We-Have-To-Pass-It-To-Find-Out-What’s-In-It Fact of the Day

A provision in the Affordable Care Act requires hospitals to charge uninsured patients no more than insured patients but it is not working because:

  • It applies only to nonprofit institutions, which means about 40 percent of all community hospitals are exempted. By comparison, the Colorado law also covers for-profit hospitals.
  • It lacks a clear formula for hospitals to determine which uninsured patients qualify for financial aid, and how deep a discount is reasonable. A California law spells out such a formula for that state’s hospitals.
  • More than three years after Obama signed his law, the Internal Revenue Service has not issued final rules explaining how hospitals should comply with the federal billing limits. Delay doesn’t signal a high priority.

Modern Healthcare.

Comments (13)

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  1. Studebaker says:

    Many hospitals will already do this but patients generally have to negotiate this in advance and pay upfront. The highest price is those uninsured patients that get care and wait for the bill to come.

    • Tom says:

      Problem is many can’t pay up front so it seems hard for them to be able to negotiate beforehand.

  2. JD says:

    Uncertainty is worse than punitive regulations. The chaos will create worse health outcomes and less-accutate prices.

  3. Dewaine says:

    “A provision in the Affordable Care Act requires hospitals to charge uninsured patients no more than insured patients”

    ? I thought that the point was that everybody would be insured.

    • JD says:

      I guess that even they realize that that is unrealistic.

      • Tom says:

        Yeah, I mean, they have the provision that penalizes the uninsured, but it seems that perhaps they even knew that costs would rise and eventually some people will still opt for no insurance because it’ll end up being cheaper (assuming they don’t get sick).

        • Dewaine says:

          It just seems like that undermines the whole thing. I guess since young people don’t need the health care anyway the system still gets their fee money, doesn’t have to pay for any health care they would need, but health care is still “cheap” for them due to price controls. This whole thing is an elaborate system of price controls.

          • Tom says:

            Sure, it is a lot of price control, but what do you mean young people don’t need the health care? You mean, the new ACA health care insurance? Or just health care in general?

            • Dewaine says:

              I mean that young people don’t need much health care. ACA forces them to pay for far more coverage than they need and is net loss for them.

  4. Tom says:

    It seems to me that hospitals already do this when they negotiate prices with patients…well, not so much prices, but form of payment more so.

  5. Linda Gorman says:

    PPACA applies only to people who are citizens or legally resident in the US. So yes, there are likely to be a lot of uninsured people even without those who, in the opinion of Chief Justice Roberts, are merely exercising their right to choose to pay a penalty rather buying a health insurance policy.

    And as one can always get a third party payer after one receives an expensive diagnosis, it is possible that it will make sense to pay the penalty.

    Hospitals do negotiate payment after the fact. Even if someone can’t pay the whole bill it makes good business sense to go after the part he can pay.

  6. John R. Graham says:

    It is a meaningless provision, found in section 9007 of PPACA, which amends the Internal Revenue Code for non-profit hospitals to limit “amounts charged for emergency or other medically necessary care …..to not more than the amounts generally billed to individuals who have insurance covering such care…”

    “Generally billed”? What does that mean? It cannot mean just the co-pay, which is what the plain language states. If it means the total charge, the hospital “bills” the insurer the chargemeaster and the insurer then adjudicates the claim according to a contract which nobody else has seen.

    I cannot see how this provision is enforceable.