North Carolina treasurer pushes for patient charity care in legislation

Published 9:26 am Saturday, June 11, 2022

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By Gary D. Robertson, Associated Press

Passing legislation to require North Carolina hospitals to provide minimum levels of free or discounted care to low- and middle-income residents not covered by insurance and offer generous repayment options is the “moral thing to do,” State Treasurer Dale Folwell said Tuesday.

A bipartisan measure, which was discussed but not voted on by the House Banking Committee, is in part a response to a 2021 study for the state employee health plan that Folwell’s agency oversees on charity care.

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“This is a pro-consumer, anti-poverty piece of legislation, and it’s time that we meet and exceed on behalf of the invisible people, not the million-dollar (hospital) executives,” Folwell, a Republican, told the panel. Chances for the bill to get approved during this year’s session appear small given the dwindling number of weeks left in Raleigh and the complexity of the measure.

The 2021 report, assembled with Johns Hopkins University, found that a majority of the state’s largest nonprofit hospital systems are not providing charity care to the uninsured or underinsured that comes close to the federal, state and local tax breaks they receive.

The result is patients who can’t afford the expensive services they have received, leading to cycles of medical debt that “weaponize” their credit scores and ability to succeed, said Folwell, a former House member and treasurer since 2017.

The measure would require hospitals, clinics and other certain health-care providers to adopt medical debt mitigation policies and screen patients before demanding payment to help them locate insurance options or assistance.

Free and discounted care for amounts not covered by insurance would be on a sliding scale of up to 600% of federal poverty levels. If debt is incurred, the hospital can’t charge interest and must cap monthly payments. The legislation also requires disclosure of health care services charges and Medicare reimbursement rates.

The State Employees Association of North Carolina and North Carolina Coalition Against Sexual Assault spoke for the bill, which also would allow the state attorney general and citizens to sue for damages if requirements are not followed.

The North Carolina Healthcare Association, which represents for-profit and nonprofit hospitals, has not taken a position on the bill, spokesperson Cynthia Charles said in an emailed statement.

Charles said federal law already addresses several bill requirements and 2013 General Assembly legislation addresses many billing and collection practice issues. She explained the numerous ways hospitals and health systems help consumers with their financial obligations.

“To suggest that hospitals ‘weaponize’ medical debt is nothing but political grandstanding,” she wrote. “Hospitals do more than any other part of the health care field to assist vulnerable patients.” The association said last year that nonprofit health systems and hospitals also provide billions of dollars in “community benefits” annually that go beyond charity care.

The measure’s legislative sponsors appear to have a tough row to hoe before the legislation could advance this session, which is already expected to end around July 1.

“Right now this bill, in my humble opinion, is not ready for prime time,” said Rep. John Szoka, a Cumberland County Republican and committee member, adding that he had several concerns. Szoka said he was willing to work with sponsors and Folwell’s office to rework it.