The Right Choice

“Is health care a right or a choice?” was the question posed to me recently by a high-school student who was interviewing me about current legislative issues.

A choice? What choice did Maria have when she fell at work, hit her head, lost consciousness, and then spent seven days in the hospital. She told hospital staff that she did not have insurance, but no one talked with her about options for covering her medical expenses. Instead, she received bills totaling more than $70,000.00. Two years later, her bills remain with a collection agency.

In another community, Ted went to the emergency room when he became ill. “It turned out I had bronchitis,” he said. “When they asked for my insurance, I told them I didn’t have any. I showed them a letter from my homeless shelter. They never told me about charity care. Instead, they sent me a bill for $315. I can’t afford that. Now it’s in collections.”

These two hospitals are among the numerous non-profit hospitals across Illinois that, in exchange for their tax exemptions, are obligated to provide free and reduced cost care, also known as “charity care,” to uninsured and under-insured people who need it. Despite the Illinois Supreme Court’s Provena ruling in 2010 that identified free and reduced cost care as the required activity that makes a hospital “charitable,” many non-profit hospitals are not doing enough to ensure full access to health care for uninsured and under-insured patients in their areas. To complicate the matter further, some hospitals, often called the “safety nets,” are doing extraordinary amounts of charity care while others, often with substantial revenue and resources, are doing significantly less. The Provena case did not say how much charity care is “enough” to earn tax exemption status.

The Fair Care Coalition (FCC), of which PCG is a member, works to help people get the medical care they need regardless of their ability to pay; distribute fairly the cost of caring for the uninsured among all non-profit hospitals; and ensure taxpayers get a real service in return for the tax exemptions given to non-profit hospitals.

To that end, the Fair Care Coalition has worked diligently with legislators, the Illinois Hospital Association, and staff from the Governor’s Office, the Illinois Attorney General’s Office, the Illinois Department of Revenue, and the Cook County President’s Office in an effort to negotiate a clear charity care standard for non-profit hospitals.

Some progress has been made on improving the application process so that people like Maria and Ted will be told about charity care and given assistance in completing and submitting their applications. However, after over two years since the Provena ruling, we still do not have agreement on what amount of medical care satisfies the charity care requirement and which hospital activities can be counted as charity care.

The General Assembly is scheduled to adjourn on May 31st, but there is still time for Illinois to make a choice. We can ignore how charity care fits into the larger health care system while we debate Medicaid cuts and hospital assessments. Or, we can agree upon a system that treats low-income, uninsured patients with respect and generates more medical care so that they receive the care they need regardless of their ability to pay.

What we must not do is maintain the status quo. Urge your legislators to support the development of a legislative standard that ensures access to health care, equity for all hospitals, and accountability to taxpayers.

Let’s make the right choice.

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