat a disproportionate share of uninsured people, essential hospitals across the country are on the front lines of managing care for the uninsured. We are also acutely aware that care for uninsured patients is far from “free.”
Let’s take a hypothetical example – one that plays out in essential hospitals every day:
An uninsured person experiences major trauma – let’s say a car accident. The patient is rushed to the nearest emergency department…in this case, they were lucky – their nearest ED was in an essential hospital with a level I trauma center. The uninsured patient is saved, but only after heroic (and expensive) treatment by the hospital.
They are ultimately discharged from the hospital. The final cost of their care – both for the trauma center and the inpatient stay following – is $50,000. This hypothetical need not be a trauma, of course. It could just as easily be a diagnosis of cancer or a heart attack or some other major illness. So, who pays for this care? In the end, we all do.
First, the hospital may attempt to collect some or all of the payment from the patient. Most uninsured people, however, have very limited financial resources and will be unable to pay. Mr. Gohmert’s congressional financial disclosures indicate even he would have a hard time paying a large hospital bill.
If available, the hospital may receive some payment for this care through Medicaid or Medicare disproportionate share hospital (DSH) payments, which are – of course – paid for by federal and state taxpayers. In some cases, hospitals may also receive direct funding from states or localities to help defray these costs. Finally, the hospital may attempt to cost shift, effectively charging paying patients (usually through private insurers) a little extra to help cover losses.
If you are truly poor and cannot afford insurance – the problem the ACA was designed to solve – then it is hard to pass blame. These financial safety nets – Medicaid and Medicare DSH, local funding, etc. – are here to make sure essential hospitals can keep their doors open while maintaining a commitment to serving all patients.
But if you can afford insurance and you choose not to get covered, you are not only risking whatever financial resources you have available, but you are also effectively saying to your neighbors (or, in Mr. Gohmert’s case, his constituents): “If I get hurt or sick, you get to pay for it.”
I’m confident that is not the message Rep. Gohmert is trying to send. I hope he reconsiders his decision and joins the millions of others around the country who are getting covered.