| OCR Text |
Show Hingkley Journal of Politics 2005 outstanding bills that are discounted after collection attempts are unsuccessful, advocacy groups argue that it should not be considered part of the total amount of charity care a hospital provides. Furthermore, horrific stories relating to the aggressive, unethical treatment by hospital collection agencies toward uninsured patients have emerged. In June 2000, Marlin Bushman, a truck driver from Champaign-Urbana, Illinois, was awakened to the police Pounding at his front door. Upon answering the door he was arrested for missing a court hearing that was scheduled for an outstanding hospital bill of $579. Mr. Bushman was booked at the local jail and guaranteed discharge upon payment of $2,500 (Lagnado 2003, A10). The same hospital chain obtained an arrest warrant for Kara Atteberry, an uninsured single mother. Ms. Atteberry had incurred a $1,678 hospital debt due to a miscarriage. After missing two court-ordered appearances, she too was arrested. Her hospital fees then totaled $2,070. Mr. Bushman and Ms. Atteberry had both initially attended their court appearances, at which an attorney for the hospital worked out an unfeasible payment plan. When they Were each served with another court-ordered appearance after failing to meet the terms of the payment agreement from the first court date, Mr. Bushman and Ms. Atteberry failed to meet their second appearances. They both expressed a fear of having no representation on their behalf and again facing the whole hounding process" (Lagnado 2003, A10). Mr. Bushman and Ms. Atteberry are not alone; they are among the 44 million uninsured individuals in the United States. Worse, Families USA reported that 82 million people were uninsured at some point within the past two years (U.S. House Energy & Commerce Subcommittee Hearing 2004). Although such practices seem harsh and irrational, it has come to the attention of the public, as well as the United States Congress, that many hospitals have participated in unfair and aggressive billing practices to retrieve outstanding bills from the uninsured. A number of hospitals have been charged with putting liens on patients' homes and garnishing wages. The effects have been devastating; many individuals have declared bankruptcy (Community Catalyst 2003, 31). The media and patient advocacy groups have responded by publishing reports and news articles exposing hospitals that have unjustly billed uninsured, indigent individuals. Their findings indicate that many hospitals bill the uninsured anywhere from a 310 percent to a 1,000 percent mark-up of the charge master price (U.S. House Energy & Commerce Subcommittee Hearing 2004). The charge master price is the catalog price of all services and supplies offered at a hospital. Unlike the uninsured that have no one to negotiate on their behalf, HMOs negotiate hospital prices lower than the charge master price in behalf of their insured. Likewise, individuals who qualify for government-funded Medicaid or Medicare programs are also protected by a third-party to bargain for lower hospital charges. Because the uninsured have fto one to advocate their cause, they are often charged such outrageous mark-up prices. Worse, the uninsured who could likely qualify for low-income and uninsured programs are not informed of existing charitable programs, or of hospital obligations and policies. Government Investigations and Legislation In order to address discrepant hospital charges and unfair billing practices, Congressman Joel Hefley (R-CO), introduced H.R. 4092, the "Hospital Billing Fairness Act of 2004" on March 31, 2004- This legislation proposed to "amend title XIX of the Social Security Act to require fair billing for hospital services provided to uninsured patients as a condition of Medicaid funding for a hospital" (Hefley Hospital Billing Fairness Act of 2004). "H.R. 4092 would amend the Social Security Act to limit such charges to individuals without insurance to 125 percent of the Medicare rate, as a condition for receiving Medicaid funding" (Washington Outlook 2003). The Act would require hospitals to apply for and receive federal certification of "fair billing practices," with non-compliance civil penalties in the neighborhood of three times an "overcharge" amount.... In effect, [Representative Hefley's bill would] condition eligibility for Medicaid payments on hospitals' commitment to cap charges to the uninsured at no more than 25 percent more than that which Medicare is charged (emphasis in original) (Washington Outlook 2003). The government has further investigated hospital billing practices by producing a series of hearings related to the fair practices of hospital billing. On June 24, 2004, the United States House of Representatives Energy and Commerce Subcommittee on Oversight and Investigations held a hearing entitled "A Review of Hospital Billing and Collection Practices," to address the unfair billing practices of the uninsured. The hearing came in response to raised "public health and consumer protection issues," as stated in a letter sent to twenty national hospital chains on July 16, 2003 (Washington Outlook 2003). Among those that testified at the hearing were the top officials and directors from the nation's leading hospital organizations and academic institutions, including Mr. Jack Bovender, Jr., Chairman and Chief Executive Officer of Hospital Corporation of America (HCA); and Dr. Sara Collins, Senior Program Officer of the Commonwealth Fund. During the hearing, Dr. Gerard Anderson, Director at Johns Hopkins Schools of Medicine and of Public Health, testified that only one in twenty-three self-pay or uninsured patients is able to negotiate lower hospital bills. Sadly, nearly half of all bankruptcies are due to medical bills. Mr. Mark Rukavina, Executive Director of the Access Project, further reported that half of Americans had problems with medical debt, many of whom used all or most of their life savings to pay for medical bills (U.S. House Energy & Commerce Subcommittee Hearing 2004). The legislation introduced by Congressman Hefley, and the hearing by the House Energy and Commerce 27 |
