The true colors of the partisan divide on health care
The true colors of the partisan divide on health care
Background for today’s Quote of the Day: California has served as a unique laboratory for the application of health care policies in the reform movement. The process is handicapped by the fact that a two-thirds vote is required in both the Assembly and the Senate if a measure would result in a tax increase. Since the Republicans control over one-third of each chamber, and they vote as a block against any tax increase, reform measures have been limited to those that do not require significant additional state spending.
Although in this environment it would be almost impossible to enact a state-funded system of universal coverage, it is truly remarkable what the legislators have been able to accomplish with the support of dedicated advocates such as the leadership of California’s Health Access.
Today’s message discusses one small but important issue: the excessive fees charged uninsured patients who have no choice when they must access the health care system on an emergency basis. The debate over this legislation
is very instructive because it reveals the true colors of those on each side of the partisan divide.
I am especially indebted to Anthony Wright, Executive Director of Health Access, who granted me permission to distribute excerpts from his message for today.
Quote of the Day:
HEALTH ACCESS UPDATE
Tuesday, August 24, 2004
CA ASSEMBLY VOTES TO PROHIBIT HOSPITAL OVERCHARGING OF UNINSURED
On Monday, August 23rd, the California Assembly passed SB379 (Ortiz) to
prohibit hospitals from overcharging uninsured patients, and provide other consumer protections. Both SB379, and a similar bill, AB232 (Chan) are expected to be voted on in the Senate and, if successful, be sent to Governor Schwarzenegger’s desk by the end of the week. Both bills would provide first-in-the-nation consumer protections for self-pay hospital patients.
SPECIFIC PROTECTIONS FOR HOSPITAL PATIENTS: The bills that address aggressive hospital billing and collections, SB 379 and AB232, are similar. They address an issue raised by dozens of “uninsured and overcharged” patients that have been sent to collections, court, or bankruptcy for the simple act of seeking needed care. Both bills ensure that self-pay hospital patients:
Are informed of their consumer rights and financial options; Have at least 120 days before being sent to collections; If they are under 400% of the federal poverty level (under $60,000 for a family of three), don’t pay more than the Medicare, Medi-Cal or worker’s compensation rate for treatment.
A fact sheet on the bill is available at:
http://www.health-access.org/ab232_fact_sheet.htm
The text for AB232 (Chan) is at: http://www.leginfo.ca.gov/pub/bill/asm/ab_0201-0250/ab_232_bill_20040817_amended_sen.html
The text for SB379 (Ortiz) is at: http://www.leginfo.ca.gov/pub/bill/sen/sb_0351-0400/sb_379_bill_20040817_amended_asm.html
ASSEMBLY DEBATE: Assemblywoman Wilma Chan, the author of AB232 (sponsored by Health Access California), served as the floor manager on the debate on SB379, by Senator Deborah Ortiz. She started the discussion by talking about a specific patient who, when her health insurance ran out, was forced to pay four times the amount that her insurance had paid for a similar treatment. Chan made the point that hospital debt is a leading cause of personal bankruptcy.
REPUBLICAN OPPOSITION: Several Republicans rose to argue against the bill,including Assemblymen Tim Leslie, Tom Harman, Dennis Mountjoy, Ray Haynes, and at the end of the discussion, Tony Strickland.
Leslie questioned why “Democrats want to attack hospitals, and they are continuing to make hospital operations more difficult.”
Harman made several points in his objections. “Hospitals are businesses.They are run like any other business, whether it is a manufacturing business, a service business, a barber shop, a beauty salon.” He mistakenly stated that, “this bill simply says, well, you’ve got to provide free medical care to certain types of patients… that you can’t use wage garnishment or a collections agency.… Well, how else are they going to collect it if they don’t pay it?” He admitted that “we need to have a plan where everyone can get the necessary medical treatment that they need.
I support that in some fashion, I don’t know exactly what it would be.” Finally, he referenced the individual story that Chan cited in her opening: “I’m sorry, but maybe that person should have had better health coverage, maybe that person should have thought about this problem. That’s what we have bankruptcy court for.… Is it any different than a contract debt? How is it different from any other kind of debt? I submit to you that it is not.”
Mountjoy also misrepresented the bill, stating that it said that “if you are a hospital that is serving a patient, and if they are low-income, you gotta give it to them. Well, why don’t we do that for plumbers?… And the electrician, he ought to give you a break, too. Where in the Constitution does it say that we owe folks health care?… We don’t own them health care.” He continued, “why should we put the burden on a business like hospitals?… They are a business not unlike any other. They are there to make a profit, they have a board of directors that looks for that every month.”
Haynes decried the “Orwellian state” he was in. “When you order somebody to give stuff away for free, or you order somebody to work for free, that is what is known in the parlance as slavery. We are basically ordering hospitals to be our slaves.”
Later, Strickland stated that “part of the reason why costs have gone up in the hospital is that the hospitals are providing a lot of charity care. The uninsured are not paying their hospital bills.… The hospitals are shutting down their emergency rooms because they are providing too much charity care.”
DEMOCRATIC REBUTTALS:. Democrats that rebutted these claims include Assemblymembers Lloyd Levine, Hannah-Beth Jackson, and Jackie Goldberg. Levine responded, “more and more people are going without health care in California. And frankly, I actually… resent the implication that they should have had thought of this sooner, and gee, they should have had health insurance. The cost of health insurance is continuing to skyrocket…, many families cannot afford health insurance, and to say ‘oh, it is their fault,’ really misses the point.… We need to pass this bill and do everything we can to make sure people have access to health care when they need it.”
Jackson brought the discussion back to the question that the bill addresses:
“Is it correct that many hospitals charge uninsured people higher rates than what they charge and are willing to receive from insurance companies and Medicare?” She continued: “This is a bill that tells hospitals that you can’t take advantage of poor people who don’t have insurance… Let’s be fair to the people that are least able to pay by not forcing them to pay more than you and I who have the benefit of having health insurance. It is a sad state of affairs when anybody takes a predatory practice to charge the least able to pay more money for any service because they can… The goal is to give everybody, whether they are rich or poor, a chance to have quality health care at a fair and reasonable price.”
Goldberg also clarified that the bill “asks that the hospitals require nothing more than the higher of Medi-Cal, Medicare, or worker’s comp.So it is not free. And why is this business different than any other business? Well, this business you can’t live without, in some cases.” She also cited statistics that showed that while the uninsured are a small percentage of the patients in many hospital chains, they account for a disproportionate share of the profits. “The only way that could be true is to be gouging those folks as compared to people who have insurance…”
Chan closed by rebutting the arguments: “This does not in any way call for free care. Back in the 80s, I believe, there were strict limits on what a hospital could charge. This does not even go that far… It just says,if you go to the hospital, there should be some ceiling on what you can be charged. Collection agencies can be called in, but this bill gives the person a chance.” She concluded: “We are not talking about something free here, we are talking about basic fairness.”
The bill passed with an unofficial vote of 41-31, along party lines.
Health Access California:
http://www.health-access.org/
Comment: Although there is certainly a partisan divide over concepts of the appropriate roles of government and the marketplace in addressing problematic social issues, in general many Americans believe market forces must be allowed the freedom to address these issues without significant government intervention. But most also believe that when the market is unable correct significant social injustices then the government should enter to provide policies that will satisfy our quest for simple fairness.
I find it difficult to believe that most politically conservative individuals personally identify with the comments made by the Republican legislators in this debate on price gouging of the insured for emergency care. I believe that if Republicans knew what their own elected legislators were doing they would replace them with conservatives who were, in fact, truly compassionate. They need to prove that Compassionate Conservatism is not the Big Lie.