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Show Hinckley Journal of Politics 2005 Burdens Encountered By the Uninsured in the Search for Hospital Care: Are Tax-Exempt Hospitals Fulfilling Their Charitable Obligations? Jennifer M. Lambert This article seeks to define the barriers encountered by the medically uninsured when searching for hospital care, and whether tax-exempt hospitals are fulfilling their obligations to provide charity care to the uninsured and indigent. First, the article outlines the problems facing the uninsured by exposing unethical hospital billing practices. Second, this article defines a tax-exempt institution in terms of a hospital, and the benefits and obligations associated with tax-exempt status. And third, this article rates Utah hospitals with an idio-graphic, nonprobability study in which seven Utah hospitals were asked about their charity and free care programs and policies. The author concludes by providing policy recommendations to better define charity care and regulate tax-exempt institutions to ensure compliance of a "charitable purpose." Introduction In February 2002, the fictitious Hollywood screen character John Q. Archibald, played by Denzel Washington in the motion picture John Q, brought to light a serious policy issue with regards to the uninsured and their search for hospital care in time of need (Cassavetes 2002). Washington's character, a low-income factory worker in the heart of Illinois, has his hours at the factory cut from full- to Part-time, adversely affecting his health insurance benefits. The plot emerges when Archibald's son, Mike, is diagnosed with a failing heart that requires a heart transplant to save his life. In a somber dialogue between Archibald and the hospital administration, he advises the head cardiologist, Doctor Turner, to proceed with the life-saving procedures by Putting his son on a heart transplantation donor list. His request is met with opposition from the hospital director, who explains that other considerations must be made before "a Prospective recipient can be placed on a donor list. Transplant surgery is very expensive, in most cases prohibitively so." John replies, "...We got insurance, major medical, he's covered." "We've already checked with your carrier, Mr. Archibald. There are no provisions in your policy for a procedure of this Magnitude." John and his wife exclaim with bewilderment, "But we got insurance." Unsympathetically, Ms. Payne, the hospital director, declares, "that may very well be, Mr. Archibald, but in the meantime, I'm afraid we're going to have to treat this as a cash account.... We require a down payment before we can put a patient's name on a receiver's list...30 percent-approximately $75,000." She continues with even less enthusiasm, "it costs money to provide healthcare. It's expensive for you, it's expensive for us." In a state of defeat, Archibald and his wife encounter another cardiologist as they leave the hospital. She clarifies, "talk again to the insurance company. Check with our human resource department for medical assistance; there's money there. There are children state services, and there's Medicaid. You find a way to keep [Mike] here. Just don't take 'no' for an answer." The Archibalds begin the quest for medical aid, which commences with the insurance carrier, who informs them that their policy was changed from a PPO to an HMO to reduce costs. After an exhaustive, discouraging search for coverage, and failure to raise the required $75,000 to keep Mike in the hospital, John takes the hospital emergency room hostage out of desperation to save his son's life. Amidst the crisis in the ER, John's colleague and good friend James Palumbo declares in an interview outside the hospital, "I got to be honest, this whole thing sucks. I mean, it all could've been avoided so incredibly easily. I mean, none of this had to happen if John had just been a freaking millionaire, right? Or if his name was Rockefeller.... There's a lotta people out there 23 |