A bipartisan health care consumer protection bill has been introduced in the State House at the request of State Treasurer Dale Folwell.
House Bill 1039, introduced on Tuesday, is titled the “Medical Debt Disarmament Act.” The main sponsors are Democrats Howard Hunter of Hertford and Billy Richardson of Cumberland, and Republicans Ed Goodwin of Chowan and Bobby Henig of Currituck.
The bill must clear the House banking, health care, and rules and operations committees before reaching the floor of the chamber for a vote.
There’s also an intriguing mix of 39 conservative and progressive co-sponsors, including Reps Pricey Harrison, D-Guilford, and Reps Lee Zachary and Jeff Zenger, both R-Forsyth.
“I was very disturbed by all the stories I read and heard about the crushing burden of medical debt,” Harrison said. “He is responsible for two-thirds of bankruptcies, including my constituents.”
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“Of course it would help some if we were successful in expanding Medicaid, but this proposal appears to offer some protection against price gouging,” Harrison said.
Intent of the bill
According to the bill and a statement by Folwell, the bill’s mission is to “create pro-family, anti-poverty and consumer protection legislation that sets parameters around the provision of charitable care and limits the ability large medical establishments to charge unreasonable interest. rates and employ unfair tactics in debt collection.
Folwell’s primary interest in the HB1039 application is its state health plan oversight authority, which has more than 727,000 participants, including current and retired state employees, teachers and legislators. It is the largest purchaser of medical and pharmaceutical services in North Carolina.
“With inflation at its highest level in 40 years and North Carolina suffering from high anxiety, families need protection from the weaponization of medical debt,” Folwell said. “One way to do this is to ensure that major medical providers are transparent about the availability of financial assistance and that appropriate levels of charitable care are available for working families in need.
“A rescue procedure shouldn’t cost your savings.”
The NC Hospital Association said Friday it “is still digesting and analyzing this bill and has no position on it.”
“A first high-level position is that federal law already meets several requirements of the bill, and the North Carolina General Assembly has already passed legislation in 2013 that addresses many state-specific issues. related to fair billing and collection practices.”
The NCHA said hospitals’ charitable care spending and community benefit investment activities “are transparent and accountable.”
“North Carolina nonprofit hospitals submit annual audits to state and federal tax regulators, who determine that the hospitals are meeting their tax status obligations.
“Non-compliance can result in the revocation of a hospital’s tax-exempt status, which has never happened in North Carolina.”
Legislative response
HB1039 represents a legislative response to an analysis of nonprofit and nonprofit hospitals in North Carolina released in October by the Johns Hopkins Bloomberg School of Public Health. This analysis was requested by Folwell and the SHP, over which the Treasurer has supervisory power.
The analysis determined that many of these hospitals – including the three largest in the Triad – are not fully honoring their charitable mission. A video link to the presentation is available at https://www.youtube.com/watch?v=pL1j4-n3ea8.
The report found that North Carolina’s largest nonprofit hospital systems received tax relief estimated to be worth more than $1.8 billion in 2019-20. In the majority of these systems, charitable care expenditures did not exceed 60% of the value of their tax breaks, the researchers found.
For the major health care systems serving the Triad, the Johns Hopkins report listed the projected annual value of tax exemptions compared to charitable care funding disclosed by the systems.
Atrium Health reportedly received state tax exemptions worth $440.1 million, while providing $260.1 million in charitable care.
Novant Health reportedly received state tax exemptions worth $324.1 million, while providing $179.1 million in charitable care.
Cone Health reportedly received state tax exemptions worth $131.6 million, while providing $105.7 million in charitable care.
Wake Forest Baptist Medical Center, now affiliated with Atrium, reportedly received state tax exemptions worth $210.3 million, while providing $54.8 million in charitable care.
Medical Debt Laws
The bill is similar to legislation in other states’ consumer protection laws that aim to protect families from the impact of medical debt on Americans.
Another study, conducted by Rice University’s Baker Institute of Public Policy, the National Academy for State Health Policy, and SHP, found that in 2019, some North Carolina nonprofit hospitals billed $149, $2 million to poor patients who should have received free or reduced-cost charity care under the hospitals’ own policies.
Additionally, up to 28.7% of hospital bad debts were billed to impoverished patients who may be eligible for charitable care.
HB1039 would require health care facilities to develop a medical debt mitigation policy that would build on an existing framework of financial assistance plans under the federal Affordable Care Act.
Folwell said his pursuit of consumer medical bill protections has been spurred by the lack of progress in addressing medical debt issues over the past four decades.
Zachary said he chose to co-sponsor the bill because of its potential to “limit the predatory lending and collection practices of certain medical providers/lenders.
“According to some people who work with Treasurer Folwell’s office, consumer debt, whether it’s necessities or consumer debt, is all under the same law.
“This bill would create a new statute for medical/veterinarian debt for necessary procedures,” Zachary said. “It’s something both Democrats and Republicans can vote yes to.”
Attorney General Review
In January, Atrium Wake Forest Baptist, Cone and Novant were determined to fully comply with federal regulations aimed at improving price transparency for patients, according to the North Carolina Attorney General’s Office.
However, the bureau listed eight community or specialty hospitals in the 14-county triad region and northwestern North Carolina as not fully compliant at the time of the report. The federal Centers for Medicare and Medicaid Services began implementing a hospital price transparency initiative on January 1.
Each hospital “will be required to provide clear and accessible pricing information online about the items and services they provide,” CMS said. Hospitals can face monetary civil penalties for non-compliance.
The attorney general’s office review found that 122 hospitals statewide are fully compliant with CMS regulations.
Meanwhile, 16 hospitals are failing to meet the requirement to provide a machine-readable list of services and prices. Hospitals listed in this category are Alleghany, Ashe, Hugh Chatham in Elkin, Northern in Mount Airy, and Randolph in Asheboro.
One hospital – Holly Hill – fails to meet the requirement to provide a consumer-friendly shopping list.
Eight hospitals are also noncompliant, including Kindred in Greensboro, LifeBright in Stokes County and Select Specialty in Greensboro.
Some hospitals in the non-compliant categories told the attorney general’s office that they were updating their tools to comply with the regulations.
In June, Attorney General Josh Stein wrote to North Carolina hospitals “to encourage them to come into compliance to better provide patients with the information they need to make informed choices about their health care.”
“When hospitals make their pricing transparent, it allows patients to shop around and control healthcare costs,” Stein said.
