Colorado’s legislature is taking up a bill Thursday that would limit how much hospitals can charge people without insurance. CPR Health Reporter Eric Whitney says the lawmaker who wrote it is trying to reduce the number of Coloradans bankrupted by medical bills.
This is a transcript of Whitney's report:
CPR Health Reporter Eric Whitney: One day last March 53-year-old Justin Swanstrom was having some chest pains. His partner wanted to take him to the emergency room, but Swanstrom resisted. He didn’t think it was a big deal, and besides, they were broke.
Justin Swanstrom: That’s why I didn’t want to go, because I was unemployed, and it just seemed like a very foolish decision to be spending money that we didn’t have.
Reporter: His partner said OK, and suggested they go to the store. He then promptly drove Swanstrom to the nearest ER.
Swanstrom: While I was hooked up to the EKG, heart attack started, and I went in for surgery and had two stents put in my heart. That was quite a day.
Reporter: A couple of days later, Swanstrom was ready to go home. For one, he thought he’d be more comfortable there.
Swanstrom: But, the cost was a huge factor. I’m getting meals, I’m getting drugs, there’s people bringing me stuff, coming in to check and see how I am, and all that costs money.
Reporter: So, you’re laying there in the hospital bed after having your heart operated on, thinking, not just, "Wow, I really want to get better," but, "Oh my God, this is costing me an arm and a leg, too"?
Swanstrom: Yes, and I’m unemployed. I do not have the money for this. (laughs).
Reporter: Swanstrom left the hospital a day early, against the advice of his doctor. He recovered just fine. But Denver Senator Irene Aguilar, who’s also a physician, doesn’t want people making decisions about their health based on fears of big hospital bills.
So Aguilar, a Democrat, wrote a bill she thinks will help. It has two parts. The first is about how much hospitals can charge.
Senator Irene Aguilar: We want hospitals not to charge patients more than what is the cost to the hospital.
Reporter: That rule would apply only for people without insurance, and only if they make less than about $45,000 a year.
Aguilar: Some hospitals charge up to 800% of cost.
Reporter: Aguilar says charging low-income, uninsured people full retail prices means they get stuck with bills they’ll never be able to pay, and drives them to bankruptcy.
Aguilar: We’d like them to have a bar that they could reach and they could actually pay off, and so to feel a sense of dignity that they paid their bill.
Reporter: The Colorado Hospital Association says mark-ups of more than 500% aren’t unusual, but it won’t give specific numbers.
The Association and Colorado’s biggest hospital companies won’t talk on tape about Senator Aguilar’s bill. But the Association has issued a statement, saying Colorado hospitals already give away a billion and a half dollars a year in free or discounted care.
Even Senator Aguilar says she was surprised to learn how generous some hospitals already are, and that she doesn’t want to demonize them.
Aguilar: So I think there’s a large misperception about what kind of safety net exists in our Colorado hospitals right now. Now, that doesn’t mean everybody’s a good player.
Reporter: The bad players are the ones Aguilar is targeting. She says hospitals that already have policies that are more generous than what’s in her bill can keep those. She just wants a minimum standard.
And while Colorado’s biggest hospital chains aren’t talking to reporters about Aguilar’s proposal, John Gardner would go on tape. He’s the CEO of the 14-bed hospital in tiny Yuma, Colorado. Gardner says hospitals need to be able to charge patients more than cost to keep their doors open. And some patients have to be charged more than others to make up for unpaid bills and other shortfalls. Gardner doesn’t want the government to set a limit on how much hospitals can charge the uninsured.
John Gardner: What we ask for is some flexibility, so we can evaluate on a case by case basis within the context of organizational constraints. You know, we have debt, and we have to keep our payroll going.
Reporter: Senator Aguilar is still negotiating the specifics of her bill with Colorado hospitals. It needs bi-partisan support to pass, and Aguilar says she can only get that if the hospital association is on board.
Where the first part of her bill deals with prices, the second part is about transparency.
It says hospitals need to do a better job of letting patients know what kinds of discounts and payment plans they offer.
And that’s a pretty big deal to Justin Swanstrom, the guy who had the heart attack with no insurance. It’s been nearly a year since his operation, he’s still unemployed, and the hospital keeps demanding more financial documents. But he still has no idea how much of his $49,000 bill he’s going to be expected to pay.
Swanstrom: My understanding from talking to them is they will adjust the bill based on my need, based on my income.
Reporter: Adjust the bill means lower the amount you have to pay? Or come up with payment plans? What does that mean, “adjust?”
Swanstrom: They have not explained that.
Reporter: That must be really frustrating.
Swanstrom: That is really frustrating (laughs).
Reporter: Swanstrom will tell his story to the Senate Health and Human Services committee Thursday when Senator Aguilar’s bill gets its first hearing.
This story was produced in collaboration with NPR and Kaiser Health News. Kaiser Health News is not affiliated with Kaiser Permanente.
[Photo: CPR / Eric Whitney]