Should Texas Tech Physicians offer a cash discount or charity write-off to uninsured non-Medicaid patients who passed on enrolling in one of the plans offered on the Affordable Healthcare exchange for which they would have qualified for a subsidy? I am curious what you think about this question and would like to hear from you.

An argument for not giving a discount to people in that situation is that patients may see financial aid as a better deal than having to pay premiums, deductibles and co-insurance on a private plan purchased via the exchange, even when facing a fine. In effect, we could be discouraging individuals from obtaining subsidized insurance. Surely, that is not a good thing.

Perhaps the bigger question is what is an individual's responsibility to obtain coverage? (Many folks could qualify for a subsidy via the Affordable Care Act to help them with the financial burden.) It is an interesting philosophical/political question — failure to continue to provide charity care might lead to some criticism; yet, one can see the dilemma we and other providers across the nation face when people have been given an opportunity to purchase subsidized insurance (in fact, they are required by law to have insurance or pay a fine) and fail to do so. Whose responsibility is it to pay for the care a person in this situation receives?

Alternatively, would you recommend we ask patients to wait to obtain elective services until after the next enrollment which will occur in November? (In an emergent or urgent case, we do not worry about payment.) Basically, should we say, "We have determined you are eligible for a subsidy and you did not enroll in health insurance coverage and therefore you are not eligible for charity at Texas Tech Physicians?" How does such a stance comport with our larger School of Medicine tripartite mission of teaching, research and clinical activity? How does that comport with Texas Tech Physicians' mission of improving health of individuals with compassion and knowledge?

Don't worry. We will have a lot of folks comment on this and get the views of many before making a decision. Furthermore, we will put our patients' interest first as well as consider mission and "larger calling" while making decisions. And, we will be guided by our values. But it is something to ponder. Today's column, much like a philosophy class, raises more questions than answers. If you have an opinion, please state it here, stop by to see me or drop me an email, if you prefer.