Sophia Hennessy | Oct 27, 2023

About a month ago my friend booked a day-of ticket to fly out to Colorado and see me – it was the type of heady impulsive behavior that I associate with movies like Sleepless in Seattle and Love Actually. Unfortunately, this blog is not about to become a rom-com (I know, I’m upset too).

B’s impromptu flight was spurred by compounding failures of the health system. Despite having just started a new job, her health insurance had yet to be set up. Added to this were years of inadequate coverage that had left her without essential medications. In the midst of a mental health crisis, B was afraid to go to the hospital.

“I don’t have health insurance yet, I can’t afford it”

“Well, what do you want to do?” I asked, deeply concerned that they were choosing to forgo vital care due to fear of cost.

After three hours of deliberating over the phone, they made a decision. Rather than go to a hospital or other health care facility B found a super cheap plane ticket and flew out to see me. 

Nearly half of the hospitals in the U.S. are non-profit entities. The foundational logic behind this tax designation is that non-profit hospitals are providing a public service. They exist to provide care to all members of their communities, regardless of those members’ ability to pay for the care. Local, state, and federal governments provide non-profit hospitals with tax breaks in order to ensure they have the funds to cover such free and discounted services. In Colorado, these tax breaks for non-profit health systems exceed $450 million a year

Yet, in the past year, one in three Coloradans have delayed medical or dental care with the majority of these Coloradans citing concerns about the cost. These fears are corroborated by the epidemic of medical debt in the U.S. A national survey conducted in 2020 found that one in four (41% of) adult Americans have some form of medical debt.  Such debt has resulted in widespread loss of savings, the forgoing of necessary expenses like food, and even loss of homes. Moreover, the crisis disproportionately impacts Black and Hispanic adults, women, lower income, and uninsured Americans. The experience of debt has been described as “having another arm tied behind your back” further exacerbating the systemic marginalization that many people in these identities experience. Of those with medical debt, 18% don’t ever expect to pay it off.

So what is happening with all these non-profit hospitals? Where is the public service they are supposed to be providing? Why are so many people in debt? Why did B feel her best option was to fly to see me? In answer, what we are seeing is a disconnect between what non-profit hospitals are supposed to do and how they are going about doing it. Despite the non-profit designation, hospitals are incentivized and financially operationalized like any other business. They are set up to seek profits. In the aptly named 2023 report, “Executive Charity: Major Non-Profit Hospitals Take Advantage of Tax Breaks and Prioritize CEO Pay Over Helping Patients Afford Medical Care” the US Senate HELP committee lays out the degree to which this is true. Many hospitals have created a world in which receiving care without fear of debt relies on insider knowledge and a rugged will to push through bureaucratic systems. As a result, receiving such care often relies on patients knowing it exists and actively self-advocating to receive free or discounted services. 

Nationally, a 2022 survey found 64% of respondents didn’t know if their physicians or hospitals offered financial resources. Only with retrospective googling did I learn there are laws in B’s state that meant they would have qualified for discounted care had she gone to a hospital in August. Hospitals have done a good job obscuring that fact-free and discounted care programs exist.

In Colorado, if you walk into a hospital without health insurance that hospital is required under state law to screen you to see if you qualify for free or discounted care. Even if you do have insurance you are still eligible to ask for this screening. The program, known as Hospital Discounted Care, has just passed its one-year anniversary as a landmark consumer protection act. Unfortunately, we are still hearing stories of hospitals refusing to share information or take any proactive measures to provide such care. As a result, it is still on Coloradans to know that under the law it is their right to be screened for discounted healthcare.

Even when forms of hospital discounted care are available, our health care system has cultivated a message of fear that deters people from seeking necessary care. These fears are further compounded by insidious billing practices and the frequent pushback patients face when they aptly advocate for their rights. Like many people who are in crisis, considering navigating the stress and hostility of the health care system added anxiety to B’s life rather than relieved it. Their ultimate choice to buy a plane ticket to be in community rather than seek hospital care was informed by years of mistrust in health care and a fear of facing bills she could not afford. 

In Colorado, Hospital Discounted Care offers an opportunity to slowly shift these experiences and narratives, however, doing so relies in large part on growing community knowledge. Hospitals have actively hidden their lawful role to provide free and discounted care. That said, when more and more community members show up knowing their rights it becomes more and more difficult for hospitals to hide these services. This is especially true when community members share the successes and failures they have faced in advocating for care. Hospital Discounted Care offers a legislative backbone around which we can rearticulate both the role we expect hospitals to play in our communities and the affordable care we should be able to count on receiving from them.

As policy makers and advocates, CCHI wants to hear community members’ experiences navigating these laws in order to support proper implementation and enforcement of them. If you have a story to share about needing or receiving Hospital Discounted Care in Colorado, whether the outcome was good or bad, we would love to hear from you. A form to submit your story may be found HERE and more information about Hospital Discounted Care can be found HERE.

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