A look at human rights and access to medical care
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This is not a question of political ideology, it's a questions of human rights -- the right to life
“We are the greatest country in the world and we do indeed provide health care for our citizens who are unable to provide for themselves. We also provide the right to earn a living to purchase insurance. We do not, however, provide universal health care as a so-called human right, since health care is not a human right, nor will it ever be. Human rights, by definition, must be free. Not free for everyone, but free to provide. Think about it.”
This is a recent comment made on a hub regarding health care insurance in answer to this statement I made: I believe that everyone is entitled to basic health care as a human right.
There is nothing free about human rights.
The rights of an individual in any society are defined as that which creates an obligation on society. Here are some illustrations of this basic social-political philosophy as taught in most universities.
*the right to vote and participate in the democratic process creates an obligation on society to provide an electoral system, the secret ballot, election workers and a policing system to ensure the process is unmolested, and even to present candidates as representatives.
*the right given to every person to a basic education creates an obligation to build schools, provide teachers, and administer an educational system.
*the right to be presumed innocent of any accusation of crime, the right to a trial before a jury of your peers creates an obligation on society to maintain an independent judiciary and a system of justice.
*the right of free congregation presupposes society’s obligation to ensure that its citizens can do so without interference, again we need the law and law enforcement.
And the big three:
*Life, liberty and the pursuit of happiness, also create obligations on society. Life is mentioned first in this list as written by the founding fathers, for good reason. All other rights are difficult to enjoy for the dead. So doesn’t the right to life also create obligations on society? Not just the obligation to do all that can be done to ensure someone doesn’t steal your life from you, but also the obligation to give you fair and equal access to that which allows you to extend it to its natural limit, and to ensure the best quality of that life one’s natural physical state will allow – fair and equal access to health care.
The cost of human rights
The history of human rights is awash in blood. They’re hard fought, hard won and harder yet to keep. As we live in the “Western Civilization,” for most of us our studies of human history are restricted to that slice of humanity.
Most historians agree that the first major step forward in human rights was the signing of the Magna Carta, in Britain in 1215 – the first document in western history to restrict the rights of the absolute ruler and assign rights to the populace. Of course, those rights only applied to the nobility, and the male nobility at that. That meant these rights were indeed “not free to everyone, but free to provide.”
The second major step forward was the signing of the Declaration of Independence, signed in America in July of 1776. Of course, despite the “all men are created equal” those rights in practice only applied to white male landowners, and again, these rights were “not free to everyone, but free to provide.”
In truth, rights that are not free to everyone but free to provide are meaningless. Unless society is prepared to shoulder those obligations created by its rhetoric, human rights are meaningless, no matter how prettily worded.
The rights you enjoy are not God given. They are not absolute. They are definitely not free. The obligations created by those rights must be shouldered and applied to all, no matter how difficult and burdensome the process may feel. Otherwise, we are back to the Magna Carta.
Today we may substitute the words wealthy, employed, government servant and welfare recipient, indigent, disabled, child or elderly for the words nobility. When it comes to health care, these two extremes as groups are the only humans enjoying the full meaning of right to life, and the right to protect it.
For those that fall between those two poles, the picture is dismal. Last year 27,000 Americans died needlessly because they did not have health care coverage.
Who gave you the idea that universal health care as practiced in other societies is free? Did I say it should be free? No, I said that all Americans should have equal access to health care regardless of their situation. Remember, no right is free to provide.
"And I'm sorry to say, but many who are unable to provide for themselves in this country do not get health care, and many who are working in this country do not have health care insurance." – my comment.
“I will venture out on a limb and speculate that you are not involved in health care on a daily basis; otherwise you would agree that those who cannot care for themselves are given free dental, free vision, free glasses, free surgery, free emergency care, free transportation to the doctor, free food, and more. I didn't say that everyone who was working had health care insurance -- you put those words in my mouth. (No I didn’t.) Everyone has the human right to pursue happiness, which for each individual may or may not include the purchase of health insurance.” – a posted comment
So I went searching all these “free” services for those without the ability to get health insurance.
I restricted my research to Florida – because that’s where I am at the moment.
Background
*Florida is ranked nationally as 44th in overall health care provided to its citizens, having fallen from 38th in two years and 49th in social assistance programs overall.
*One in four Floridians between the ages of 25 and 64 are without health insurance coverage of any kind, including Medicare (for the disabled in this age group) and Medicaid (for families in need with very strict income caps).
*Of this group, 58.6% are working full time but without employer paid medical benefits and along with 26.3% unemployed and collecting unemployment, fall into that never, never land of holding assets, or having income higher than the cap for public medical assistance, but still low enough to find insurance premiums an overwhelming hardship. The remaining people have been refused coverage for a myriad of reasons, do not qualify for public assistance, and cannot afford the alternatives, whatever they may be.
How does Florida treat its poor? Who are those poor?
What improvements can citizens realistically strive for?
From the Florida Catholic Conference:
EXPENDITURES OF THE FLORIDA TAX DOLLAR FROM THE GENERAL REVENUE (Report of Comptroller 2008)
$0.57 - to education
0.14 - to general government
0.09 - to health programs
0.03 - to PUBLIC WELFARE
0.09 - to corrections and law enforcement
0.03 - to natural resources
0.05 - other
-----------
$1.00
COMPARISON OF FLORIDA’S PER CAPITA EXPENDITURES WITH THE 50 OTHER STATES (Federal Aid to States, U.S. Treasury, 2006)
Health Services 38th
Medicaid 49th
Social and Child Welfare Services 38th
AFDC Payments 45th
Since the first edition of FACTS ON FLORIDA WELFARE sixteen years ago, Florida has moved from 49th to 45th in AFDC payments; dropped from 36th to 38th in Child Welfare Services; and has remained 49th in Medicaid.
WHO ARE FLORIDA'S POOR?
Over 1/3 of our poor are children.
1/5 of our poor are over age 60.
The remainder are disabled, unemployed or marginally employed adults.
ARE MOST OF FLORIDA’S POOR ON WELFARE?
There are over 2 1/2 million Floridians living at or below the poverty level.1
70% of the poor receive no cash assistance from the state.
Public financed health options are based on your income relative to the poverty line. So what is the poverty line?
The 2009 Poverty Guidelines for the
48 Contiguous States and the District of Columbia
Persons in family Poverty guideline
1 $10,830
2 14,570
3 18,310
4 22,050
5 25,790
6 29,530
7 33,270
8 37,010
For families with more than 8 persons, add $3,740 for each additional person.
Looking for the free services
The first thing I did was go to Access Florida, the state website intended to give the public easy access and understanding of those programs there for the benefit of all. It wasn't forthcoming, simply giving general guidelines, and required a fair bit of digging, and phone calls to get the specifics.
Here’s the information I found there.
Medicare provides assistance for hospitalization and doctors' costs if the individual has paid into the Social Security fund and either has been receiving Social Security Disability benefits for two (2) years or has attained age 65. There are limitations of Medicare coverage. For example, Medicare, in contrast to Medicaid, does not pay for prescriptions. In some instances, it is possible to qualify for both Medicaid and Medicare.
Medicaid is a program that provides health coverage to some low-income Florida residents. Medicaid covers families with children and pregnant women, medically needy individuals, the elderly, and people with disabilities, if state and federal guidelines are met. Medicaid does not cover uninsured, low-income adults without children unless they are deemed "medically needy."
In Florida, you may be eligible for Medicaid if you are an infant, a child, pregnant, the parent of a dependent child, medically needy, elderly, or disabled, and your family income meets the Medicaid income standard. Low income persons eligible for Medicaid in Florida*
Category Income eligibility (as percent of federal poverty level)
Infant 200% (monthly income of about 3,052 for family of 3)
Child 1-5 133%
Child 6-18 100%
Pregnant woman 185%
Working Parent 55%
Non-Working Parent 21%
Medically Needy
Individual 25%
Couple 25%
Let’s say Jane Doe is a single mother with 2 children ages 8 and 10. She is 36 years old, works at two part-time jobs and earns a total of $21,000 year. Her rent for a small house is $900 monthly, so this leaves her around $800 to pay utilities, groceries and all other expenses. You can bet your bottom dollar, she can’t afford health insurance (the average premium for a family of three would be $275 -- $375 minimum) nor can she qualify for Medicaid.
She can qualify if she quits working one of her jobs, or quits both and goes on welfare. (However, that is not as easy as it may seem.)
So we’ve eliminated the public options for health insurance already. This leaves charity.
Still on the trail of those free services, we’ve looked at the listings for non-profit medical groups in our area. We’ve found a number of listings for clinics, and call them. The first provides medical screenings and blood draws (?), and boasts a limited pharmacy, but specializes in assistance for migrant farm workers. The second provides screening and primary care on a non-profit basis, providing you pass the means test – which she does not. There’s another serviced by a volunteer network of physicians doing pro-bono work, again only if you can prove your necessity, and you will in all likelihood never see the same doctor twice. If I were to list all the options I called and asked about their operations, I’d need to write 6 hubs.
So let’s just say, I didn’t find all these free benefits anywhere I looked. I did find a large number of dedicated health workers doing their best, and sometimes beyond that. One clinic worker I spoke with said they see up to 200 uninsured patients every month, and it was a problem because they often had serious issues that were well advanced, because they didn’t have regular medical care. But they (the clinic) can't go beyond that number and stay in operation. It's a real problem, one the state is reluctant to face.They receive no government funding for this. So yes, I found a glimmer of hope, but I didn’t find this paradise of free care, including rides to the doctor.
Next, it’s safe to assume Jane Doe takes her sick children who she fears may have H1N1 to the hospital emergency room. Perhaps she’ll find all these free services here.
I called two of the major hospitals in our area and interviewed them as to their policy on the uninsured. Both hospitals emailed me a copy of “Financial Assistance for Florida’s Uninsured Policy Guidelines for Florida’s Hospitals.” I pasted a copy below the comments section for those who wish to read it. It is well worth it for anyone who is trying to understand the health care issue.
I read the comment I printed above, and asked the administration of both these hospitals where all these free services I’ve been assured existed for those Americans unable to care for themselves could be found. They laughed.
What does this mean?
There are more than 9,599,000 people between the ages of 25 and 64 living in Florida. 25.6%of these are uninsured. Statistics show that uninsured Floridians are sicker and die sooner than their insured counterparts.
Families USA estimates that more than six working-age Floridians die each day due to lack of health insurance. (2,400 people in 2006.) From across the United States, in 2006, twice as many people died from lack of health insurance as died from homicide.
Before you scoff and say impossible, consider this. Uninsured adults are more likely to be diagnosed with a disease in an advanced stage. For example, uninsured women are substantially more likely to be diagnosed with advanced stage breast cancer than women with private insurance.
The uninsured are less likely to have a usual source of care outside of the emergency room.
The uninsured often go without screenings and preventative care.
The uninsured often delay or forego needed medical care. And are likely to have problems getting the care.
The uninsured pay more for medical care. They are unable to negotiate the discounts on doctors and hospital charges that insurance companies do. They are often charged more than 2.5 times what insured patients are charged. Three out of five uninsured adults or 60% under the age of 65 report having problems and stress over medical bills.
And to add insult to injury, the uninsured are held responsible for their situation by some. Whether they are uninsured because they are unemployed, can’t afford the premiums as an individual payer, or have been turned down as a poor risk by an industry not really in the business of providing health care but in that of making money, their situation is not a voluntary one.
Consider the arrogance of this doctor who writes on a medical blog-site:
“Is it acceptable to allow people to choose to be without health insurance? I say no. There are too many common, potentially devastating medical illnesses lurking out there. If Cindy were to find a lump her breast, for example, she would probably lose her job and her health, go bankrupt, and eventually, after prolonged suffering, end up on Medicaid. She would also, with her pre-existing condition, be uninsurable for the rest of her life. It should not be the public’s job to pick up the pieces when an individual takes a risk and loses out. While one Cindy is a small risk for a society to take, a million of them is a serious risk, and one the public has a right to weigh in on. “
Thank you to: The Uninsured: A Closer Look, Families USA, Agency for Health Care Administration, Access Florida, St. Petersburgh Times, The U.S. Census Report, Sarasota Memorial at North Port, Peace River Medical Center, Florida Health Insurance Risk Sharing Plan, Dying for Coverage in Florida, and many others to numerous to mention.
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Comments
Excellent, thank you. The U.S. is the only developed nation in the world that takes the position that is citizens should *earn* access to medical care and if they do not *earn* it then it is their own fault. The brutality of that position is obvious. It's also an ignorant position because often the first thing that happens when someone becomes extremely ill, even with insurance, is they can no longer earn money.
People keep repeating this obscene position because 1) they don't wish to be bothered by the problems of others (until they are become the 'others'), 2) they have made politics into a religion, 3) they are lying but someone is paying them to do it so they keep on lying. It's really disgusting.
The comment you got on your other hub is from a guy who just says that no matter what, over and over. That's about ALL that guy says. If his own mother collapsed at his feet he'd tell her to get a job.
This is one article that must be read thoroughly. I dare say you did a very good investigative reporting on this very delicate issue.
Great job!
Great hub man! I know many people don't want to write about this touchy issue, good job Immartin!
lmmartin - You certainly worked very hard to research you hub. I can agree with much of what you had to say, however, there is so much in those 1,990 pages of the House bill that needs removing. I believe that truly great advances in our application of medicine to the masses could be inscribed on just a very few pages. What is needed a lot more than fiat from a bloated and inept central government is some common sense re-tooling of what is already at our disposal. Folks seem to be mistaking "transform" for what they like to call "reform." To me, reform is to make something better than it was, but not to take away from those who have fortunately been able to make a currently operating, but wacky, system work. I have worked within the medical provider field since 1948, and I do not recall ever witnessing anyone being turned away who needed medical assistance. For the impoverished who need medical care, it is there for them to ask. Here in Houston, Texas we have a county medical system at work with a large number of medical clinics seeing thousands of patients daily, and several large, modern hospitals, a huge dental school, and a lot more. For those, the "single payer" happens to be the millions of us citizens who pay our taxes into the system to pay the medical bills for those who cannot do so. It is very definitely not charity. Society cannot allow the indigent sick and injured-handicapped to run around spreading disease and other misfortunes. One has to take care of those who cannot do it themselves. If not, their TB, their AIDS, their swine flu become everyone's maladies. But to have the central government try to do things so complex, when those politicians have problems locating their own congressional rear ends, that would be a big mistake. However, with all of that said by this guy here, lmmartin, your article was superb. Gus
Thank you Gus. Much of what you say is very true and the health workers I interviewed for this piece are very dedicated people doing their best with an impossible situation. As you so rightly point out, the population of this country is already paying for the medical care that the uninsured receive, so why not make that official? Many people are not getting the preventative care that would decrease the 'panic' care, that is often too late. As far as I can ascertain it is the hospitals that are bearing the greatest portion of this burden.
I am not so much suggesting the central government take on this responsibility (as from what I can see they are only interested in covering there own oversized asses) but some system has to come into play. Even if only to compute what is being spent and on whom. Keep it at the state level if you desire, although that does not seem to function well either.
It would more efficient to develope some vehicle to allow those to get the early care than to deal with the continuing crisis. As you say, society cannot afford to let a section of the population become Typhoid Marys.
Still, I have to hold exception to your comment, their TB,Aids, etc becomes everybody's -- although it is a true statement. I am not speaking of simply the indigent or homeless, but an entire section of society -- families and adults who are working or would like to be working -- who are left dangling in the wind.
Thank you for your thoughtful comment. And as always, I appreciate your point of view.
Thank you retellect. Your comment is gratefully recieved.
lmmartin - Your healthcare hub, here, is destined to be one of the "biggies" on Hubpages. What I mentioned in my earlier comment was not clearly spoken. The clinics and the care provided here in Harris County (Houston, Texas)provide preventative care and all of that. It is a successful system that the feds should probably try their best (?) to emulate. If a person is "broke" they can obtain a "Gold Card" and get the very best of medical care. If the country as a whole cannot do the same, I would be very much surprised. If you were impoverished, would you not "kill" to be both respected and treated in the largest and most advanced medical center in the entire world? If you are in Houston, Harris County, Texas, you would not have to "kill" to have that working for you. :-)))
p.s.: This is the place where the Katrina hurricane victims were welcomed, rehabilitated, and helped back into a reasonable life once again. Local beats federal every time!
Hurray for Texas. And it is good to know that in Harris county all can indeed find care. But why should it not be financed on a more equitable basis?
All that you describe there, is not what I find here, although as I mention, there are pockets of hope. Here, until you are really sick -- forget it. So, how about we write a real great hub describing this as a role model for those less fortunate areas?
And add in the financial picture if you can. Will Harris County co-operate with such an article? If you wish, and can make introductions, I will gladly research, interview and write it up myself.
45,000 people are killed each year in automobiles.
The study where you get the 27,000 number also says:
"Our study has several limitations... We were unable to measure the effect of gaining or losing coverage after the interview... Earlier population-based surveys that did validate insurance status found that between 7% and 11% of those initially recorded as being uninsured were misclassified. If present, such misclassification might dilute the true effect of uninsurance in our sample." (Emphasis added.)
"Unmeasured characteristics (i.e., that individuals who place less value on health eschew both health insurance and healthy behaviors) might offer an alternative explanation for our findings."
Yet the study doesn't claim that the deaths it estimates among the uninsured are preventable, only that they are "associated with" lack of health care.
By contrast, a comprehensive study of over 35,000,000 -- yes, that's million -- acute care records over a recent three-year period concludes that preventable medical mistakes actually cause far more deaths in the government-run Medicare program. The sixth annual HealthGrades Patient Safety in American Hospital Study examined records "among Medicare patients at virtually all of the nation's 5,000 non-federal hospitals" from 2005-2007 and determined that over 92,000 deaths were attributable to medical errors.
Further, the report noted that mistakes which could harm a patient are only reported 73% of the time and concluded that their figures "likely represent a fraction of the number of avoidable patient safety deaths and associated costs."
Another recently released study by HealthGrades concludes that "224,537 Medicare lives could have potentially been saved during 2006 through 2008" if all hospitals across the country had performed at the quality of care levels of its top-ranked facilities.
Yet why aren't the Democrat demagogues braying about a "holocaust" in government-run Medicare, as they did about the inflated uninsured deaths figure?
Actually, our Constitution here in the U.S. says are rights are God-given.
There is certainly no right to health care in our Constitution. What else do you suppose there is a right to? Water? Food? Clothes? Shelter? Transportation? Electricity? Telephone? Education? TV? Living Wages? Good working conditions? Ramps for the handicapped? To "Privacy" as in abortion?
Let me ask you: what do people not have a "right" to?
Hi James Watkins, nice to hear from you. Actually the source I was directed to didn't mention that, but I'm glad you do. This is a whole new problem. So, if my Jane Doe does manage to get coverage from somewhere, she now has to face the fact that she may be killed by a hospital mistake? Wow.
It's of interest to note here that without fail, all of the medical and hospital personnel I interviewed were positive in their views that some vehicle must be found to provide coverage for the uninsured -- but not necessarily the Federal package as presented. They pray for it. They are the ones on the front lines that see the devastating effects for those that find difficulty obtaining continual care and only show up when the situation is now advanced.
This article is not a push for the Federal program, it is simply a review of the effects of lack of coverage.
The neighborhood I live in when in Florida is for working people, and many of the families I know are in the difficult position I describe here -- too wealthy to get public paid services and too poor to pay for private insurance. I don't believe that any of them eschew health insurance. Many of the them worry about what might happen should they get sick, or have an accident.
Your comments are greatly appreciated, even though it opens the door on yet another horror in health care. And in answer to your question -- I don't know.
Oh! While I was commenting on your first comment, your second showed up. I know the constitution says rights are God given, and that was the fashion of speaking of the time, but rights are whatever a society is prepared to take on as an obligation. Many societies do take the right to health care as an obligation, and it works well. The U.S. may or may not chose to make that a right, only time will tell. The constitution does not say the rights as set out there are exclusive, it says 'foremost among these' and if I've misquoted it is because I was not educated here and have not committed it to memory. As for your other list, that is not the issue at hand. Equitable access to health care is.
Immartin, great work here and you did do the work and research that are providing us with such valuable insight and info - I actually posted this on my facebook page and recommended this to my friends. How people can still be arguing against health care reform is beyond absurd - I simply do not get it - we the people can and should want to change our systems that are unjust and don't work for us - why are we so afraid to even consider what works in other countries - like Canada? And, why are people like James Watson making this issue about what they consider to be "a bunch of Left wing kooks?" - he continues throwing out numbers and figures that he considers somehow relevant to the issue, when in fact, he's simply diverting attention from the points you mentioned. The logic is simply erroneous, and I will say a tactic James seems to use frequently. I actually cannot even engage with the naysayers on this one - simply to upsetting!
Thanks for your comments Kartika. And you do me honor by posting this for others to see. As I've pointed out (many times now) this is not a push for the govt. package because as far as I can tell, it does nothing to address the issue I'm presenting here -- the situation for those who can not get private health insurance but don't meet the needs test for the public options.
And my dear, we must allow all points of view, all opinions are welcome on my hub. But you should see some of the emails I'm getting! Maybe I'll take a selection and post them in another hub. Expressing concern for those caught in this gap in health care access and suggesting it should be treated as a human right means 1. I'm a socialist/communist from a communist country and why don't I go back where I came from, 2. I must be an abortion supporter (???) 3. I simply don't understand how things work here because I'm stupid 4. the constitution (written by men over two hundred years ago) rates up there with the ten commandments and is actually a missive from God, is exclusive and all encompassing, and how dare I suggest rights are not God-given.
Oh well. What is the saying? On this issue 'there is no bad publicity' so I do wish the people who have emailed me would be brave enough to post publicly.
Well done Immartin, for researching this so thoroughly, and laying it out so plainly. Here in the Uk we have our excellent national health service, which although it does indeed have flaws, is nonetheless, always there for us. The more I read hubs like these, the more appreciative I become!
Hi Amanda, thank you for dropping by. Yes, I'm aware of how well your system works, as I once benefited from it. I'm Canadian, and have had excellent care there all my life. Much is made in the U.S. about problems in our system, but it is nothing, and I do mean nothing like the propaganda found in the media here. I recently took a trip to the hospital here in my Florida winter home (H1N1) and the scene in the emergency room looked like a triage scene from the movie Mash. Those people work so hard, and if not for the hospitals and their commitment to doing what they can, and often absorbing the costs, the situation would be catastrophic.
Plaudits for a herculean effort researching this piece.
The recognition of human rights would be no problem but for the poison in the punch called profit.
One thing that must always be kept in mind when scathing criticism is leveled at government public programs. The fact is, they are intentionally underfunded, understaffed and hindered in every way possible from performing the functions with which they are tasked. There is a very simple reason for this. It "proves" that the government is incapable of doing the job and, therefore, the obvious solution is to eliminate the "entitlement" program and privatize that function. We can't let any source of profit go untapped can we? Especially if it's something essential to survival. After all, what is more important than profit? It's interesting to note the portion of the customer base that the health care industry is happy to cede to government programs, anyone who really needs health care.
It should be perfectly clear to anyone who cares to open their eyes that there is, in fact, no longer any government in amerika. It is merely a wholly owned subsidiary of the korporatocracy. The illusory political process is just a dog and pony show presented for the purpose of keeping the unwashed masses distracted and fighting amongst themselves, as witness the constant bickering we see here at HP.
Most of the population has been so indoctrinated to the paradigm of consumer delirium that they are incapable of independent thought. They cling to the system that has conditioned them with the blind faith of the religious zealot. They vote and act against their own best interest and attack anyone who attempts to alert them to their plight.
We observe today a plutocracy, a flock of profit hungry vultures picking over the corpse of what was once America. These bankers, korporatists and politicians have no interest except self, comply with no laws, honor no pledge, are loyal to no nation and worship only the gods of money and power. When they are done here, they will continue with the rest of the world.
lmmartin. Well done. You make your point after some very in-depth research. There are always those who will argue their point of view with great feeling but without the facts. Or again those who attempt to deflect from the issue as it is presented. Regardless, I am impressed with the arguments you have presented.
I don't face these issues with health care, for which I am ever grateful, but kudos for your work on this. You are obviously very passionate about the issue to have spent the time to research it.
FINANCIAL ASSISTANCE FOR FLORIDA’S UNINSURED
POLICY GUIDELINES FOR FLORIDA’S HOSPITALS
OVERVIEW
Florida’s hospitals are the healthcare safety net for the 4.8 million Floridians who are without health insurance for significant periods of time every year – one out of every three [now four] Floridians under the age of 65. In order to meet the healthcare needs of Florida’s uninsured, hospitals incurred $1.5 billion in direct costs last year, only a portion which is offset by special Medicaid and Medicare payments and local taxes.
Florida’s hospitals are committed to serving our patients regardless of their ability to pay, but hospital resources are limited and payment shortfalls from government payers make it even more difficult for hospitals to care for the uninsured. As an example, Florida’s Medicaid program will pay hospitals during this fiscal year $430 millionless than our actual costs of providing care to the Medicaid recipients.
In addition to the almost $2 billion in direct costs to care for the uninsured and underfunded Medicaid patients, Florida hospitals pay $300 million to the state’s general revenue fund through a tax on hospital revenues known as the “sick tax.” The proceeds from this tax were originally intended to finance expansions of the Medicaid program, thus reducing the number of uninsured; now, the proceeds finance general government activities with no net reduction in the number of uninsured.
The solution to providing coverage to the uninsured is a shared responsibility of the federal government, employers, insurers, and individuals. Florida’s hospitals and their patients should not be the primary funding source for the uninsured. The goal of financial access to health services for everyone will promote better overall health for individuals, families, communities, and the state.
Florida’s hospitals are committed to treating all patients with compassion and dignity regardless of the ability to pay. Fear of a hospital bill should never prevent a patient from receiving essential healthcare services. At the same time, patients must recognize their responsibility to access public or private health insurance whenever and wherever it is offered and to pay for health services according to one’s financial ability.
The following principles and guidelines have been developed and approved by the Board of Trustees of the Florida Hospital Association for dissemination and use by all member hospitals on a voluntary basis.
Financial Assistance For Florida’s Uninsured
Principle: A hospital bill should not deter an uninsured patient from receiving essential health services.
Each hospital should have a written, board-approved program of financial assistance for the uninsured who do not have the financial resources to pay a hospital bill. Financial assistance may include predetermined payment amounts, or discounts based on the amount of the bill in relation to patient income and assets. These voluntary policies should include at a minimum the following:
Ø Eligibility criteria for financial assistance which should be stated clearly and applied uniformly;
Ø Hospital services for which financial assistance may be available should be described; similarly, hospital services for which financial assistance will not be available should be clearly stated; and all other hospital services should be handled on a case-by-case basis;
Ø Methodology for determining the amount of the payment for which the patient is responsible should be clear, understandable, and applied uniformly;
Ø Explanation of how assets may be considered in determining eligibility for financial assistance;
Ø Explanation of patient financial responsibility, including minimum payment, if required, or flexible payment plans for that portion of the bill which is the patient’s responsibility; and
Ø Procedures and timetable for evaluating and updating the financial assistance plan on regular intervals.
Principle: Hospital financial assistance policies must be made available to patients and communicated in a dignified, compassionate manner in languages appropriate to the communities and patients served.
Each hospital should develop a plan for communicating to patients or responsible party the hospital’s financial assistance program. The communications plan should include the following:
Ø Placing signage, brochures, or information in appropriate areas of the hospital providing a description of the hospital’s financial assistance plan and where to obtain further information and where to apply for financial assistance;
Ø All communications concerning the financial assistance plan should be in languages which are representative of the community and patients served by the hospital; and
Ø Identification of where patients can go to obtain further information about the financial assistance plan, fill out and return application forms, and receive financial counseling.
Principle: Financial assistance policies do not eliminate personal financial responsibility.
Ø Patients must recognize their responsibility to access public or private health insurance programs and to pay for health services according to financial ability;
Ø Patients requesting financial assistance must recognize their responsibility to the hospital by providing timely, accurate, and complete personal financial information; and
Ø Patients must fully cooperate with the hospital in order for the hospital to determine if the patient is eligible for public or private coverage or for financial assistance under the hospital’s program.
Principle: Hospitals should maintain uniform collection procedures for all patients including those receiving financial assistance.
Each hospital should have written, board-approved policies for how patient debt is advanced for collection and should exercise its best efforts to ensure that all patient accounts are processed fairly and consistently, as follows:
Ø Third-party collection agencies retained by hospitals should be expected to abide by all applicable state laws as well as any guidelines developed by the hospital for collections;
Ø Written agreements should be obtained from third-party collection agencies indicating adherence to state law and hospital guidelines, if applicable;
Ø Legal action, including the garnishment of wages, placement of liens on property, and pursuit of third-party liability settlements or tortfeasors, may be taken by the hospital after approval by the person so authorized in the program and pursuant to the requirements of federal, state, and local laws;
Ø Hospitals and collection agencies acting on their behalf will not force the sale or foreclosure of a patient’s primary residence in order to seek payment of an outstanding medical bill; and
Ø Hospitals and collection agencies acting on their behalf will not seek body attachment to require the patient or responsible party to appear in court.
“The Uninsured: A Closer Look,” Families USA June 2004
Hospital Financial Data, Florida Hospital Uniform Reporting System, Agency for Health Care Administration, FY2002. FHA analysis of estimated uncompensated care costs based on individual cost-to-charge ratios.
Estimate based on information contained in cost reports submitted to the Agency for Health Care Administration.
papajack says:
4 weeks ago
I applaud the depth of your research and insight. It's far to easy to say, "it's not my problem." Bravo!