Hospitals Forced to Comply with Charitable Care Standards in
the US
Charitable care nationally represents
only 1.4% of hospital operating costs, yet these behemoth money making
corporations still seek to deny care to those most in need, often causing
people to defer medically necessary procedures or forcing them into bankruptcy.
Does being a working-class person mean your health is less important-I think
not. Read this article to learn more about laws that protect your rights to
obtain health care in the United States. The Patient Protection and Affordable Care Act requires
hospitals to offer charity care and to inform patients of their rights
and eligibility for free or reduced cost health care if those facilities accept
any federal reimbursements. (Congress, 2010)Many hospitals have
not complied with this federal law, resulting in multitudes of lawsuits from
Attorneys Generals and private citizenry. This article reviews these actions
and results benefiting patients and the general public.
A 2019 lawsuit against St. Joseph Hospital of Tacoma,
Washington by State Attorney General, Bob Ferguson found that the
hospital had repeatedly violated the state Consumer Protection Act by not
informing patients of their right to reduced cost health care under charitable
care provisions. As a result, this hospital and all the others owned by CHI
Franciscan, a nonprofit Catholic health care entity, were required to forgive 20
million in debt, refund 2.22 million for patients who were hornswoggled, and to
restore their credit. Most egregious was the hospital’s practice of turning its
own employees over to debt collection rather than providing them care
assistance. Additionally, the hospital group had to pay the Attorney General’s
Office 2.46 million. Further, this settlement was only for a five-year period
from 2012-2017 and impacted over 5,400 people who had received care. (Washington State Attorney General's Office, 2019)
This opportunistic behavior continues unabated, in 2022, State Attorney General, Ferguson sued Providence and its Swedish Hospital affiliates
for failing to provide patients with the charitable care to which
they were legally entitled. Providence
hospitals are located across the state, from Seattle to Walla Walla and in many
cases are the only hospital in a community. As a testament to Providence’s management, 54,000
people were sent to collections even though it knew they were eligible for
charitable assistance and many should have had their bills forgiven in entirety.
In this lawsuit the Attorney General is asking for 70 million in damages. (Washington State Office of the Attorney General,
2022)
As cited in the Center for American Progess, seven of the
ten most profitable hospital groups in the country were nonprofits. (Gee, 2022)
State Charitable Care Mandates
Washington
Requires hospitals to make charity care accessible to patients
whose income is at or below 200 percent of the Federal Poverty Guidelines.
Hospitals are required to:
- Provide notice of the availability
of charity care both verbally and in writing
- Screen patients for charity care
eligibility before attempting to collect payment
- Only require patients to provide one
income-related document to prove charity care eligibility
Oregon
In 2019, Oregon began mandating charitable care standards for hospitals and clinics to offer free or reduced-price health care. It requires free care for anyone within 200% of the federal poverty limit (FPL) and discounted care for those within 400% of the FPL. (Tiel, 2019)
California
California has had a Hospital Fair
Pricing Act since 2007 and California’s largest public hospital was found to
have violated the act and as of June 2023, to notify its 43,000 patients they
may be eligible for charitable care refunds and billing corrections because of this
settlement. This settlement was with Santa Clara Valley Healthcare. (Work, 2023)
In order to receive a state tax
exemption, hospitals must offer reduced price or charitable care to those whose
incomes are within 400% of the federal poverty level.
Charitable Care Mandates
for Other States
In 2019, states requiring nonprofit hospitals to provide a minimum level of charity care were; Illinois, Nevada,
Rhode Island, Pennsylvania, Texas, and Utah.
Colorado and New Mexico have new laws
that require medical facilities to assess a patient’s eligibility for financial
assistance before billing them. (Pitsor, 2022) Check your state
legislative site for updates on consumer protection regulations for healthcare
as there is much activity on this issue nationally.
Even during the corona virus, hospitals
have not stopped suing patients for unpaid bills. A Yale University found that
nonprofit hospitals were more likely to sue patients for unpaid bills than for
profit entities. (Gee, 2022)
Determining Community Benefit
After the passage of the Affordable
Care Act spending on uncompensated care for hospitals declined from 6% to 4% of
operating revenues, which is nearly half. So, as taxpayers we are subsidizing
their gratuitous profit making at the expense of people who need care. Definitions
of community benefit do not necessarily include care for those who need it the
most, and can include less medically urgent things like building walking tracks and various classes. This needs to change, because hospital care is critical access and
people who need it should not be bankrupt because of the avaricious behavior of
a few in corporate finance.
Studies have shown that some
nonprofit hospitals spend only a small portion of their community benefit
spending on services that help the community and a much greater percentage on
services that benefit the hospital (Wen et al., 2022). One study found that
for-profit hospitals spent a greater share of the total revenues on charity
care than nonprofit hospitals (Bai et al., 2021). These studies have raised
interest among policymakers in how to provide incentives for nonprofits to
increase the level of community benefit and charity care they provide. (Hossein, 2023)
Human Rights Watch published an article on the predatorial behavior of US healthcare hospital groups in 2023 and it is worth a read. https://www.hrw.org/report/2023/06/15/sheeps-clothing/united-states-poorly-regulated-nonprofit-hospitals-undermine
What You Can Do to Make Sure You Are
Not Overcharged
Federal law requires hospitals
operating as nonprofits to provide some level of charitable care and 58% of all
local community hospitals are in this category. Here is how you can assess
whether your hospital is within the guidelines and what you can do to make sure
you and your loved ones obtain the fair-priced health care that you deserve. Federal poverty standards, which determine assistance eligibility are listed in this link.
https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines
At a minimum if your family's income falls within 200% of the federal poverty level range you may be eligible for free or discounted health care. Ask about charity care
and demand to see the eligibility standards for the facility which is billing you. If they are reluctant to provide the information, this is all the more reason to discover it, because you probably are eligible for some discount. If you need
someone to advocate for you, have someone with healthcare finance experience write a letter on your behalf. Document everything. Record the
meeting with the financial representatives of the facility. And reach out to
your state Attorney General for guidance on how to proceed.
Hospitals, which are making tons of
money in the US do not want to appear “greedy,” but it is much too late for that
moniker for these behemoths. By way of example, Seattle-based Providence Health Care,
makes so much money it has its own venture capital fund. Methinks Americans
would rather pay less for their health care then finance someone else’s
capitalistic dream.
And this is the healthpolicymaven
signing off encouraging you not to sign blanket authorizations when you agree
to health care procedures. Do stipulate that for which you agree and which you
don’t and do have a medical guardianship or POLST agreement to see that is
enforced.
Roberta Winter is a freelance journalist
who accepts no money from healthcare industries for this column, opinions here
are her own. She is the author of a guidebook to the US healthcare system,
which focused on consumer information on how to access quality in care. https://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972
References
Gee, E. W. (2022, October 2022). Policies to Hold
Nonprofit Hospitals Accountable. American Progress. Retrieved
September 1, 2023, from
https://www.americanprogress.org/article/policies-to-hold-nonprofit-hospitals-accountable/
Hossein, Z. P. (2023, March 9). When States
Mandate Hospital Community Benefit; Provision Increases.
doi:https://doi.org/10.1097%2FJHM-D-22-00156
Tiel, R. (2019, September 17). WHAT OREGON’S NEW
HOSPITAL CHARITY CARE LAW MEANS FOR YOU. Retrieved from Our Health
Oregon.org:
https://ourhealthoregon.org/news/what-oregons-new-hospital-charity-care-law-means-for-you
Washington State Attorney General's Office. (2019,
April 26). Following AG’s charity care lawsuit, St. Joseph parent company CHI
Franciscan will provide up to $25 million in restitution, debt relief and
fees. Washington. Retrieved September 1, 2023, from https://www.atg.wa.gov/news/news-releases/following-ag-s-charity-care-lawsuit-st-joseph-parent-company-chi-franciscan-will
Work, M. C. (2023, August 14). Patients in
California County May See Refunds, Debt Relief From Charity Care Settlement. KFF
Healthcare News. Retrieved September 1, 2023, from
https://kffhealthnews.org/news/article/charity-care-settlement-debt-relief-patient-refunds-santa-clara-california/?utm_campaign=KHN%3A%20Daily%20Health%20Policy%20Report&utm_medium=email&_hsmi=270170941&_hsenc=p2ANqtz-8SNEPlsuaEb7MYh2zoC5ruEMhnT1k7kNjPPr7
