Escalating health challenges for inner city Milwaukee

Two recent reports have raised concerns about healthcare access for low-income Milwaukeeans. First, The Business Journal Serving Greater Milwaukee reported on Aurora Health Care’s relocation of orthopedic and heart surgeons from its Sinai Medical Center, located just west of downtown, to a new hospital in Grafton. The transfers have caused some to fear further service reductions at Sinai, particularly in light of the decades-long trend of hospital closures in the City of Milwaukee. Days after the Business Journal article, the Center for Urban Population Health (CUPH) released a report revealing entrenched health disparities among Milwaukee residents based on socioeconomic status. With state budget cuts to Medicaid as an additional hurdle on the horizon, are the healthcare challenges facing low-income Milwaukeean’s about to get even worse?

Since 1977, nine hospitals have closed in Milwaukee, including the 1995 closing of the county-owned John Doyne Hospital, which had long served as a safety net for the uninsured. Initially, these losses were tied to the city’s population decline, but the most recent closings – Northwest General in 2000 and St. Michael’s in 2006 – occurred despite a stabilization of the city’s population during the past decade. Another major factor that has been linked to hospital closings in the city is a dramatic increase in poverty, which has resulted in higher rates of publicly insured and uninsured residents.

Despite the fact that Sinai has operated at a loss nearly every year over the past decade, Aurora Health Care maintains it is committed to downtown Milwaukee. But with the state’s proposed $500 million in Medicaid cuts over the next two years, private hospitals may be faced with further cuts in Medicaid reimbursement and/or an increase of uninsured patients. The details of the state’s Medicaid budget have not been announced yet, but the BadgerCare Plus Core plan for childless adults had already instituted a waiting list long before budget debates began.

Milwaukee’s healthcare safety net for the uninsured has gone through several changes over the past 20 years. The county’s John Doyne Hospital served the uninsured free of charge until it was closed by county officials in 1995. To partially replace Doyne Hospital, Milwaukee County created the General Assistance Medical Program (GAMP), which provided health coverage for low-income, childless adults – the portion of Milwaukee County’s low-income population that didn’t qualify for Medicaid at the time. When the State of Wisconsin expanded BadgerCare in 2009 to cover childless adults, the GAMP program was eliminated. Consequently, if BadgerCare eligibility is now restricted in response to the state’s Medicaid funding gap, there will be no public safety net program to provide backup.

Milwaukee’s four federally qualified health centers (FQHCs), which provide primary care services to patients regardless of their ability to pay, fill an important role in serving the city’s uninsured. All four centers are expanding their operations and together may be positioned to take on additional patients in the near future. In addition, the downtown AIDS Resource Center of Wisconsin (ARCW) clinic is working to become a fifth primary care FQHC, which would allow it to serve many more patients. These are encouraging signs, but capacity constraints remain a concern at the FQHCs and continue to be a focus of the health system leaders who comprise the Milwaukee Health Care Partnership.

As the local impacts of the state’s Medicaid budget are revealed, there may be even greater strains on the regional healthcare system. A key question is whether Milwaukee policymakers and healthcare leaders will be able to respond as quickly and effectively as the demand for services may warrant.