What’s the issue: Truman Medical Centers, with campuses near Lakewood and on Hospital Hill, is the area’s only safety net hospital. Critical funding is at stake, and Congress this week only passed a stopgap measure to address it.

How does it affect me: About one-fourth of TMC’s patients lack health insurance. It provides more than $100 million a year in uncompensated care – one-third of that for residents of Eastern Jackson County.

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In passing legislation to keep the federal government running through mid-January, Congress left safety-net hospitals hanging on a question of funding for indigent care.

Before adjourning for the year, Congress approved spending to avoid shutting down the government, and it extended the Children’s Health Insurance Program for several weeks. Families USA says about four young Americans out of 10 are covered by CHIP or Medicaid.

The vote by Congress was meant to signal to states that they should not start shutting down CHIP programs and that it will come back to leaders’ promises earlier this year to reauthorize CHIP and pay for it for another five year.

But another piece of that puzzle puts hospitals at risk.

Truman Medical Centers relies on $12 million to $14 million a year in government payments to offset care it provides and that patients cannot pay for. TMC says its annual uncompensated care is $101.2 million – $34.8 million of it for Jackson County residents outside Kansas City.

So budgets are lean, and TMC runs on an operating margin of 1 to 2 percent, “which is pretty typical of safety-net hospitals,” said President and CEO Charlie Shields.

Shields points out that TMC is not only the lone true safety net hospital in the metro area, but it’s the only one in the state. Its Lakewood campus in Eastern Jackson County and Hospital Hill campus in midtown Kansas City account for more than one birth in 10 in all of Missouri.

The state of Missouri has been withholding those federal uncompensated care payments since summer because Congress hadn’t permanently reauthorized them. Shields said that could put hospitals such as TMC in a cash-flow bind. Congress has talked about extending those payments for another two years, and Shields said indications are that that will happen early in the new year.

“Our cash position is good, and we’re not in panic mode,” he said.