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City report: charity‑care patients and spending fell after ACA expansion; hospitals remain essential safety net
Summary
The FY2015 Charity Care Report showed unduplicated charity‑care patients dropped from about 97,000 to 60,000 and charity‑care expenditures fell roughly $93 million from FY2014 to FY2015; the report recommends maintaining current reporting guidelines because of ACA uncertainty and highlights continuing needs among hard‑to‑reach populations.
Krishna Patel of the Department of Public Health presented the FY2015 Charity Care Report to the Health Commission, summarizing citywide trends and hospital‑level data. Patel said the data reflect the effects of the Affordable Care Act and local programs such as Healthy San Francisco on coverage and charity‑care use.
Patel reported that the number of unduplicated charity‑care patients fell from about 97,000 in FY2014 to roughly 60,000 in FY2015 — an approximate 38% decline — and that charity‑care expenditures declined by about $93,000,000 (from $178,000,000 to $84,000,000). She also reported that medical shortfall (the difference between hospitals' cost of care and program reimbursement) increased modestly and that the combined total of charity care plus medical shortfall in FY2015 was reported at $566,000,000.
The presentation distinguished Healthy San Francisco participants from traditional charity‑care patients: Healthy San Francisco showed a particularly large decline (Patel said roughly 3,807 participants were disenrolled and moved to medical coverage between January and June 2015), while traditional charity care remained concentrated in specific supervisor districts and continued to serve a substantial cohort, many of whom face homelessness or other barriers to insurance.
Patel said the department had evaluated options for changing reporting guidelines but recommended no changes at this time to preserve a consistent longitudinal dataset, citing uncertainty about future ACA changes. David Serrano Sewell of the Hospital Council of Northern and Central California praised the report and urged continued collaboration between hospitals and the city as coverage debates continue at the state and federal levels.
Commissioners commended the report's longitudinal approach, noted shifts in emergency‑department use among traditional charity‑care patients, and asked that hospital partners and DPH continue to collaborate on tracking and outreach.
