Tag Archives: medical debt

Paying for Coronavirus and Medical Debt

Pearl River     Ten percent of Americans have absolutely, flat-to-the-bone, no health insurance.  Many others have Trump-plan insurance with high deductibles, covering nothing much at all, but maybe catastrophes up to certain lifetime payment levels.  Many of these same people are exactly the people who have to work, rain or shine, not because they are delivering the mail, although those folks are on the job as well, but because they are the underpaid infrastructure of the service economy from health care to food service to almost anything you can name.

Yesterday, one of the consumers at ResCare, a large national company where we represent workers in Lafayette, Baton Rouge, and New Orleans in their community home operations, tested positive for coronavirus.  He’s still in the home, although with others.  Three of our workers are exposed.  There is no personal protective gear other than gloves, and in having forced the company to share their policies, not much of a plan for the consumers or workforce on any deep and serious level.  The minimal health policy the company offers that complies with the Affordable Care Act takes the fully allowable 9% of wages and then requires a deductible of over $4000, which was not capped by Obamacare.  Out of some 250 workers, less than five, and I’m being liberal here, actually participate, yet all of them are barred from the subsidies and supports available on the ACA marketplace, because their company offers something that is called health insurance and in compliance.  We’re on this like white-on-rice, but if any of our workers get the virus, they could be in big trouble.

Testing is free, reportedly, and the stimulus package forces insurers and employers to cover the tests.  Of course, if you hit the doc and don’t have the virus, that’s good news with a but…since you could still owe for the visit and a copay.  If you have it, the treatment will cost you.  The Wall Street Journal estimates low end $1300 out-of-pocket, but with major complications more than $20,000.  You could also have surprise bills of course, because despite bipartisan agreement, the lobbyists managed to sidetrack Congress this year on that problem.  Of course, if these lower waged, essential healthcare workers had managed to sneak onto Medicaid, under the Louisiana expansion, rare in the south, there would be no cost.  In Texas, no such luck, and same for a bunch of other states like Mississippi, Alabama, and the rest.

If they lived through it, welcome to medical debt.  On Wade’s World,  I was talking to an old colleague, Chuck Shuford, who has become an advocate demanding action on medical debt in rural Virginia where he lives now.  He talked about RIPMedicalDebt.org, where he has become involved.  They buy debt for pennies on the dollar.  Churches and others have pitched in to get rid of millions in debt, and they have created a special fund for Appalachia.

That’s a good thing, but for ResCare workers or anyone in the United States, there shouldn’t be any medical debt.  Period.  Why do we allow such a system?  Isn’t the coronavirus teaching us to build a better system?

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Nonprofit Hospitals Are Going to Have to Prove They are Not Wolves in Sheep’s Clothing

medical-bills1-660x330Little Rock     For many top executives and CEO’s it easy to imagine that running a big urban nonprofit hospital has been a sweet gig.  Looking at some of the 990’s that all nonprofits submit to the IRS annually, salaries in the millions are not unusual at some of these big hospitals and many make millions all down the corporate flow chart. They are big whoops in their local communities with thousands of jobs and money to spend and, hey, for all that the regular folks out there know — they’re doing fine, while doing good. Luckily for their patients and the whole community, their world is going to have to change.

Modern Healthcare, the industry’s bellwether magazine, reported recently on the shivers running through many nonprofit hospital CEO’s spines as they absorbed the new world in which the courts and the Federal Trade Commission are no longer willing to take their word for it when they say that mergers and consolidations in their markets will just mean better patient care, when it is clear that they will also create healthcare monopolies able to charge escalating prices on a captive market. A federal appeals court has ordered St. Luke’s Hospital in Bosie, Idaho to unwind their purchase of a major area medical practice, the Nampa, Idaho-based Saltzer Medical Group.  The court essentially said that they could hear St. Luke’s saying it would be better for the community and patient care, but in fact St. Luke’s would have to prove that it wasn’t really much more than an attempt to build a health care monopoly with no price controls.  The FTC had earlier delivered a similar blow to an Ohio hospital, and the head of the FTC has been speaking loudly and clearly in recent months about the agency’s skepticism towards healthcare mergers now.And, then of course you have the fact that nonprofit hospitals are going to have to toe the line because of the new rules from Treasury and the IRS being implemented under the Affordable Care Act. As we assemble our “volunteer army” to look at the 990s for nonprofit hospitals in Texas, Arkansas, and Louisiana, we’re already seeing enough to turn our stomachs.  A billion dollar children’s hospital that claims to spend only $6 million in charity care and some of that is suspect, along with huge fundraising efforts that seem mainly about politics, public relations, and marketing and in fact lose money at year’s end. So-called “community benefit” items included under charity care by other nonprofits that are also in many cases simply marketing efforts dropped into the category.  Many are simply self-serving like one outfit that put the cost of training its doctors as a community benefit under charity care.  I get the feeling when Local 100 finishes pulling all of these pieces together it’s going to make our hair burn and our hearts’ hurt.St. Luke’s in Idaho is a bit far out of our range, but looking at their particular cut on the twisted reality of all of these matters gives me a feeling that they also are going to have many lessons to learn. In their Q&A section they are careful to point out that they are nonprofit and exempted from some taxes, and in their view that requires them to invest in expansion and new services. How about charity? No mention of that. In fact in their self-presentation they have a unique way of describing for their whole hospital system how they see charity. Here’s how they explain their munificence when it comes to handling Medicaid:

The amount of money St. Luke’s receives from Medicaid is an indication that St. Luke’s provides care to a large number of Medicaid patients. In fact, St. Luke’s provides more care to patients covered by Medicaid than any other health care provider in the state.  Medicaid pays hospitals well below the cost of providing care to Medicaid patients.  The costs that count for Medicaid purposes do not include all of the hospitals costs, so the reimbursement is even less on a percentage basis than it would appear.  Because Medicaid pays below cost, a higher volume of Medicaid funding results in lower net revenue for the hospital.  In other words, on balance, St. Luke’s pays to see Medicaid patients because we spend more on the care of the patient than we receive in payment for the care we provide.

What a unique argument!  St. Luke’s “pays” to see the poor, because they believe that Medicaid reimbursement rates are low compared to their view
of their market pricing.

In a similar bit of double-speak, St. Luke’s communicates in totally imperial and oblique terms their collection policy for the poor Idahoan
that cannot pay the sticker price.

If a patient has difficulty paying their medical expenses, St. Luke’s Patient Financial Services works with them to determine what options are available for assistance, including a possible payment plan.  If it is determined that a patient can pay all, or a portion, of their medical bills but chooses not to do so, St. Luke’s refers those accounts to a collection agency to help collect payment from patients. St. Luke’s may charge interest on outstanding accounts depending on the circumstances.

“Chooses” not to do so?”Interesting.  Probably the same way they “choose” to be poor or unemployed or even for that matter, sick and in the hospital in the first place.  It doesn’t take much imagination to believe that St. Luke’s is taking a page out of the now notorious Heartland Hospital’s playbook in St. Joseph, Missouri.We’re doing the work, but we can already tell even as we get started that we are not going to like what we find, but neither are some of these nonprofit hospitals, because change is coming. There are way too many wolves in sheep’s clothing seeing nonprofit status not as a mission but as a tax dodge.
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Please enjoy Modern Times by Dropkick Murphys

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