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Podcast: 'An Arm and a Leg' -- How Charity Care Made It Into the ACA

Analysis  |  By Kaiser Health News  
   September 09, 2021

Charity care is one tiny provision in the giant Affordable Care Act, and it can make a big difference for patients who face huge bills.

This podcast was released on Thursday, September 9, 2021 by Kaiser Health News.

By Dan Weissmann 

Can't see the audio player? Click here to listen.

Healthcare — and how much it costs — is scary. But you're not alone with this stuff, and knowledge is power. "An Arm and a Leg" is a podcast about these issues, and its second season is co-produced by KHN.

Charity care is one tiny provision in the giant Affordable Care Act, and it can make a big difference for patients who face huge bills. How did it get into the law? One Republican senator made sure the ACA required nonprofit hospitals to act more like charities — and less like loan sharks — but he still voted against the whole bill.

The national requirement to offer charity care emerged from the Obama White House's failed courtship of GOP Sen. Chuck Grassley of Iowa. In this episode, we hear how that political tango almost tanked the ACA — and how the battle over the ACA "broke America." Featured are David Axelrod, a former adviser to President Barack Obama; longtime health policy reporter and KHN chief Washington correspondent Julie Rovner; and a top Grassley aide.

This is the second in a four-part series that looks at the (slow, uneven) development of legal protections for consumers (aka patients, aka people who just don't want to die and aren't Bill Gates) against outrageous medical bills and draconian collection practices.

Catch up on the first episode, before or after listening to this one. It's about how a legendary lawyer — the guy who beat Big Tobacco in the 1990s — tried to sue nonprofit hospitals into acting more like charities and less like loan sharks. (He lost, but it wasn't a total dead end; that's where this episode picks up.) 

Here's a transcript for this episode.

To hear all KHN podcasts, click here.

Subscribe to "An Arm and a Leg" on Spotify, Apple Podcasts, StitcherPocket Casts, or wherever you listen to podcasts.

"An Arm and a Leg" is a co-production of KHN and Public Road Productions.

To keep in touch with "An Arm and a Leg," subscribe to the newsletter. You can also follow the show on Facebook and Twitter. And if you've got stories to tell about the healthcare system, the producers would love to hear from you.

Kaiser Health News is a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.


KEY TAKEAWAYS

The national requirement to offer charity care emerged from the Obama White House's failed courtship of GOP Sen. Chuck Grassley of Iowa.

Grassley made sure the ACA required nonprofit hospitals to act more like charities — and less like loan sharks — but he still voted against the whole bill.

In this episode, we hear how that political tango almost tanked the ACA — and how the battle over the ACA "broke America."


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