Vision of a New Way (VNW) applauds Stacey Abrams, former Georgia state representative and candidate for governor, for her Fair Fight Political Action Committee (Fair Fight) paying off $212 million in medical debt.

Good Intentions, But…

Think of hospital organizations as being the school bully demanding your lunch money. With Fair Fight’s buying medical debt from numerous hospital organizations, you have in fact paid off the bullies.

The $1.34 million in this case relieved the financial stress of thousands of purported debtors, let me emphasize, purported debtors. The truth is the purported debtors likely did not owe the medical debt. The bullies, nonetheless, got what they wanted – the money and of more importance they increased their reimbursement rates. The foremost concern of the bullies is increasing reimbursements rates.

The bullies are indifferent to what their charges do financially to stakeholders: taxpayers, obligors, citizens, employers, and insurers.

Clearly Fair Fight is in the position to promulgate the truth concerning medical debt. You have been very successful elevating the issue in the country’s consciousness.

Yes, the “medical debt crisis” can be eliminated and spending on health care can be reduced an estimated 40 percent, or in dollar terms $1.5 trillion annually, with hospital organizations’ complying with Centers for Medicare & Medicaid Services(CMS) policy and Internal Revenue Code (IRC) § 501(r).

Their compliance will result in all Americans’ lives being improved: access to care, affordability of care, reference: the reduction in spending, being generally healthier, and longer life expectations. (See: Additional Information)

Referencing Fair Fight’s web site: the statement is not correct – hospital organizations’ compliance with CMS policy and IRC § 501(r) means both Fair Fight’s and VNW’s shared goal: “[to] restore the wellbeing of our communities ravaged by medical debt” will have been accomplished.

Furthermore, the restoration can begin tomorrow, and at no cost to Fair Fight – just promulgate the truth (facts)! Fully eliminating our country’s medical debt crisis will require policy changes that provide affordable, quality access to medical insurance and medical care to everyone.

Until then, Fair Fight, along with RIP Medical Debt, will continue to lead the call to help restore the wellbeing of our communities ravaged by medical debt.

VNW’s Work In The Past

After multi-years of advocacy by VNW, Secretary Tommy Thompson (R), U.S. Department of Health & Human Services (HHS), in an exchange of letters, February 19, 2004, provided guidance to Richard J. Davidson, President, American Hospital Association (AHA) “to take action to assist the uninsured and underinsured.”

With this guidance as a tool, I strongly encourage you to work with AHA member hospitals to take action to assist the uninsured and underinsured and therefore, end the situation where, as you said in your own words, “uninsured Americans and others of limited means are often billed and required to pay higher charges.”

It was inspiring working with the staff of HHS, conscientious, competent, and dedicated civil servants. VNW provided written testimony to the U.S. Senate Committee on Finance.

Again, the committee’s staffers were knowledgeable, competent, and dedicated. VNW worked with HHS Secretary Sebelius’s office. Unfortunately, it was at a time of intense political pressure against the Patient Protection and Affordable Care Act (ACA).

Secretary Tommy Thompson Asserted:

Your letter suggests that HHS regulations require hospitals to bill all patients using the same schedule of charges and suggests that as a result, the uninsured are forced to pay “full price” for their care.

That suggestion is not correct and certainly does not accurately reflect my policy. The advice you have been given regarding this issue is not consistent with my understanding of Medicare’s billing rules.

To be sure that there will be no further confusion on this matter, at my direction, the Centers for Medicare & Medicaid Services and the Office of Inspector General have prepared summaries of our policy that hospitals can use to assist the uninsured and underinsured.

This guidance shows that hospitals can provide discounts to uninsured and underinsured patients who cannot afford their hospital bills and to Medicare beneficiaries who cannot afford their Medicare cost-sharing obligations. Nothing in the Medicare program rules or regulations prohibit such discounts. … (Emphasis added)
Centers for Medicare & Medicaid Services Summary:
Questions On Charges For The Uninsured

Q: Can a hospital waive collection of charges to an indigent, uninsured individual?

A: Yes. Nothing in the Centers for Medicare & Medicaid Services’ (CMS’) regulations, Provider Reimbursement Manual, or Program Instructions prohibit a hospital from waiving collection of charges to any patients, Medicare or non-Medicare, including low-income, uninsured or medically indigent individuals, if it is done as part of the hospital’s indigency policy.

By “indigency policy” we mean a policy developed and utilized by a hospital to determine patients’ financial ability to pay for services. By “medically indigent,” we mean patients whose health insurance coverage, if any, does not provide full coverage for all of their medical expenses and that their medical expenses, in relationship to their income, would make them indigent if they were forced to pay full charges for their medical expenses. (Emphasis added)

In addition to CMS’ policy, the Office of Inspector General (OIG) advises that nothing in that agency’s rules or regulations under the Federal anti-kickback statute prohibits hospitals from waiving collection of charges to uninsured patients of limited means, so long as the waiver is not linked in any manner to the generation of business payable by a Federal health care program – a highly unlikely circumstance.
CMS: Definition (Policy) for Charity Care (Financial Assistance)

Charity Care – The value of medical expenses that exceed the patient’s financial ability-to-pay the hospital organization’s charges so as to not cause the individual being rendered medically indigent.

Medically Indigent – Patients whose health insurance coverage, if any, does not provide full coverage for all of their medical expenses and that their medical expenses, in relationship to their income, would make them indigent if they were forced to pay full charges for their medical expenses

Indigency Policy – means-test insured and uninsured patients as to his or her financial ability-to-pay the hospital organization’s charges and not be forced into “medical indigency.”

Deciphering the Legalese

Insured (underinsured) and uninsured obligors of limited means are required to pay out-of-pocket only an amount he or she can afford, if any. Any medical expenses exceeding the amount an obligor of limited means can afford should be attributed to “charity care” to protect obligors from being rendered “medically indigent” and for accounting purposes. If an obligor fails to pay his or her adjusted billing, defaults, any balance due should be attributed to “bad debt” for accounting purposes.

Existing Technology Can Make It Work

The determination, decisioning, of the amount an obligor can afford can be accomplished in seconds at admission. To eliminate conflicts of interest and protect stakeholders the decisioning should be accomplished by an independent third-party credit expert. The experts utilizing today’s credit management technology to achieve transparent, objective, and replicable decisions. Such technology is common and has been used by lenders for decades. A specific decisioning algorithm can be implemented at an individual hospital, county, or state level to determine the amount an obligor of limited means can afford out-of-pocket.

Vision of New Way Would Like To Help

VNW would welcome any opportunity to meet or speak with Fair Fight and address any questions you may have. Thank you in advance for your work on behalf of all Americans, stay healthy & best regards, Roger Berliner Advocate

Additional Information:
Senator Chuck Grassley Op-Ed: Some Tax-Exempt Hospitals Are Lax At Providing Charity Care And Accountability

Atrium Health Financial Assistance Policy Work Sheet

What is “Medicare for All? Don’t Let the Fox Guard the Henhouse.