Retiree Lee Johnson went in for knee surgery at a hospital in Seattle, and came out with a bill for $30,000, even after his insurance paid its share of the costs. No one at the hospital told him about the availability of charity care. So, to pay off his debt he took on a new one by refinancing his home. He believed it to be the only option in addressing the medical bill.
Soon, he found himself fighting to save his house and avoided foreclosure only after a costly legal battle.
Around the country, hospitals are hitting low-income patients with astronomical debt, demanding deposits before offering needed care, garnishing wages, sending collections agencies after patients, putting liens on property, and taking patients to court. A recent investigation by ProPublica found that “[i]n Missouri alone, hospitals and debt collection firms working for them filed more than 15,000 suits in 2013.”
The Affordable Care Act (ACA) is designed in part to prevent this kind of abuse – and it gives community groups new tools for doing just that.
Getting people insured isn’t the only thing the 2010 law does. Although expanding coverage is certainly the ACA’s main goal, it aims to change our health care system more broadly, recognizing that health insurance, standing alone, won’t guarantee affordable care for everyone. (Lee Johnson knows this from his own unfortunate experience.) For that reason, the ACA also calls on non-profit hospitals – key health care institutions – to better meet the needs of their communities and play an active role in promoting community health.
Under new rules, non-profit hospitals must adopt written financial assistance policies and publicize those policies – and provide interpretation and translation. The new rules also introduce limits on how much hospitals can charge patients for certain services and when they can use “extraordinary” collection tactics.
That’s not all. Now non-profit hospitals also must develop community health needs assessments and implementation plans addressing those needs. With these plans, they can go beyond health care and tackle the causes of health problems, such as barriers to healthy diets.
But community organizations shouldn’t wait for hospitals to act on these rules – which leave a lot of blanks to be filled in. If we want to see the ACA implemented well, we need to let hospitals know how we expect them to meet their new obligations.