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editorial

Hospitals should show restraint in billing uninsured patients

Thanks to its 2006 health care reforms, some of which were strengthened in the federal Affordable Care Act, Massachusetts is far ahead of every other state in helping lower-income patients obtain health insurance. But still there are gaps. It may not be possible to close all of them, but a few common-sense measures would prevent families caught without insurance from being completely submerged by medical debts.

About 98 percent of Massachusetts residents have some form of health insurance. The other 2 percent seem to fall into two categories: lower-income families who are waiting for coverage programs such as MassHealth and Commonwealth Care to take effect, and people who are so overwhelmed or unprepared or unwilling to obtain coverage that they’ve failed to sign up. People in both groups should have to pay for their health care; there should be no free lunch, and even the most troubled families need an incentive to seek out coverage.

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But as things stand right now, hospitals often charge these uninsured patients top-dollar rates, the “sticker price” that hospitals use to begin negotiations with insurers. Almost no one else — certainly no one with insurance, or the insurance companies themselves – pays so much for individual procedures. Since even a modest reduction would come as a major relief for some families — perhaps forestalling a mortgage foreclosure, or a credit-rating reduction — hospitals should give these uninsured patients the courtesy of charging the lowest negotiated rate. That would be, essentially, the amount the hospitals charge the largest insurance companies. In the emergency room as much as the auto lot, no one should pay the full sticker price.

And most of the beneficiaries are not freeloaders, but people who sought insurance, or even signed up, only to get caught in a waiting period. Consider the case of Carlos Vazquez, 27, who left the military and started attending classes at Holyoke Community College. He sought coverage from MassHealth, but learned he was ineligible. He then signed up for subsidized insurance through Commonwealth Care, but while waiting for it to take effect on the first of the month, his wife was rushed to the hospital and incurred a $1,675 bill. The bill now hangs over the family’s prospects, a debt they can’t afford to pay.

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The federal government is in the process of implementing an Obamacare rule that would force nonprofit hospitals to explain financial assistance programs to patients, and State Rep. Jeffrey Sanchez is hoping to require Massachusetts hospitals to limit the amount they charge uninsured patients. Both moves might be helpful, but hospitals should show restraint on their own. In the process, they’ll improve their chances of getting paid, and of keeping some of the state’s neediest families from falling deeper into debt.