Medical bill malaise: Munson pro-bono cases on the rise; rural clinics provide help to uninsured

TRAVERSE CITY – In 2003, an estimated 1,400 patients were enrolled in Munson Medical Center's Charity Care Program – a program that writes off medical bills once it's determined that a patient can't pay. Many of these patients do not have health insurance, or are under-insured. Five years ago, these "pro-bono" cases cost Munson around $1.8 million.

Fast-forward to today, and these numbers have increased by almost six times. Munson's Senior Vice President Kathleen McManus says during this fiscal year alone, Munson will see between 8,000 and 8,500 Charity Care patients at a cost of more than $10 million.

"Since 2006 until present, the amount of people who are not able to pay their medical bills has doubled. This is the worst I have ever seen it."

Because Munson is a non-profit organization, McManus says the $10 million comes off its bottom line and will affect its operation budget. But, she adds, "Despite our financial concerns, no patient will ever be turned away or denied medical care."

McManus sees a correlation between high employment rates and more uninsured patients coming into Munson.

Michigan's unemployment rate is currently the highest in the nation. The Michigan Department of Labor and Economic Growth reports that in March, the state unemployment rate was 7.2 percent, compared to the national average of 5.1 percent. In February, more than 3,988 people in Grand Traverse County alone were without a job.

Along with an increase in uninsured patients, Munson is also seeing another alarming trend: In the past, about 25 percent of patients who came to the emergency room were admitted to the hospital. Since January of this year, McManus says the number of patients who require hospitalization has increased to 35 percent.

"People are sicker than in the past. Maybe because they don't have health insurance they are waiting longer to get care – hoping that they will get better on their own."

However, not all area hospitals are seeing an influx in uninsured patients. Jim Austin is an administrator for both Kalkaska Memorial Health Center (managed by Munson Healthcare) and Paul Oliver Memorial Hospital in Frankfort (owned by Munson Healthcare). He says neither hospital has seen an increase in the number of uninsured coming to the emergency rooms.

"In Kalkaska, we have a provider-based rural health care clinic that is available within the hospital for people who are underinsured," said Austin. "At Paul Oliver, we have not seen an increase because there is good access to care in Benzie County."

The Rural Health Clinic at Kalkaska Memorial Health Center opened in 1991 and was certified as the state's first provider-based rural health clinic ("provider-based" means it is attached to a hospital). Some of its services include a pediatric clinic and a family wellness clinic that provides vaccinations and flu shots. The clinic is staffed by a physician assistant or nurse practitioner with physician backup. The clinic accepts patients with Medicare or Medicaid and works with families when there are payment issues.

Eligible residents in Grand Traverse, Leelanau, and Benzie counties can also receive discounted or free medical care through the Coalition Health Access Program (CHAP), located in Traverse City.

CHAP is made up of physicians, nurse practitioners, volunteers, hospitals, and other health care organizations that donate their time and medical services to low-income, uninsured people who are at least 19 years old. Currently there are 1,600 people enrolled in the program.

"The goal of the CHAP program is to treat people's medical issues before they become very serious and they have to be hospitalized," said board member Bill Crawford.

While free clinics and charity programs can help relieve the symptoms, some activists say the government is the only cure for the high number of uninsured.

"There are more than one million Michigan residents without health insurance," says former state representative John Freeman of Madison Heights. "We can't sit and wait for the problem to get better. We need to take action now."

Earlier this year, Freeman started a campaign called MichUHCAN (Michigan Universal Healthcare Access Network) and is petitioning to get a proposition on the November ballot.

If supporters can gather at least 380,000 signatures by the end of June, voters will decide whether to change the state constitution to guarantee that every Michigan resident has affordable and comprehensive health care coverage. The proposal would also force the state legislature to control health care costs.

Freeman, who also worked on the successful push to raise Michigan's minimum wage, says this could help fix what he calls a "health care crisis."

For more information on MichUHCAN, visit For more information on CHAP, go to