Truman Medical Centers faces significant challenges as the area’s only safety-net hospital, its president and CEO says.

“There’s no other true safety-net hospital in the state of Missouri,” CEO Charlie Shields told Jackson County legislators this week. The county’s annual subsidy of $9.88 million is included in the $314.81 million budget legislators are set to pass next week.

About half of that subsidy is for operations and about half is for debt service.

“We tend to operate on a 1 to 2 percent margin, which is typical for a safety-net hospital,” Shields said.

That could be in peril. The hospital gets $14.4 million a year from the federal government to offset some of the cost of care for those cannot pay.

Federal payments for uncompensated hospital care were supposed to go away under Obamacare because, as the law was written, every state would expand Medicaid coverage, leaving virtually no one without some form of health insurance. But Missouri is among 19 states that have not expanded Medicaid. Shields said 25 to 30 percent of TMC’s patients have no insurance.

TMC’s two campuses on Hospital Hill and at Lee’s Summit Road and Gregory together provide 12 percent of all uncompensated care in the state, Shields said. That’s $101.26 million a year, about one-third of it for residents of Eastern Jackson County.

The federal payments to help offset that expired Oct. 1, and Congress is working on restoring them. Otherwise, Shields said, TMC will slip into a budget deficit.

Legislator Crystal Williams, D-Kansas City, said the program in question – the Child Health Insurance Program, commonly called CHIP – serves low- and moderate-income families. CHIP covers kids in families with incomes up to three times the poverty level.

The cuts in question hit the middle class as well as poor people, she said.

“This is what we’re in danger of losing,” she said.

Shields said the two campuses have a long list of needed improvements. More neonatal ICU space is needed. TMC is the only area hospital still with “semi-private” rooms, that is, two patients to a room. Lakewood needs more space for family care and dental care. Two buildings at Lakewood dating to 1908 and 1928 are “frankly are just crumbling around us,” Shields said. He suggested a bond issue might be needed at some point.

The hospital is working to improve health care with more efforts in the community. It opened a clinic a few years ago in the Fairmount neighborhood of northwest Independence and is working with the Linwood YMCA in east Kansas City.

The idea is to improve health at a more basic, lifestyle level.

“We have to do that outside the four walls of the hospital,” Shields said.