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Legislators hope to make hospital financial assistance more accessible in 2023

With the 2023 Legislative session approaching Jan. 3, Minnesota Legislators, like Rep. Tina Liebling, DFL-Rochester, say unaffordable medical bills are top of mind.

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(From left to right) Minnesota Rep. Tina Liebling, Rep. Liz Reyer and Sen. Melissa Wiklund
Contributed / Minnesota House of Representatives and Minnesota State Senate
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ROCHESTER — With the 2023 legislative session approaching Jan. 3, Minnesota Legislators say unaffordable medical bills are top of mind and that they are drafting a bill that would make hospital financial assistance more accessible.

Nonprofit hospitals are required by the Affordable Care Act to provide financial assistance, also known as charity care, to eligible, often low-income, patients, but few qualified patients know this option exists. Minnesota Rep. Tina Liebling, DFL-Rochester, and others want to change that through legislation.

“Even if you have health insurance, out-of-pocket medical costs can be a real financial hardship for people when the only thing they did wrong was get sick or have a family member get sick,” said Liebling, who chairs the house Health Finance and Policy Committee. “It’s a huge issue.”

Part of the plan is to revamp a failed bill from last session, which would have required hospitals to presumptively screen uninsured patients for eligibility to a range of public assistance programs, including charity care.

Rep. Liz Reyer, DFL-Eagan, who was the chief author of that bill, plans to lead a new iteration. Reyer said she wants to be more ambitious in 2023 and present a package of legislation, galvanized by the Post Bulletin’s reporting on the subject .

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Anna Odegaard, who has worked with Reyer to advocate for this legislation, said one possible provision she envisions is requiring hospital billing offices to screen patients for financial assistance eligibility before implementing a payment plan, so patients don’t get stuck paying off a medical bill they never should have owed in the first place.

Odegaard, the director of the Minnesota Building Asset Coalition, and Reyer are also hoping to expand the 2022 language to include screening underinsured patients, those with high deductible plans, in addition to uninsured patients.

“We're not asking hospitals to change their charity care policy,” Odegaard said. “We just want to make sure that all patients that are eligible for the existing financial aid program at that hospital, know that it exists and are able to apply to receive funding.”

Following a Post Bulletin investigation about Mayo Clinic suing low-income patients for unpaid medical bills, Reyer and Odegaard said they are brainstorming ways to curb lawsuits and other aggressive debt collection practices, such as garnishing wages and denying care due to owed debt.

“I’m intrigued by the October JAMA editorial , which categorized these tactics as 'never events' — harmful policies that hospitals should never pursue,” Reyer said. “Filing lawsuits against patients. Withholding care. It’s just mind-boggling to me.”

Liebling echoed this sentiment, adding that not only do lawsuits hurt those sued, those lawsuits are not a good use of judicial resources, especially when some patients could have qualified for financial assistance.

For Reyer, and for many of her constituents, the issue of unaffordable health care and its impacts are personal. After her dad died, Reyer said her father’s medical debt was passed on to her mother, forcing her mother to file for bankruptcy.

Every nonprofit hospital, including Mayo, is required to provide free or discounted care, also known as "charity care," to maintain its nonprofit status with the IRS and reap the benefits of tax exemption. Experts say that financially strong nonprofit hospitals need to be doing more to make it a fair exchange.

“I saw how devastating and personally humiliating it was for her to file bankruptcy for something that she couldn’t have prevented,” Reyer said. “You remember that feeling when you see it in your own life and the lives of the people you care about.”

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In 2018, nearly 750,000 Minnesotans, 17% of the state’s adult residents, had medical bills in collections, according to the U.S. Financial Capability Study. Minnesota Department of Revenue data from 2019 showed that over two-thirds of the claims referred to collections were for patients with household incomes below $40,000.

While Liebling is supportive of legislation proposals around hospital financial assistance, she noted it might be difficult to come up with a blanket mandate that could apply to all hospitals — from the financially well-resourced hospitals like Mayo Clinic to small, rural ones.

“We want to make sure people get the health care they need without going broke,” Liebling said, but because of variability in the financial stability of hospitals, lawmakers wish to avoid an enforcement solution that could push under-resourced hospitals into bankruptcy.

Something she is considering is having the state step in to play a role. If some smaller hospitals can’t help out their patients adequately with financial assistance, the state might be able to supplement the costs.

Many patients haven’t heard of "charity care," also known as financial assistance, although every nonprofit hospital, including Mayo Clinic, is required to provide it. And even when patients discover it, many struggle because the application process is too burdensome or they avoid it altogether, reluctant or hesitant to apply for “charity.”

Liebling said she and her counterpart in the Senate — Sen. Melissa Wiklund, DFL-Bloomington — plan to work closely to ensure their efforts make it past the finish line.

Wiklund, who is chairing the Health and Human Services Finance and Policy Committee in the Senate, said she can’t yet commit to carrying specific bills, but said that she shares Liebling’s interest in the issue.

“I definitely see a need for us to find ways to make the hospital financial assistance process better,” Wiklund said.

Liebling said that although the state no longer has a divided Legislature since the DFL gained single-party control in November, she can’t be sure what will happen with Reyer’s legislation.

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“I'm hoping that we will make some real progress during this legislative session,” Liebling said. “But I can't say that there won't be any opposition to it.”

Nonprofit hospitals must offer free or discounted care to eligible patients. But the Post Bulletin discovered that some patients sued by Mayo for unpaid medical bills didn't know this option existed.

Molly Castle Work is an award-winning investigative journalist. She has investigated a range of topics such as OSHA and worker safety during COVID-19, racially-disproportionate juries and white-owned newspapers' role in promoting lynchings. Readers can reach Molly at 507-285-7771 or mwork@postbulletin.com.
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