The push to change the rules is based on the concern that the offer of free or discounted care deters patients get coverage subsidized by the government.
If a patient is eligible to buy subsidized coverage through health markets online but not recorded, “Should hospitals provide charity care to the same level of generosity as they did previously?” Peter Cunningham, an expert question health policy at Virginia Commonwealth University.
Most hospitals still struggle with this question, but few have advanced and changed their programs, says Cunningham.
For example, the online charity care policy at Southern New Hampshire Medical Center in Nashua, now states “that apply who have rejected buying health coverage, which is now mandatory under federal law, despite being eligible, will not be beneficiaries of charity care. “
The same rule disqualifies helps those who refuse to apply for expanded Medicaid expansion state representatives who voted in New Hampshire, which begins Aug. 15 programs.
Some hospitals ask for a nominal contribution
In BJC HealthCare, which has 12 hospitals in Illinois and Missouri, including Barnes Jewish Hospital in St. Louis, everyone who receives financial assistance should make some contribution to their care, for example, $ 100 for emergency care. BJC restringela no financial assistance to those who refused to buy insurance through the health care law.
While all uninsured patients have a 25% discount on the listed securities, BJC gives additional to those earning up to three times the federal poverty level, or $ 35,000 for an individual discounts. Previously, these additional discounts were available to those earning up to four times the poverty level, or about $ 46,000.
“Patients will continue to receive the medical care they need, regardless of their ability to pay at time of service,” says spokeswoman Kim Kitson, adding that these regulatory changes affect less than 3% of patients.
Indeed, hospitals have a strong financial interest in having more patients with medical coverage. And this is particularly true of hospitals that many patients are uninsured because health law also reduces government payments for uncompensated care.
The assumption was that most of the uninsured would gain coverage and those huge bills that would end no one could afford. But since the Supreme Court ruled that states could choose not to adhere to the law that provides for the expansion of Medicaid, 24 decided not to participate. Hospitals that treat a large number of low-income patients in those states face real financial pressures.
The law also requires health policy charity of nonprofit hospitals are widely available, however, does not specify what criteria should be used hospitals to determine who is eligible. Assistance programs are not just for the uninsured: most hospitals help patients with insurance who are struggling to pay deductibles or other costs associated with medical care.
“Even those with health insurance are ‘unlocked’ by an increase in the percentage of health care they need” because many have higher annual deductibles, said Steven Lipstein, president and CEO of BJC HealthCare, in a column published in The St . Louis Post-Dispatch.
Yet, while the health care law changes the insurance market, “we are seeing reductions in charity care,” says Michael Miller, director of strategic policy at Community Catalyst, an advocacy group in Massachusetts.
While Miller says health care law will result in more people with insurance, the need for financial assistance programs remains. Not according to the charity programs discourage consumers from registering for coverage as most other services need health care outside the hospital.
“It’s really premature for hospitals begin to boast that level of calculation is presented as someone who is not insured,” says Miller.
Does the patient will not or can not pay?
The hospital executives say they are considering many questions, to assess whether they change their policies. Do people decided not to enroll or were not able to browse the market for health insurance during the open enrollment in the fall and last spring? Can they afford coverage even without a subsidy, since many health plans have deductibles that may rise to thousands of dollars annually?
“This is something that hospitals have struggled for decades: the patient is unwilling or unable to pay ?, says Katherine Arbuckle, senior vice president and chief financial officer at Ascension Health.
In Ascension, one of the nonprofit hospital groups larger profit in the country, based in St. Louis, Missouri, a team of special work will make recommendations by the end of the year on whether to make changes.
“How do you treat those who refused coverage? Must receive free services where others have to pay ?, says Arbuckle.
While nothing has been decided, Arbuckle said that the chain of Catholic hospitals have ruled out any changes, arguing that they will not reduce the income threshold for those who qualify for free care, now twice the federal poverty rate. Ie around $ $ 23,340 for an individual.
Some hospitals are simply checking if their regulations meet the requirements of the health care law, said Todd Nelson, Director at Healthcare Financial Management Association, which represents more than 40,000 people working in health care finance.
Nelson is not we surprised that some require applicants to sign up for insurance.
“Hospitals have always encouraged patients to apply for coverage you are entitled to receive, whether through commercial insurance, employers, or programs like Medicaid,” he says.
Many hospital chains, including two of the largest, Tenet and HCA say they have no plans to change its policies on charity care. Both offer free care to those that meet certain criteria, including earning less than twice the federal poverty rate.
While many charity programs have been running for decades, others were established after extensive claims and demands made in the late 90s as a result of the aggressive tactics of the hospitals to collect payments. These included placing liens on patients’ homes and charge the uninsured the highest rates of lists, which were much more than insurance companies pay for services to their members.
Now, under the law of health, nonprofit hospitals must make reasonable efforts to determine whether patients qualify for assistance before taking any action to collect debts. And the law says the amount is charged to the patient may not be the list price of the hospital, but an amount close to what you usually charge insured patients.
The big benefit is that the health care law requires hospitals to publicly disclose their policy charity says Mark Rukavina, an expert in medical debt consultant hospital.
“The requirements of the ACA dramatically improve transparency,” he says.
Kaiser Health News is an independent editorial program belonging to the Henry J. Kaiser Family Foundation. It is an impartial, nonprofit organization dedicated to the study and dissemination of information on health policy program. Kaiser Health News is not affiliated with Kaiser Permanente.