Sunday, February 25, 2018
Opinion

Obamacare critic leaves us holding her hospital bills

If I were trying to persuade the Supreme Court later this month that Obamacare should not be declared unconstitutional, I would tell the story of the Florida Panhandle woman who was the original named plaintiff in the lawsuit filed by the National Federation of Independent Business, one of the fiercest critics of the health care reform law. • The NFIB thought it had found the perfect person when one of its members, Mary Brown, a 56-year-old owner of an automobile repair shop in Panama City, volunteered to lend her name to the lawsuit.

Brown was outspoken in her belief that Congress had gone beyond what the U.S. Constitution allows when it included in the reform law a requirement that, beginning in 2014, most Americans will have to obtain health insurance or pay a fine to the IRS. She said she was uninsured and was that way by choice.

"She firmly believes that no one should have the right to tell her she has to use her own money to pay for health insurance," Karen Harned, executive director of the NFIB legal center, said when the NFIB filed its lawsuit in 2010.

She turned out not to be such a perfect choice after all.

Last year Brown shuttered her business and filed for personal bankruptcy. Among her debts: nearly $4,500 in medical bills. More than $2,000 of that was owed to Bay Medical Center in Panama City. The rest was to doctors in Florida, Alabama and Mississippi.

Because she filed bankruptcy at least in part because of debt due to medical costs, her case actually becomes an argument for the Affordable Care Act, not against it.

The NFIB had to scramble to find another small business owner to replace Brown's name at the top of the lawsuit. Although Brown still remains as a plaintiff, the NFIB asked the Supreme Court in January to list two more plaintiffs from New York and West Virginia.

Here's why I would make sure that Brown's unfortunate turn of events was brought to the high court's attention: It is people who have decided not to buy coverage — but who nevertheless get sick or injured and seek medical care when they do, even if they don't have the money to pay for it — that make health insurance so expensive for the rest of us. And it is why the cost of coverage has become completely unaffordable for millions of other Americans who, unlike Mary Brown, really want it and know they need it.

While Brown says it was not just the unpaid medical bills that forced her and her husband into bankruptcy, more than 60 percent of people who file for personal bankruptcy in this country do so at least in part because of medical debt. That doesn't happen in any other developed country in the world.

I called Bay Medical Center to find out if any of other patients had been unable to pay for the care they received there, even some of their insured patients.

It turns out that that one hospital gets stuck with $30 million in uncompensated care every year. Spokeswoman Christa Hild said it had become such an unsustainable situation that Bay Medical Center decided it can no longer make it as a stand-alone hospital.

It is not truly accurate, of course, that that $30 million a year in uncompensated care at Bay Medical Center is, indeed, uncompensated. Somebody has to pay for it. And guess who that is? It is all of us. Even Mary Brown. She and the rest of us cover that uncompensated care either through higher taxes to support the Medicare and Medicaid programs or through higher health insurance premiums. The care that is "absorbed" by the hospitals is, in reality, being absorbed not by those facilities but by us. This is what the term "cost shifting" is all about.

And this irrational way of paying for that so-called uncompensated care has us locked into a dysfunctional system in which costs for the insured and the uninsured spiral upward.

If just one relatively small hospital in Panama City has $30 million in "uncompensated" care every year, think of what the total amount is for all hospitals and doctors in this country.

Now do you see why we have to get everybody covered? Mary Brown might have avoided paying those medical bills by filing for bankruptcy, but that doesn't mean the rest of us are off the hook.

Wendell Potter is an analyst at MSNBC and the Center for Public Integrity.

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