Healthcare policies, from the federal level down

Healthcare policies, from the federal level down to the institutional level, are agreements that determine the collective intent, choices, actions, and goals of administering care. Nowhere in the constitution does it say we have a right to healthcare; however, affordability and accessibility are social values with great influence over policymaking. Policies inform legislation, which in turn is applied through regulations. The Internal Revenue Service (IRS) is a federal agency whose regulations have significant impact on how hospitals operate as businesses. Through the IRS the federal government can regulate policy at the institutional level. Federal healthcare policy may champion access to care for those who can’t afford the cost; however, some hospital executives have conflicting interests, many of them profit-driven. There are approximately 5,000 nonprofit hospitals in the United States; close to 50% of the country’s hospitals. As nonprofits, they are legally entitled to certain exemptions and generous tax breaks in return for providing free care to patients who can’t afford the cost. Healthcare policy with the intention of lessening the burden of costs on vulnerable communities is articulated through these IRS regulations; nevertheless, nonprofit hospital chains are able to amass annual profits comparable to that of massive for-profit companies like Walmart. On January 25th The Daily, a podcast produced by the New York Times, aired an episode revealing the culmination of over a year of journalistic investigation into “How Nonprofit Hospitals Put Profits Over Patients.” In this podcast, Jessica Silver-Greenberg discusses findings that she and her colleague Katie Thomas published in a series of articles in NYT between September and December of 2022. Their journalism exposes an internal web of deceit and extortion inside of nonprofit hospitals in the US. The results of their investigation illustrate how policies are often abused and hijacked in the interest of business, harming the very communities they were intended to benefit. Silver-Greenberg and Thomas share the case of Providence, one of the country’s largest nonprofit hospital chains whose mission statement is to be: “steadfast in serving all, especially those who are poor and vulnerable.” In 2018, Providence’s executives hired a consulting firm to develop a plan that would offset the millions of dollars they were spending each year on providing free care. Consultants devised a program called Rev-Up (for “revenue, up”), which aims to maximize the amount of money the hospital makes from patients’ out-of-pocket payments, regardless of their ability to pay. The centerpiece of this program was a set of explicitly outlined talking scripts for employees to use in conversation with patients about their unsettled bill. These scripts stress emphasis on how patients will pay and not whether they could pay. Unpaid patient accounts were sent to collections, holding patients liable for thousands in debt that they should never have had to pay. The program lacked any mechanism for screening patients to determine whether they qualify for free care. On the contrary, it instructed employees not to accept no as an answer when asking patients to pay. Hospital employees, many of whom were making little less money than the patients they were hounding, felt conflicted by what they called “predatory tactics,” such as requirements to chart repeated requests for payments at their patient’s bedside. On paper, Providence provides more free healthcare than any other hospital in Washington state, qualifying them for a deal with the IRS. In practice, regulations fail to deliver on the promise of healthcare policy. Providence has sent over 55,000 patient accounts to collections agencies, wrongly claiming that these patients owed more than 73 million dollars. Patients who were the target beneficiaries of healthcare policies that sought to protect them are instead spiraling into debt while Providence profits from their pain and illness. In February of 2022, the Attorney General of Washington State sued Providence, and hospital executives have since made public statements, saying that they will refund patients who were wrongly charged and will no longer use collection agencies to get money from low-income patients. A decision on the case awaits to be made. After years of patient advocacy, lobbying efforts, and recent media coverage policymakers are forced to contend with the evident failure of healthcare policy to hold nonprofit institutions accountable to the communities they serve. HOW TO REPLY TO THIS DISCUSSION BOARD

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