Hospitals, Insurance & Inequality: Inside America's Broken Healthcare System

I see the signs in the emergency rooms, both in English and where I live in Spanish, that you're entitled to care.

We can't withhold care.

If you can't pay for it, we can make an arrangement.

I don't know how easy or difficult that is and what the steps are you have to take.

What are the concerns with respect to a hospital's provision of charitable care in addition to what we've already discussed? So those

signs that you see in the hospital are required by legislation to report, and well, everybody can see it.

And now in Spanish, that these are the requirements for charitable care and whether or not you qualify.

There are two other issues that I studied in the past, though.

In 2004, it's a little bit ago, but class action lawsuits were filed against 300 nonprofit hospitals in 22 states.

because of aggressive collection practices against the uninsured through overpricing.

Charitable care patients in most places were asked to pay for costs that exceeded insurance-covered or government-sponsored patients, Medicare people.

Hospitals utilize a master charge list that was used for charitable care patients.

In fact, no one pays the prices on master charge lists.

It's sort of like the list price for cars.

As a result, new state legislation passed laws to stop hospitals for charging underinsured patients more than Medicare, Medicaid, or third-party insurance would pay.

And in this particular paper, I have a table that lists all of the states and then how their laws now have changed to stop that practice.

And so hopefully these things that you see listed in the hospitals for charitable care qualifications are really helping charitable care uninsured and underinsured patients.

In many ways, the Affordable Care Act in 2010 also addressed this problem in that government-subsidized insurance was available to all U.S. citizens through insurance portals in each state.

In some Medicaid

non-expansion states, Texas, Georgia, and Florida, the rates will be even higher for people in those states.

they decided not to expand Medicaid to more patients or they reduced the amount of Medicaid in total.

And so Medicaid is actually paid by the states, not the federal government.

The federal government does indeed subsidize Medicaid payment, but it's the state that decides how much will be allocated to Medicaid and then how many patients will get it.

And so those states reduced the amount of Medicaid that they would give to the patients there.