Dive Brief:
- Among the ACA's reforms was a set of collections and financial aid rules that not-for-profit hospitals must abide by in order to hold onto their tax-exempt status. The problem is, those rules omitted the critical guidelines specifying who should receive charity care, and who shouldn't—so hospitals are exploring both ends of that spectrum.
- Some not-for-profit hospitals are choosing to deny care to those patients who meet the qualifications for subsidies available through the ACA's exchanges, hoping that it might reduce their costs while motivating those people to get insured. According to Modern Healthcare, three hospital systems have engaged that policy: Trinity Health, an 86-hospital Catholic system; Broward Health, a tax-supported safety-net system in South Florida; and The Southern New Hampshire Health System.
- Meanwhile, some hospitals are opting not to change their policies on the principle that caring for the indigent is not a commitment that changed as a result of the ACA. For example, Bill Burman, director of Denver's Public Health Department, told Modern Healthcare, "I don't feel it's appropriate to say you must do this brand-new thing or you can't get care."
Dive Insight:
This debate has no easy answers. On the one hand, it’s not a bad thought to try transforming patients with no insurance into patients with insurance and access to regular healthcare. On the other hand, is denying poor people needed care the way to do it?
For Keith Hearle, president of Verite Healthcare Consulting, that point is moot, as he predicts that such policies regulating the denial of care for patients eligible for subsidies will soon be the new rule, and no longer the exception. With the current concerns that not enough of the uninsured are enrolling for plans through ACA exchanges, some health leaders believe that turning away the potentially insured is their best choice.
That said, many long-standing not-for-profit hospitals will have a problem with that, and like Burman, may not want to relent on their commitment to treat the needy. Our bet is that the religiously-based not-for-profits will not change their policies. They may incorporate ways to help their poor patients get insured—they just won't deny them care to do it.