Tag Archives: poverty

For Nonprofit Hospitals Who Sue Patients, New Rules

Nonprofit hospitals get big tax breaks for providing care for patients who can’t afford it. Under new IRS rules these hospitals must take extra steps to inform poor patients they may qualify for financial assistance.

Hospitals that don't take these steps before suing patients could face the ultimate penalty of losing their tax-exempt status. That sounds clear enough. But the first catch is that the IRS does not have a history of aggressive enforcement.

Last month, ProPublica and NPR detailed how one nonprofit hospital in Missouri sued thousands of lower income workers who couldn't pay their bills, then seized their wages, all while enjoying a big break on its taxes.

Since then, the IRS has released long-awaited rules designed to address such aggressive debt collection against the poor. Largely because these new rules fill a void — there were hardly any rules at all — patient advocates agree they are a major step forward.

Even so, they have easily exploitable gaps. It remains up to each hospital, for example, to decide which patients the new rules should apply to. And because the rules only apply to hospitals that have been granted tax-exempt status by the IRS, they don't apply to for-profit hospitals or most public hospitals. ProPublica reported last month that public hospitals can be even more aggressive in collecting debt than nonprofits.

Most hospitals in the U.S. are charitable organizations. They don't pay taxes because they are supposed to be a key part of the safety net for the nation's poor patients. In theory, patients who aren't covered by Medicaid and can't afford insurance — or who are underinsured and can't afford their out-of-pocket costs — can receive necessary care from a nonprofit hospital without facing financial ruin. Each hospital is required to offer services to lower-income patients at a reduced cost and to have a financial assistance policy that states who qualifies for aid, known as "charity care."

But while hospitals are required to have this policy, there have been very few rules on how they publicize it or how they treat patients who qualify. That's where the new rules, which go into effect in 2016, will make the biggest difference. The rules were required as part of the 2010 Affordable Care Act.

At Heartland Regional Medical Center in St. Joseph, the hospital featured in our story, many patients had been sued despite apparently qualifying for financial assistance. In interviews, patients either didn't know the hospital had charity care or wrongly believed they didn't qualify.

Under the new rules, all nonprofit hospitals will be required to post their financial assistance policies on their websites and offer a written, "plain language summary" of them to patients when they're in the hospital. If patients don't apply for assistance or pay their bills, then the hospitals are required to send at least one more summary of the policy, along with mentioning it on billing statements.

And if hospitals plan to sue patients over unpaid bills, they must attempt to verbally tell the patients about their policies, as well as send notices that they are planning to sue and that the patients may qualify for financial assistance.

Hospitals that don't take these steps before suing patients could face the ultimate penalty of losing their tax-exempt status.

That sounds clear enough. But the first catch is that the IRS does not have a history of aggressive enforcement.

"That's always been the problem with the charitable hospital rules," said Corey Davis, an attorney with the National Health Law Program, a nonprofit patient advocacy organization. "The IRS doesn't enforce them and nobody else can enforce them."

The second catch is that hospitals are still responsible for setting their own financial assistance policies, and these protections are only helpful to patients who qualify for help.

"There's all sorts of discretion because [hospitals] just have to have a policy," said Chi Chi Wu of the National Consumer Law Center. The rules don't set a baseline for the type of assistance hospitals must provide, she said.

A hospital could limit aid to uninsured patients with income below the federal poverty line — $11,670 for a single person with no dependents.  A hospital could also restrict aid to uninsured patients, excluding patients with bare-bones insurance policies who might face huge out-of-pocket payments.

For patients excluded by the policy, all these protections would be effectively moot. Even those covered by the policy might receive some reduction on cost, but still find themselves pursued over the outstanding balance.

The hospital industry's reaction to the new rules has been muted. A spokeswoman for the American Hospital Association said it had no comment. But best practices for the industry, set by the Healthcare Financial Management Association, urge hospitals to take steps beyond the new rules to ensure patients eligible for financial assistance aren't the target of lawsuits. For example, as we noted in our story, some hospitals automatically identify some patients as eligible without them having to apply.

Jessica Curtis, an attorney with Community Catalyst, a national nonprofit consumer organization, joined other advocates in stressing that the new rules were welcome. But, as before, she said, there will be large variation among hospitals in how generously they treat lower-income patients. "It will come down to: How seriously does the hospital take this issue?" she said.

 

This article republished via ProPublica via CC license .ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for their newsletter.


 

Feature photo via   Flickr.com/ 401(K) 2012


 

Does This Definition Make Me Look Rich?

Photo via StockMonkeys.com/Flickr

How much income do America’s households take in? How much do they have left after taxes? Do federal taxes leave the nation less or more unequal?

Questions don’t get much more basic than these. Or more complicated. How, for instance, do we define income? Anything anybody collects from a paycheck, of course, should count.

But what about the money an employer shells out to cover an employee’s health insurance premiums? Or safety net benefits like unemployment insurance? Should these dollars count?

Conservatives regularly claim that we need a much more expansive definition of income than we can get from looking at people’s tax returns.

Statistics based on tax returns, they argue, overstate the income share of America’s rich because they don’t take into account the value of the government benefits — like food stamps — that the poor collect.

Conservatives who consider America’s affluent the victims of an oppressive, tax-hungry federal government have already begun scouring a new study from the non-partisan Congressional Budget Office for ammunition. They’ve found some.

In 2011, the new CBO numbers show, America’s top 1 percent took in 14.6 percent of all income and paid 24 percent of all federal taxes. So should we all now feel sorry for America’s most affluent?

Hardly. The new CBO study, taken as a whole, actually reinforces what most Americans already suspect: In modern times, things have never been better for America’s wealthiest. They sit comfortably atop a staggeringly unequal nation.

And that inequality stands out starkly even when researchers define income in a way that tends to deflate the share of the rich and inflate the share of everyone else.

The Congressional Budget Office study counts nearly every possible benefit that low- and middle-income Americans receive from government or their employers as part of their income. The report, its authors acknowledge, “strives to measure income as broadly as possible and thus includes in income some items that people may not usually consider to be part of income.”

Items like employer-paid health insurance premiums. In this new CBO study, these premiums count as income for the working families that receive them. So do their employers’ shares of payroll taxes for Social Security, Medicare, and federal unemployment insurance — as well as the value of benefits lower-income households receive from social safety net programs ranging from food stamps to free school lunches.

Meanwhile, the CBO counts the dollars corporations pay in taxes on their profits as a tax on rich people, since rich people own the bulk of corporate assets. In the CBO breakdown, 75 percent of the taxes corporations pay gets counted as taxes paid by America’s most affluent.

The sum total of all these definitional choices? Lower-income people end up looking richer than they do on their income tax returns, and higher-income people end up looking poorer.

But the CBO report goes on to show that inequality in America, even after all these statistical contortions, just keeps getting worse. How much worse?

Between 1979 and 2011, the study shows, the after-tax income of America’s top 1 percent tripled after inflation — rising 200 percent to an average $1,453,100.

This huge boost for the nation’s top 1 percent ran over four times the income increase that America’s poorest fifth of households realized, and five times greater than gains for middle-income Americans.

However we define income, in other words, the richest Americans are getting much more than their fair share.


 

OtherWords columnist Sam Pizzigati, an Institute for Policy Studies associate fellow, edits the inequality weekly Too Much. His latest book is The Rich Don’t Always Win: The Forgotten Triumph over Plutocracy that Created the American Middle ClassOtherWords.org. Photo via Photo via StockMonkeys.com/Flickr.


 
 

NYC’s Food Pantry Shortages Aggravated By Last Year’s SNAP Cuts

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In the 11 months since the SNAP cuts of 2013, hungry New Yorkers have lost a total of more than 56 million meals, according to a new report by The Food Bank for New York City

According to the group's findings, the cuts are forcing hungry New Yorkers into already-crowded food pantry programs.

As a result, 80% of the city's food pantries reported increased demand this year, coupled with "significant increases in food shortages ...across the network."

In a recent meeting with the City Council, Human Resources Administration Commissioner Steven Banks noted that around 1 in 7 New Yorkers (1.4 million people) have trouble getting enough food.

Meanwhile 60% of food pantries surveyed by The Food Bank of New York reported that they ran out of food, or types of food, to make adequate meals this past September. Last year, only 48% did.

The scale of inequality in New York City means the bad logic, and worse morality, of food stamp cuts has become fiendish reality for many hungry New Yorkers who now have even less places to turn for help.

By September of this year, 37% of New York City food pantries reported having to turn people away due to a lack of supplies.

Last year in September, only 26% of the city's food pantries reported having to turn people away.

With Congress falling to Republican hands this past election, it's likely things will get far worse for New York's hungry communities before they get better.

(to read the full 8 page pdf of
"The Hunger Cliff: One Year Later"
from The Food Bank for New York City
CLICK HERE
)

 

featured photo via Robert S. Donovan/Flikr

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Record Homelessness in Billionaire-Heavy NYC

the uss inequality sinking-ship-inequality-cartoon

the uss inequality sinking-ship-inequality-cartoon

In terms of extreme poverty and wealth, New York City is having a banner year.

Hyperbole has become reality in the city that is now the sixth most economically unequal metropolitan area out of America's 50 biggest cities (and the most unequal of any city with more than one million residents).

Every day in The Big Apple, billionaires and the millions of lives they impoverished intermingle on the city's overpoliced sidewalks -- and the chasm between their economic worlds is only growing wider.

In the wake of the Great Recession and nearly two decades of Bloomberg-Giuliani-Pataki policies (that decimated the local "real" economy in favor of the FIRE industries), most New Yorkers' wages are either stagnating or dropping.

Whatever "economic recovery" has happened has mostly benefited the already-wealthy, leaving average New Yorkers further behind (EPI study-pdf) than ever.

But the news is even worse. According to a recent report, New York City now houses 56,000 people in its homeless shelters, the highest number in the city's history.

At the same time, the UBS billionaire survey found 108 billionaires living in New York City -- more than any other city in the world.

Meanwhile, in the city's wealthiest borough, Manhattan, homeless rate spiked 14% in the last year alone as cost of living increased steadily while wages continue stagnating or declining in real value.

Earlier this week, on WNYC, Commissioner of the Department of Homeless Services Gilbert Taylor discussed some of the challenges homeless individuals face and the services the city is trying to provide them.

According to the National Employment Law Project, the average family needs to earn more than $68,000 year to be economically self-sufficient in NYC.

New York State as a whole has seen an uneven recovery rewarding the already-wealthy with even more wealth.

This follows a national pattern of uneven economic recovery, which itself comes on top of a lost generation of stagnant or, worse, declining value in real wages.

According to IRS records, 90% of Americans haven't seen real growth in their wages in more than 30 years.

At the same time, whether anti-worker policies were shaped as Reagonomics, Triangulation, Neo-Conservatism or Neo-Liberalism, the "new" economy that arose as the real economy was gutted, ultimately lined the pockets of the nation's uber-wealthy overclass, giving 1% of the nation's population around a 50% share of its economy.

De Blasio pushes for federal health center grants

(Photo: Diego Lopez/CC/Flickr)

... officials as one way to reduce health inequality between income brackets. In 2012, nearly 900,000 New York city residents visited an FQHC, and ... ...Click Here to Read More at Capital NY

“Current capacity cannot address the ever-increasing demand for high performing, community-based primary care in New York City,” the mayor wrote, according to the letter obtained by Capital. “If awarded, this federal funding will allow (the center) to increase access to much needed comprehensive primary care and preventive services in the neighborhoods it serves.”

VIDEO: Warren and Krugman talk economics at CUNY

krugmanwarreninconversationatcuny

 
The following description via the CUNY TV Youtube channel

Senator Elizabeth Warren (D-MA) and Paul Krugman, economist and columnist for The New York Times and Distinguished Scholar at the Luxembourg Income Study Center, at the Graduate Center, CUNY, engage in a discussion of public policy, economics and the middle class. Moderator: Janet Gornick, Director of the Luxembourg Income Study Center, CUNY. Taped at CUNY Graduate Center, Sept. 4, 2014. (90 min.)

Check out other great CUNY shows here.


 
 
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