Opinion: It’s time to hold nonprofit hospitals in NC accountable

Nonprofit hospitals are supposed to operate like charities, providing affordable health care to those in need while improving their communities. But the truth is that across the country – including here in North Carolina – nonprofit hospitals are implementing toxic policies that put profits ahead of patients.

Recently, egregious, profit-seeking behaviors of nonprofit hospitals have been spotlighted in investigations and reports by The New York Times, Axios, the documentary film inHospitable, issue advocacy organizations such as Innovation for Justice, the Lown Institute and many others.

North Carolina health care consumers have felt the impacts of nonprofit hospitals acting like big businesses.

Nonprofit hospitals are granted tax-exempt status in exchange for providing affordable, quality care to those in their communities that need it most. This community aid can come in the form of charity care for low-income patients to offset their cost of care. Yet nonprofit hospitals are failing to hold up their end of the bargain, as they continue to clearly prioritize financial gain over service to their community.

North Carolina nonprofit hospitals have a “fair share deficit” of $366 million dollars in aggregate. In other words, nonprofit hospitals in North Carolina received a whopping $366 million more in tax breaks than they spent on charity care for low-income patients and community benefits. This isn’t surprising given the fact that nonprofit hospitals spend less on charity care than for-profit hospitals of comparable size.

Take a look at some of the nonprofit hospitals in our state. UNC Medical Center charges patients 3.5 times more than it costs the hospital to provide care. Duke University Hospital charges 4.4 times more than the cost of care. The same is also true for Wake Forest Baptist Medical Center, but for Carolinas Medical Center — part of Atrium Health, one of the largest nonprofit healthcare systems in America — the upcharge is 4.7 times the cost of care.

These upcharges, along with inadequate charity care provided to low-income patients, shows nonprofit hospitals are failing to provide affordable, quality care to their communities in more ways than one.

Not only are North Carolina’s nonprofit hospitals charging patients outrageous markups, they are also flouting federal price transparency laws. The latest report by Patient Rights Advocate shows that only 55% of North Carolina’s hospitals are in compliance with federal regulations requiring all hospitals to post their prices online and make them easily accessible and searchable.

Without price transparency, patients are unable to make informed decisions about medical care. They cannot compare costs between hospitals, or catch when they are being charged more than the cost of care, putting them at risk for sinking into medical debt.

In 2021, 1 in 5 North Carolina residents had medical debt in collections – a number surpassed by only five other states. As a result of North Carolina’s weak debt protection policies, North Carolina residents are at risk of becoming victim to devastating debt collection methods if they can’t pay their medical bills. That means already vulnerable North Carolinians could have their wages garnished, bank accounts seized or homes foreclosed.

Fortunately, North Carolina’s elected officials — both at the state capital and in Washington, D.C. — recognize too many nonprofit hospitals are taking advantage of vulnerable patients and taxpayers and are taking action to hold them accountable.

Indiana’s Rep. Victoria Spartz recently joined forces with Washington Rep. and chair of the Congressional Progressive Caucus Pramila Jayapal to introduce legislation that would help stop anticompetitive practices by nonprofit hospitals. As Rep. Spartz said, “More than one of eight Americans … are in collections due to medical debt, which is unacceptable. Non-profit hospital status should not be a loophole to avoid antitrust enforcement.” This sentiment is being echoed here in North Carolina, where state lawmakers have recently filed bills to promote competition and crack down on anticompetitive practices by hospitals, including nonprofit hospitals.

I am encouraged by these efforts and urge lawmakers and Gov. Cooper to do everything in their power to ensure North Carolina’s nonprofit hospitals act like nonprofits and provide the affordable care their communities demand. It’s time for statewide changes that will make a difference, including prohibiting hospitals from pursuing toxic debt collection practices, setting standards for charity care eligibility and obligations, and enacting standards and ceilings for common abusive practices like high interest rates on medical bills and reporting on medical debts prior to insurance determinations. North Carolinians deserve nonprofit hospitals that put patients and their communities first.

Jim Manley is a former senior advisor for former Senate Majority Leader Harry Reid and current board member for Consumers for Quality Care.

This article originally appeared on Asheville Citizen Times: Opinion: It’s time to hold nonprofit hospitals in NC accountable