Johns Hopkins Hospital is under a harsh spotlight again for taking some of its poorest and most vulnerable patients to court over $4.8 million in unpaid medical bills since 2009. The medical institution was first criticized for this practice in 2008 after a Baltimore Sun investigation unveiled the practice, leading to reforms in state regulations. Now a new analysis by the AFL-CIO, National Nurses United and the Coalition for a Humane Hopkins has found the medical system is back to its old ways, targeting people with limited means even more aggressively than in the past. In some cases, Johns Hopkins garnished the wages of hundreds of people who live paycheck to paycheck and can barely pay rent. Many of the patients live in the shadows of the institution already known for its rocky relationship with the community.
The hospital should cease this practice until they come up with a better way to measure whether a patient can truly afford to pay. Right now, the institution uses public records to make a determination about what, if anything, a patient can contribute toward medical bills. But this may not take into account other bills or unexpected costs that could throw a low-income person’s budget completely off kilter. The hospital sued people on Medicare and Medicaid and even its own employees, according to the report. Some would have qualified for charity care under state law, the report found.
In one case, a 75-year-old African American man in Baltimore who is on Medicare was ordered to pay $100 a month for a debt of $2,220.53 and $74 in costs. The hospital pursued another patient for wage garnishment who earned $13.95 an hour from a nonprofit employer. The patient, an African American male Baltimore resident who lives near the hospital, was billed $2,100.86. At the time of lawsuit in 2015, the patient’s wage would have qualified for 60 percent to 100 percent of charity care coverage depending on the size of his household and if he had no other sources of income.
(We should point out one of the groups behind the report, National Nurses United and the Coalition, is trying to unionize nurses at the hospital. But that doesn’t invalidate the evidence they found.)
What this uncompensated care is costing Johns Hopkins is nothing compared to the toll it takes on families saddled with these debts, one of whom told The Sun her bank accounts were cleaned out. The accumulated debts are about one tenth of one percent of Hopkins’ operating revenues, which were $2.4 billion in fiscal year 2018. Is making it so families can’t afford to buy groceries worth the cost to an institution whose mission is to help people? Not to mention the bad publicity it brings: Suing poor people is not a good look.
Plus, Johns Hopkins, like all Maryland hospitals, gets public funding for charity care to help pay the bills of patients who can’t. In 2017, Hopkins received $164.4 million in tax exemptions and $25 million in rate support to provide charity care, $3.3 million of which was in excess of charity care provided, the report found. The report’s authors maintain that excess charity care funds from 2017 alone could have been used to forgive nearly all the $3.4 million sought in medical debt cases filed by the hospital in Maryland courts from 2015 to 2018.
The medical system has been pursuing more people even as the overall amount of uncompensated care faced by hospitals has dropped under the Affordable Care Act, which made insurance and Medicaid available to more people. The number of lawsuits filed by Hopkins increased from 20 in 2009 to 535 in 2016, according to the report. Statewide, uncompensated care has dropped from over 7 percent of hospital revenue to about 4 percent. Hopkins officials said they are using better analytical tools to determine if people can pay, which probably resulted in the higher numbers.
People should pay their medical bills if they have the means. Charity should be for those who really need it, and those who abuse the system contribute to higher costs for everyone else. Hospitals certainly can’t afford to just give out free care to anyone who decides not to pay. Patients also need to take some responsibility. It is not uncommon for people struggling financially to avoid looking at bills they know they cannot pay. This does not make the bill go away. They may also miss court dates because of work, which doesn’t help the problem.
Hopkins officials said they exhaust all efforts to contact people before turning to the legal system, with patients typically receiving more than a dozen calls or emails over many months and several opportunities to file for financial or medical hardship. The hospital only chooses to sue when a patient refuses to answer any of the communications or somebody they have deemed can pay does not. Patients are told about financial assistance through their bills, signage throughout the hospital in a patient handbook and in appointment reminders. But people are still slipping through the cracks. The patient who spoke to The Sun said she never received notices about the outstanding bills. Low income people may also be transient or change phone numbers often, making them hard to reach. Clearly, more needs to be done to reach people before going to court.