Tag Archives: hospitals

Holding Hospitals Accountable in Washington State

Washington Can Protests Budget Cuts at the State Capital

Washington Can Protests Budget Cuts at the State Capital

Little Rock        Like most people, I’m pretty sure the quality of my life is directly improved in proportion to my ability to avoid this strangely named thing called “webinars.” Surely, that’s a weapon that is used in some old Star Wars movie, not an organizing tool?

I’m not going to change my mind about webinars, I don’t think, but this one organized by the Alliance for a Just Society was playing our song about how to force hospital accountability, and all of our team wanted to learn every chorus. Listening to the presentations by Will Pittz of various hospital campaigns waged in recent years by Washington Citizen Action Network was a joyous sound. It was almost embarrassing how many questions our folks were asking, but we were hungry for this.

Washington CAN detailed campaigns that they have fought in Tacoma, Seattle, and Spokane with both nonprofit and for profit hospitals, including some in the huge Catholic and Deaconess networks that are among the largest in the country. One early insight Pittz shared that was worth the price of admission was that they had found for profits more responsive to meeting about improving charity policies than nonprofits, and not only did that resonate with our own initial experience where letters to nonprofits in Little Rock, Dallas, and Houston asking for a meeting to discuss these issues has thus far been met in silence, but was convincing that we needed to target them equally even though the Affordable Care Act handle on nonprofits is so much stronger. The nonprofits, rules and tax exemption be damned, are hunkering down hoping that they can continue to do business as usual and the patients and communities be damned.

Amazingly Washington CAN in fact had won a financial assistance policy at one for profit that set us back on our heels: 300% of poverty guideline eligibility for full charity care and at 500% of poverty 75% charity care. We had been assuming that we might be lucky to win a clear standard in Texas, Louisiana, and Arkansas at 200% of poverty for charity care from nonprofits, and the notion that anyone, anywhere could win this 300 to 500% standard is a game changer, and with a for profit unheard of.  At one point in the webinar, and OK, I’ve used it in a sentence, so I guess I’m now saddled with this preposterous word for life, Pittz asked the listeners if anyone had won or heard of a higher standard because it would be helpful to him to know. I don’t know Pittz, but he delivered the line sincerely without seeming to brag, but, believe me, there was nothing but silence in response to his call. This will be the gold standard for holding hospitals accountable in this campaign, trust me on that!

None of the Washington campaigns seemed easy. Their efforts were significantly resourced and determined, involving hitting 2000 doors in the area of one hospital, putting up 500 yard signs, and essentially throwing the kitchen sink at them. Not quite the sink, the PowerPoint, and, yes, I’ll admit I studied one of those bad boys carefully, too, it featured a cute tactic of holding a “debtor’s carnival” under a canopy on the grounds of Swedish Hospital in Seattle.

Washington CAN’s experience has led them to distill some standard demands not only on poverty guidelines, but also on brass tack items like the length and detail of the applications, which many of the nonprofits are using to discourage and disqualify desperate people, winning a straight forward 2-pager in some cases. They also have fought for – and seem to have won in some cases – the ability for patients to back file for charity care and by doing so extricate themselves from court and debt collection procedures, which is also huge. They did a group filing for charity care, which was right up our alley as well.

We’re going to drink this Kool-Aid and share it with as many thirsty organizers as possible!

 

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Using Local Property Taxes to Push Hospitals on Charity Care

shriverNew Orleans      John Bouman, the President of the Sargent Shriver Poverty Law Center based in Chicago was my guest on Wade’s World recently on KABF/FM talking about a number of subjects but especially the handles for pushing nonprofit hospitals to provide care for lower income families as part of their nonprofit status and especially their federal tax exemptions under the 501c3 classification of the Internal Revenue Service.  He continues to have hope that the Affordable Care Act can decrease inequality and particularly can advance racial equality since African-Americans and Hispanics have gotten such short shrift from the health care system of the country.  He argued vigorously, and correctly, that the Affordable Care Act was the most significant piece of social legislation passed and implemented over the last fifty years.

Bouman mentioned that in Illinois, thanks to unions and community pressure including from the old ACORN affiliates, they had enjoyed a version of the new national rule that forces nonprofit hospitals to actually deliver more free and reduced price health care to lower income families for some years.  Their rule seems like it might even be a model for best practices for all of the hospitals now under the federal mandate to produce a rule that would allow them to keep their tax exemptions.  The Illinois standard is transparent.  A family would be eligible for such care at 200% of the poverty level.  I like a “no ifs, ands, and buts” standard, and that’s what we need to push for everywhere.  The Illinois standard also was clear about remedial practices before more strenuous collection efforts.

Almost in passing, Bouman mentioned that in Illinois the state and some cities and counties also had the ability to punish hospitals that were scofflaws on the act or really just wolves in the sheep’s clothing of nonprofits.  I asked Bouman how could they do that, and he said of course they could take away any local or statewide property or revenue tax exemptions or allowances that they were getting as nonprofits with their charitable status.  Whoa, I thought!  We had overlooked the obvious handle there that could help us bring the fight to a very local level.

In Louisiana, where we might not have a chance with the state, the local assessors at the parish or county level are elected and often very close to the ground in terms of their responsiveness to community pressure and organizing.  Furthermore, there are absolutely property tax exemptions enjoyed by all of the big, and many of the small, tax exempt organizations from the huge outfits like the universities and colleges as well as the small housing operations holding properties for development.  Immediately, I could see organizationally how we could challenge a host of property tax exemptions that are worth millions.

In Arkansas, a quick look comes down to a test of how “public” the service or facility might be.  My point is that in each state and in many local jurisdictions there might be handles available to increase the pressure for hospitals to do right. The fight itself might be enough to force some change, as we have already seen in the reaction of St. Joseph, Missouri’s Heartland Hospital and its jump to attention when they received an inquiry from Iowa’s Senator Charles Grassley asking them to defend their exemption given their collection practices.

It might be one thing for nonprofit hospitals to turn their backs on community organizations and unions asking about their policies and asking them to do better, but it would be a whole different problem if they had to defend such inadequate programs and cutthroat collection efforts in public before a board of adjustment, an assessor, a tax equalization board or any other public forum.

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Please enjoy The Danielle Nicole Band’s You Only Need Me When You’re Down, thanks to KABF.

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