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Show Burdens Encountered By the Uninsured in the Search for Hospital Care: Are Tax-Exempt Hospitals Fulfilling Their Charitable Obligations: Jennifer M. Lambert who don't got $250 grand in their bill fold. To shame a man like that and back him into a corner, seems to me that something is outta whack, not someone...." Although John Q fictitiously displayed a radical approach to obtaining healthcare, the film demonstrated the desperation of, and unfairness to, those in our society who are unable to pay for medical treatment. Unfortunately, as Dan E. Jones, Political Science Professor at the University of Utah and professional pollster, once stated, "people don't care about health insurance until they need it and don't have it" (2004). Thus, this essay provides three objectives. The first is to define the uninsured and the increasing barriers faced by the uninsured and underinsured in their search for hospital care, including recent discoveries behind aggressive hospital billing practices. The second objective of this essay is to determine the obligation of hospitals to care for the medically uninsured, by providing comparative data between not-for-profit and for-profit hospitals, and to explain the federal standards and obligations required of tax-exempt hospitals. Finally, this essay provides information from an independent survey conducted by the author, of Utah's not-for-profit and for-profit hospitals, in an effort to determine if Utah hospitals are fulfilling their charitable responsibilities. Defining the Medically Uninsured Clarification of terms is important to understand the difference between the uninsured, underinsured, and insured, although the uninsured and underinsured are often referred to together. To note, the political terminology for the uninsured is "medically uninsured." The medically insured (hereafter referred to as "insured") are those individuals "whose interests are protected by an insurance policy, or a person who contracts for an insurance policy that indemnifies him against loss of...health" (WordNet 2004). A medically underinsured individual (hereafter referred to as "underinsured") is defined as one who has some health insurance, which would cover catastrophic events, but not enough to cover all healthcare needs and costs. An individual known as medically uninsured (hereafter referred to as "uninsured") lacks health insurance of any kind (Robert Wood Johnson Foundation 2004). For further reference, the term uninsurance refers to the adjective of uninsured. Reasons for Uninsurance The number of uninsured individuals has exceeded 44 million in the United States. Although it is difficult to determine why each of the 44 million is uninsured, there are two universally-accepted reasons. The first reason is the soaring cost of health insurance premiums that many individuals cannot afford. Second is the lack of employer-based healthcare. Due to the high costs of health insurance premiums, a number of small business employers do not provide insurance to their employees. Much like the fictitious John Q. Archibald, near- ly 70 percent of the uninsured are employed, but either lack coverage or the necessary benefits to provide them with needed care. Although it is true that "not all employees are eligible for their firm's health benefits and not all who are eligible choose to participate in them" (Kaiser Family Foundation and Health Research and Educational Trust [KFF] 2003, 50), statistically it is proven that fewer employers are offering benefits to their employees. In 2003, the number of companies, with three to nine workers, that offered health benefits was only 55 percent, the lowest percentage since 1996. 65 percent of all small firms in 2003, comprised of 3 to 199 workers, offered benefits, again, the lowest since 1996. In contrast, 98 percent of all large firms of 200-plus workers offered health insurance in 2002 and 2003, ironically the lowest percentage in over seven years (KFF 2003, 41). The consequences of the uninsured on the community are not difficult to identify. Where there are disadvantaged individuals, the immediate community will be indirectly responsible for the deficit. Such costs to the community occur not only in healthcare, but in education, housing, and other lost community benefits. Options For The Uninsured The government has provided a number of programs to protect the indigent, among which are the Federal Government's Medicaid and Medicare programs, which provide government subsidies to the poor, elderly, and disabled. The eligibility standards of many government-provided healthcare programs are contingent on income level. As previously mentioned, many individuals without health insurance are employed. Many of them do not and cannot qualify for the meager income levels that would allow them to receive care under Medicaid. For example, an individual with an annual income of $8,980 would meet the Federal Poverty Guidelines at 100 percent. A family of three with an annual income of $15,260 would also be at 100 percent of the Federal Poverty Level (FPL). And a family of four with an annual income of $18,400 would be at 100 percent of the FPL. These individuals or families would likely be eligible for the Medicaid program, which has been designed to benefit the severely indigent. Realistically, though, many individuals and families have income above 100 percent of the FPL, yet cannot afford health insurance. The dilemma occurs for individuals and families who do not meet these criteria: they have a minimal income, do not receive health insurance through employment, cannot afford the high monthly health insurance premiums, and do not qualify for government-assisted programs. In a state of medical emergency, like that of the son of John Q, the ability of these individuals to pay for hospital and medical care is questionable. 24 |