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PolitiFact Florida: How much do the uninsured cost the insured per hospital visit?

Published Feb. 2, 2015

The Florida Chamber of Commerce is weighing in on the state's rising cost of health care, decrying the Affordable Care Act's plans to expand Medicaid but acknowledging uninsured residents cost big bucks.

"Floridians pay an additional $1.4 billion in hidden health care taxes to cover health care received by the uninsured," a chamber task force said in a recent report. "Insured Floridians pay about $2,000 for every hospital stay to cover the cost of the uninsured."

We wondered whether insured residents paying an extra $2,000 was a true expense, or just another padded invoice.

The chamber's report, "Smarter Healthcare Coverage in Florida," was released Jan. 13, ahead of potential action from state lawmakers during the legislative session, which starts March 3. The report said 3 million Floridians don't have health insurance. That's a bit low; an estimate using Census data said about 3.8 million of Florida's 19 million residents were uninsured in 2013. But overall, Florida is third among the states in its percentage of uninsured, behind Texas and Nevada.

Calculating how much those uninsured Floridians cost other patients is not easy. We asked several state, medical and insurance agencies whether the $2,000 number was accurate, and no one had a statistic measured that way. The chamber said it collected data from "an urban hospital" and tracked that unspecified facility's cost-to-charge ratio (how much care actually costs a hospital versus how much it charges a patient).

The chamber then divided the uninsured procedures' costs by the total number of admissions through managed-care insurance plans. After adjusting for accounting discrepancies and other factors, the chamber determined the cost was about $2,300 per patient. It also estimated a lower end of the range at $1,700, or about 75 percent of the first estimate. The chamber acknowledged setting this low end was a "somewhat arbitrary determination."

The description of "about $2,000" was meant to be an average of this range, chamber spokeswoman Edie Ousley told PolitiFact Florida. "The intent of the calculation was to take real data from a representative hospital and try to provide an order of magnitude of the cost shift of the uninsured," she said.

The chamber said there was $1.4 billion in unpaid hospital expenses in 2012, a number that jibes with a Florida Hospital Association report. To put that in perspective, the Agency for Health Care Administration reported more than $119 billion in charges for all hospital admissions in 2012. The average stay was about five days and cost more than $44,500.

FHA president Bruce Rueben has said he hoped the number would be lower in future reports, when people newly insured under the Affordable Care Act are taken into account. The federal insurance exchange didn't open until Oct. 1, 2013, with policies starting in 2014, so data on how that affects charity care aren't available.

Linda Quick, president of the South Florida Hospital and Healthcare Association, said she had heard the chamber's number used before, but wasn't aware of how it had been calculated. Nonetheless, it's an estimate that is rooted in a real problem, she said.

"I think the underlying premise — those who do pay, pay for those who can't or don't — is true," she said, "although the 'cost shifting' had become more burdensome before the Affordable Care Act and the availability of affordable coverage."

If Florida fully implemented the health care law, it would reduce the ranks of the uninsured. The pro-expansion Florida Center for Fiscal and Economic Policy estimates about 1 million people would be covered under Medicaid expansion by 2020.

Returning to the $2,000 figure, it's based on an estimate the chamber developed, calculating an average based on the unnamed "urban hospital," using recent data. But there's no way to tell just how accurate that estimate is for all Floridians. Experts we talked to said there are problems with the specific figure, but it's a somewhat reasonable illustration to a real problem in Florida: People who are insured end up paying for those who aren't. The statement is partially accurate but leaves out important details or takes things out of context. We rate it Half True.

This report has been edited for print. Read more fact-checks at PolitiFact.com/florida.