Unwelcome Assistance

As collecting money from self-pay patients becomes ever more important, some providers might dream of the day the government does it for them.

But not those in the Show-Me State.

A new law that allows the Missouri Department of Revenue to intercept an individual’s lottery winnings and tax refunds to offset their delinquent medical bills has evoked little gratitude from those who might benefit.

“We had nothing to do with it, and we want nothing to do with it,” says Tom Holloway, director of government relations for the Missouri State Medical Association. Hospital executives are equally frosty. “The Missouri Hospital Association neither suggested nor supported the measure. In fact, we would have preferred that it not be included in the legislation,” Marc D. Smith, Ph.D., president of the Missouri Hospital Association, wrote in a letter published in the state’s largest newspaper.

Smith is referring to a bill into which state Sen. John Loudon inserted the debt-collection measure. The bill, Loudon says, aims to encourage uninsured people to buy private insurance without mandating it. Some fail to purchase insurance, he says, because they know they can receive treatment at hospitals. Just knowing the state might intercede, Loudon says, might decrease the rate of uninsurance in Missouri, even if the state did not do any bill-collecting. “There is nothing wrong with expecting people to pay their bills, including hospital bills,” state Rep. Doug Ervin, Loudon’s legislative colleague, says.

Most people would agree, but critics point to three features that make it unpalatable: It lets the state seize money regardless of an individual’s financial circumstances; it applies to all claims filed by providers if a bill is at least 90 days old and “appears meritorious on its face”; and it permits the state to keep up to 20 percent for administrative expenses.

Smith says the law contradicts the hospitals’ role as a safety net. “Our communities rely on us for compassion in times of need,” he wrote. “Using the state to pursue payments from those with the least ability to pay would undermine that trust.”

—Lola Butcher