Non Profit Hospitals Can Do Better
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A Good Day To Advocate for Better Healthcare
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Project 2025 is a Threat to Medicaid
Project 2025 is the Heritage Foundation’s plan for the next Republican presidency.
It is a frightening look into an authoritarian dystopian future. I want to thank the Health Justice Monitor for their review.
The Medicaid Reform Proposals are on pp. 466-472. I don’t want to repeat them here but they are based on the belief that Medicaid needs to be cut way back. They view this safety net program for the poor as a program that is rife with patients cheating the system. Work requirements, lack of funding for any organization/network that offers abortion and here is my favorite - if a state has a law that requires health insurance to cover abortion care - All Medicaid payments to the state cease.
You can read it and be sick about it like I am and then take action. Project 2025 and the Republican platform for healthcare will be a disaster and we need to make sure it is stopped.
ACTION
Share the information about what Republicans are planning for Medicaid with those you know and then
Vote so that they are stopped.
Their plan is cruel and will harm people in ways that are hard to imagine. Stop Them At The Ballot Box
Non Profit Hospitals - Not Always What They Seem
Before we start let me point out that some non profit hospitals really do operate in the public interest. In my state, Washington, Jefferson Healthcare and Children's Hospital in Seattle are the only ones who NEVER send patients to collection. They also abide by Washington law to offer charity care based on income. Thank you, Angela).
When you think of a non profit hospital, you imagine a place that will take care of you regardless of your ability to pay, like those two I mentioned above.
In the past we have written about a how non profit hospitals actually make significant profits though their non profit status. They pay no local, state or federal taxes - that is worth often 20% or more of net revenue.
To get and maintain that status they need to be operating in the public good. Sadly, federal law (IRS Code 501 c 3) specifies the kind of actions appropriate to maintain federal tax exempt status but not any minimum levels of participation. Public education is one such category and many hospitals have public outreach campaigns that are little more than advertising - and yet that counts for charity work for which we let them pay no tax.
I am not writing this to ask that we collect the money, only that the charity status they have should really include charity work - like paying for healthcare for those that can’t afford healthcare since we still don’t have universal healthcare.
Now some states have laws requiring that hospital bills be covered at some level for the poor. Washington and Colorado do and I am sure there are others.
Not long ago Senator Bernie Sanders held hearings about the amount of charity care to patients hospitals provided. Here is a table from his work detailing recent comparisons of charity care and revenue based on 2021 data. Some are less than 1% some are as much as 8%. Still way less than the 20% plus we give them as tax breaks.
One study, mentioned in Sen. Sanders’ report, found that in 2017 tax exempt hospitals billed patients $2.7 billion when they should have eligible for charity care. Hospitals make it hard to figure out how to access charity care that they are supposed to offer. The reference is in the linked report (#12)
UCHealth, in Colorado had revenues of $6.9 billion in 2023 and offered $26 million in charity care, that is 0.37% of revenue.
The reason I mention them is that they are also actively pursuing their patients for collection but they are particularly sneaky about it. It looks particularly heartless to have your name on a lawsuit seeking a judgement against patients especially if you are a non profit SUPPOSEDLY OPERATING FOR THE PUBLIC BENEFIT.
In Colorado, UCHealth, a not for profit health care firm, has found a novel way to collect from patients. In the last five years, patients have been sued 15,710 times for money owed to UCHealth. That’s about 8 lawsuits per day. (Colorado Sun)
Most of those lawsuits were filed in the name of debt collectors working for the hospital system. They deliberately use those third-party collection agencies to obscure the fact that they are the ones suing the patients.
In a given year, UCHealth’s network of 14 hospitals and more than 200 clinics treats almost 3 million patients — a number equivalent to roughly half the state’s population. They claim that only 0.07% of patients are pursued for payment in court. And yet, hundreds of new lawsuits are filed monthly against UCHealth patients for debt the hospital system claims it is owed, making UCHealth among the most litigious systems in the state, according to consumer advocates.
The hospital system “assigns” the debt to a debt collector without relinquishing ownership of the debt.
Here is how most collections work. The debt is sold to the collection agency, often at a much reduced price, and then what ever the collection agency can recover over that price is profit. What UCHealth does is just outsource the collection to hide from the shame of suing 8 patients every day. All while their charity care percentage is 0.37%. Disgraceful.
Legal Side Note
My wife and I used to run a non profit and we learned that to have state tax exempt status, you first must have federal tax exempt status.
Summary
These non profit hospitals know what they are doing looks bad. That is why they conceal it from the public. They are not required federally to provide any charity care. They can spend their money on public education at tiny levels. They hire others to sue patients who cannot afford the bills to keep the hospital’s name out of the court records. We need them to be accountable to us. After all - we give them an enormous break by not having to pay taxes and allowing them to accept donations from the public.
ACTION
Let’s let our elected representatives in Washington D.C know about the problem and that the IRS code that addresses hospital tax exempt status needs to be updated. Member of Congress and Senators email/phone numbers are here, https://www.usa.gov/elected-officials. We can recommend that the IRS specify that a minimum percentage of revenue be allocated to charity care for patients. I like 10%.
Or use RESISTBOT on your cellphone sign PVVYDA to 50409 to send this message.
“I am your constituent, and I want you to know that non profit hospitals offer little in the way of charity care to patients who cannot afford to pay. These not profits pay no federal, state or local taxes. That easily saves at least 20% of their net revenue which could be used for charity.
Some of these hospitals are the most egregious and aggressive collectors of debt from patients and offer little in the way of charity care. UCHealth in Colorado, for example sues 8 patients every day, and offers 0.37% of revenue in charity care.
I want you to change the IRS code to demand that there be a minimum percentage of revenue allocated to charity care for patients. Let’s say 10% and while we are there let’s make sure that if the patient is at 2.5 times the federal poverty limit they also receive charity care if needed.
We are giving them a gift of NO TAXES to operate in the public good let’s make sure they do. Thank you.”
Resources
Find My Elected Officials
Contact State and Federal Representatives - phone and email
Healthcare Advocacy (Us) Website
Our Newsletter resources including reproductive healthcare - Healthcare Advocacy Reading List
Important Healthcare Resources
League of Women Voters Healthcare Reform Toolkit
Organizations to Contact
National Nurses United Medicare4All
Physicians for a National Health Program
One Payer States
Healthcare Now
Reproductive Health
NARAL - Pro Choice America
Charley. chatbot abortion resource - make sure to use a secure incognito browser if you live in a state that has banned abortion
Planned Parenthood
Miscarriage and Abortion Hotline has references about where to procure abortion medications. They also assist women in the process of self managed abortion or miscarriage by phone or text and will respond in an hour. Details and hours of operation at their website.
United State of Women Reproductive health page (bottom of the page) has important resources such as medical support, access to Telehealth, prescriptions by mail, and legal support references.
Practice careful communications - The Digital Defense Fund has a number of tips to keep texts, calls, and internet use private. Here is their site.
If you need financial help with an abortion try abortionfunds.org
Claims Denials and Appeals & What to Do
Appeal a Healthcare Decision
Appeal/Negotiate a Hospital Bill
Disinformation Management
Cybersecurity Infrastructure Security Agency
Save Democracy
Chop Wood, Carry Water by Jessica Cravens
RESISTBOT
Link to the RESISTBOT site to learn more
Link to Chop Wood, Carry Water RESISTBOT write up
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Thanks, Alan. So shocking to realize we give away millions in tax revenue and don’t get the intended charitable care in return. Maybe these hospitals should be required to pay the taxes first and then apply for refunds if they provide charity, real charity care to real patients, not just reputation scrubbing '’education’. And instead of being allowed to accept donations directly, tdonations could go into a pool that hospitals could apply to for grants. They have not been honest brokers. The onus should be on them to earn these benefits. They should not be given the key to the cash drawer.