Why 60,000+ Central Texans Could Lose Access to Ascension Hospitals Next Month

Seton Shoal Creek Hospital (Photo by Seton / CC BY-SA 3.0)

A month after The New York Times published a damning investigative piece on the "profits over patients" model of Ascension hospitals, news broke last week that a deal between Ascension Texas, the state's largest private hospital network, and Blue Cross Blue Shield of Texas, the largest insurance company in Central Texas, is falling apart. If the two can't agree on a deal in the next three weeks, come Feb. 1 thousands of Central Texans could lose access to some of the most-relied-on hospitals and medical facilities in the area.

By BCBSTX's own count, about 66,000 of their members accessed Ascension providers or facilities at some point last year, so about that many people could be affected if Ascension becomes out-of-network for their members. (Although, importantly, Blue Cross always covers emergency room visits for serious or life-threatening ailments, regardless of whether a hospital is in network.)

Ascension has not responded to the Chron­icle's questions, but announced in a statement that they're looking for a "commitment to reasonable terms." Meanwhile, BCBSTX's own statement points out that Ascension "is already one of the most expensive health systems in the Austin and Central Texas area. As a customer-owned health insurance industry leader in Texas for more than 90 years, it is important to stand up for affordable care."

Although, as a nonprofit, Ascension describes profits as "excess of revenues and gains over expenses and losses" and avoids more than $1 billion each year in taxes, its CEO earned $13 million last year, per the December 2022 New York Times report. A former CEO, who in 2007 said, "We are a [Cath­olic] ministry. We're not a business," now leads the nonprofit's investment arm and earned about $11 million in his first year in that role. The Times found that while executive salaries swell, Ascension has been running on skeletal hospital staffs to bolster the bottom line – "emblematic of the industrywide movement to keep labor costs low."

To understand how that model affected patients, the Times focused on hospitals in Illinois and Michigan where nurses had started unions. They found delayed surgeries; patients who had waited for hours on gurneys with serious, time-sensitive ailments; and instances of patients with gaping bed sores because nurses weren't able to reposition them often enough.

In September, staff at Austin's own Ascen­sion Seton Medical Center unionized. Samantha Steel, an eight-year Ascension employee, declared that "nurses are performing more than just their nursing job. A lot of times they're having to do the clinical assistants' jobs, the janitorial jobs. The desk clerks have been reduced [and] charge nurses are having to answer phones that are ringing nonstop. Charge nurses are having to take patients because we don't have enough RNs."

Ascension's partnership with Central Health to treat low-income Central Texans has also been on shaky ground since at least last May. Starting in 2012, the two have collaborated to provide health care to 25,000 Medical Access Program (MAP) members, low-income uninsured locals. But per an op-ed submitted by Ascension Texas to the Chronicle in May, "We stand at an impasse with our longtime partner." It explained that demand for medical services has exceeded the program's 25,000-patient design by about 4,000 patients, but "Central Health has refused to provide funding to support Ascension Seton's care of these additional MAP members. This budget shortfall now runs in the tens of millions of dollars."

So, what's to become of Ascension hospitals if 29,000 MAP patients and 66,000 Blue Cross members are largely cut off from their facilities? We'll sniff around and let you know what we find out.