Health Care Critics Say ACA ‘Fair Pricing’ Provision Lacks Oversight
A provision in the Affordable Care Act requiring not-for-profit hospitals to charge uninsured patients no more than what insured patients are billed is not working due to lax enforcement and numerous loopholes in the legislation, according to groups that lobbied for the provision, Modern Healthcare reports.
The criticism comes soon after HHS Secretary Kathleen Sebelius' decision to release federal data documenting wide disparities in what different hospitals nationwide charge for the same procedures.
According to AP/Modern Healthcare, these disparate hospital pricing policies have the largest effect on patients with little or no insurance.
Loopholes, Lack of Oversight Make Rule Ineffective, Critics Argue
Critics outlined several issues, including that:
- The provision applies only to not-for-profit hospitals, which means that about 40% of community hospitals are exempt;
- The provision lacks clear guidelines on how hospitals should determine whether uninsured patients qualify for financial aid, and how deeply their procedures should be discounted; and
- The Internal Revenue Service has not yet issued final rules governing how hospitals should comply with the provision, signifying that the rule is not a high priority.
Glenn Melnick -- a policy professor at University of Southern California -- said that the provision creates additional disparities because it allows hospitals to determine which uninsured individuals qualify for aid. "One hospital could say [the rule] applies to people at 100% of the poverty line, and another could say 200%," Melnick explained.
Meanwhile, observers have said the federal government has not done much to ensure that hospitals are complying with the law. The Obama administration countered that the provision is law and hospitals must comply even if the rule had not yet been finalized. An IRS spokesperson added that the department has begun compliance reviews (Alonso-Zaldivar, AP/Modern Healthcare, 6/23).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.