Uneven Results in North Carolina Indicate that New Nonprofit Hospital Rule Might Work

316261297889322-xlNew Orleans   A combination of factors has curbed some, but not all, of the appetite for nonprofit hospitals’ frenzy of legal actions against lower income families in North Carolina, giving hope that the new Affordable Care Act restrictions against draconian collection practices might actually be effective.

We have been following closely whether or not nonprofit hospitals are modifying their behavior around the country in the wake of the final IRS and Department of Treasury rules that will require them to be much more effective in allowing lower income families to access charity care at the peril of their own tax exemptions.  Much of what we have seen while examining IRS form 990s, which the hospitals are required to file annually with the IRS, has not been encouraging given that all of these institutions have known this was coming since 2010 when Obamacare became law.  The leisurely four years until the rules became finalized at the end of 2014 should have allowed mountains to be moved in normal behavior and now that we are entering the penalty phase, the battle lines are being formed.

North Carolina may become one of the more interesting ones.  The passage of the Act and its amendments involving charity care prompted an investigation in 2012 by the states big newspapers, including the Charlotte Observer, in the biggest city uncovered 40,000 lawsuits that the state’s nonprofit hospital has filed to collect debts.  The headlines led to a happy confluence of forces with the legislature passing a law restricting emergency collection practices much like the language in the federal statute.   An updated review of the court records by the newspapers indicates that some hospitals have attempted to comply, others are scofflaws, and some cleaned up their act completely.  On the whole that’s good news and a potential harbinger of good things to come for the rest of the country as well.

A recent story by Ames Anderson and David Raynor in the Charlotte Observer,

…found that lawsuits by the state’s hospitals dropped by more than 45 percent from 2010 through 2014 – from about 6,000 to 3,200. At Carolinas HealthCare System, the state’s largest hospital system, the drop has been even sharper. The Charlotte-based hospital system filed about 1,400 lawsuits against patients last year – roughly half the number it filed in 2010.  One hospital, Iredell Memorial in Statesville, has stopped filing lawsuits against patients. In 2013, it was one of the state’s most litigious hospitals, filing about 270 bill-collection lawsuits. Last year, it filed none.   Lawsuits have also slowed to a trickle at two other hospitals: High Point Regional Hospital, which has recently joined UNC Health Care, and Lexington Medical Center, owned by Wake Forest Baptist Health.

More than 3000 cases is still a lot, and 1400 in one year from the Carolinas HealthCare System is outrageous, but progress is progress, and now with a powerful stick coming into the hand of advocates and organizations in North Carolina that could threaten and remove the hospitals’ tax exempt status, we might see more hospitals devoting themselves to their nonprofit mission like Iredell Memorial.

This is clearly a fight, but seems increasingly like one that we can win.

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Please enjoy Hurricane by Blues Traveler, Thanks to KABF.

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A Work and Time Time Test for Public Housing Tenants

Frankfort   Hidden in plain sight in the Obama Administration budget proposal before the U.S. Congress now is a potentially huge and unsettling change in the way that public housing is administered.  The budget seems to envision an expanded requirement that living in public housing could require proof of a job and could be time limited.

             Of the more than 3000 public housing authorities, HUD has only approved experiments along these lines in less than 40 communities according to a recent article in the Wall Street Journal.  Nonetheless, the new budget proposes opening up such work requirements and time limits broadly.  Housing advocates, including the National Low Income Housing Coalition have correctly warned that such requirements could end up ejecting lower income families and exacerbating homelessness.

             Some local housing authority officials have somewhat disingenuously lobbied for this new eviction flexibility based on the scandalous size of the waiting list for public housing that numbers thousands and thousands in virtually all large cities and often means delays of a decade or more before a family on the list actually acquires an affordable unit in public housing.  The painful paradox is that even as the waiting lists have been growing over the last 30 years, the number of public housing units available has been drastically reduced as a curious matter of national housing policy in both Democratic and Republican Administrations.  Now rather than seize the bull by the horns and enable local housing authorities to increase the number of available units by adding capacity, the Obama Administration is planning to run from the problem by simply allowing more time stamped evictions and work tests even while everyone acknowledges the painfully slow pace of new employment being created as the country theoretically leaves the Great Recession.   How do they come up with this stuff?

             Why not accelerate job creation programs in public housing through public works that recycles families into private sector housing or increase section 8 vouchers and prioritize recruitment and allocation of an expanded voucher program with a preference for public housing tenants to allow them to exit?  I thought Republicans loved vouchers if they deteriorated support for public institutions?  There are probably a 100 better ideas that others could list as well.

             The one thing that seems clear though is that we can not solve the crisis of our affordable housing shortage by creating specious grounds for eviction from the few available units left.  We need to have a solution for these problems, not a willingness to trade bad problems now for even worse problems in the future.

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