Promise of price cut on hospital bills in health care law is in limbo
Going without health insurance is a calculated risk taken by many young people starting out their careers. Farman, 26, said the $120 his employer charged monthly for premiums was too much for his budget. Besides, he was in good shape and an avid weightlifter. But months of deep tiredness and unexplained weight loss led him to consult doctors, and he was eventually diagnosed with lymphoma.
Treatment at Upstate University Hospital in Syracuse was successful, but Farman faced more than $54,000 in medical bills, between the hospital and doctors.
"After I went into remission, the bills started to roll in," said Farman. The hospital did not tell him that financial assistance might be available, Farman said.
He had to fend off collection agencies. "That's not too fun," he added.
A spokesman for Upstate said the federal fair pricing law does not appear to apply to the hospital because it is publicly owned and not incorporated as a nonprofit under federal law. Spokesman Darryl Geddes said he could not discuss individual cases, but the hospital does not decline care to anyone based on the individual's ability to pay. Upstate maintains a financial assistance program that complies with state law, he added.
Part way through his treatment, Farman was able to get on Medicaid. With the help of a community agency, he also applied for assistance under New York law to help pay for his medical care during the period he was uninsured. On Friday, he received a letter saying his application had been approved and his debts would be greatly reduced.
Such discounts should be taken up front, advocates say.
Congress needs to take a second look at the federal law, says University of Southern California health policy professor Glenn Melnick.
As written, the law leaves it up to hospitals to determine which uninsured people qualify for discounted bills, and that could create a whole new set of disparities.
"One hospital could say it applies to people at 100 percent of the poverty line, and another could say 200 percent," Melnick explained. He called the enforcement provisions were "very weak."
A California law could serve as a model, he said. It defines the patients who qualify for assistance as those who are uninsured or making at or below 350 percent of the federal poverty line — $40,215 for an individual and $82,425 for a family of four. Those patients cannot be charged more than the hospital would receive from Medicare.
"This issue will not go away," said Melnick. "Even when the (Affordable Care Act) is fully implemented, there will be millions and millions of people without insurance."
Health care law: http://www.healthcare.gov
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