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President's Perspective: Access and Equity

By Thomas M. Priselac, President and CEO

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I am pleased to let you know that Cedars-Sinai has further expanded eligibility for our financial assistance programs, effective Jan. 1, 2020. Also, I want to correct the erroneous idea that a hospital's community benefit should only be measured by the amount of charity care provided.

First, about the expanded eligibility: This is one part of our longstanding commitment to providing community benefit and accessibility to healthcare—especially for low- or no-income patients. We now provide free care to people earning up to 400% of the federal poverty level ($103,000 for a family of four) and significantly discounted care to those earning up to 600% of the federal poverty level ($154,500 for a family of four).

A key benefit of the Affordable Care Act (and Covered California) has been an increase in people who now have some type of insurance coverage (Medi-Cal or commercial health insurance). Consistent with the reason the Affordable Care Act was passed, there has been a statewide decline in patients who need traditional "charity care" for the uninsured. However, there has been an increase in commercial insurance plans that have a high deductible or copay, which is causing financial difficulty for patients. To help address this, as well as continue to support the uninsured poor (who need traditional "charity care"), Cedars-Sinai has expanded the eligibility criteria for free or discounted care. This will enable more people to be eligible for our financial assistance.  

Second, about the erroneous idea that a hospital's community benefit should only be measured by the amount of charity care provided: For decades, the measurement of a hospital's community benefit has gone far beyond the amount of charity care provided. While direct financial assistance programs such as charity care are an important part of total community benefit, they do not provide an accurate view of a hospital's community benefit in the 21st century. As a nonprofit, nongovernmental hospital, Cedars-Sinai provides community benefit in many ways, including paying for the unreimbursed costs of our care for Medi-Cal and Medicare patients (because government payments to hospitals are well below the cost of care), the unreimbursed costs of our medical research and education programs, grants to community service organizations and a broad array of programs to improve the health of the community. (In FY2018, our total community benefit contribution was $561 million, or 16.5% of total expenses.)

The narrow view that a hospital's community benefit contribution should be measured only by looking at the traditional "charity care" provided has been outdated since the mid-1960s, when government programs such as Medicare and Medicaid began. Starting back then, the measure of a hospital's contributions to the less fortunate and to the wellbeing of the community was broadened to include the types of programs, services and initiatives that comprise a hospital's community benefit today.

This includes strengthening underserved communities by partnering with local organizations and reducing health disparities.  And it recognizes that government programs such as Medi-Cal and Medicare do not fully cover the cost of caring for these patients. (This is especially significant at Cedars-Sinai, which serves substantially more Medicare patients—many of whom are low-income individuals who are also on Medi-Cal—than any other hospital in the state, and is in the top 16% of all hospitals in California for number of Medi-Cal patients.)

From the founding of Cedars-Sinai in 1902, providing access to healthcare for the vulnerable in the community has always been an important part of our mission. Thank you for sharing Cedars-Sinai's commitment to the health of our region.