North Carolina treasurer, seeking comment on medical debt bill, visits Buncombe

ASHEVILLE — North Carolina Treasurer Dale Folwell traveled to Asheville on Sept. 7 to advocate for a new law and learn how medical billing issues and resulting debt could hurt residents in western North Carolina.

Buncombe County has been its first step in what could be several public outreach initiatives to garner broader support for the bill in an upcoming legislative session.

Folwell – echoed by Brevard Mayor Maureen Copelof and patient advocate and locally practicing emergency physician Dr Mitchell Li, who also spoke – said the bill he is advocating is not political.

There “Medical Debt Disarmament ActHouse Bill 1039, would require hospitals, clinics and other medical centers that have revenues over $20 million to provide care and transparent pricing based on patients’ ability to pay.

Related:Will AG Stein, Folwell Treasurer, be implicated in new HCA lawsuits? Here is what they said.

The bill passed its first reading on May 26, but did not make it past the short session of the General Assembly as lawmakers did not decide to consider it for the rest of the year.

Coming to Asheville is an effort to breathe new life into Bill. Folwell said he doesn’t know if his office will pursue further public hearings on the topic of medical debt.

Either way, he thinks it’s something everyone, Democrat or Republican, can go along with.

“Anyone trying to call this politics is lazy,” Folwell said, speaking at Asheville-Buncombe Technical Community College to a room of nearly 20 people and an online audience that peaked at 21 viewers. “It’s not about people doing the work of health care. These are businesses.

To that end, Holly Jones, WNC representative for Democratic state Attorney General Josh Stein, read a statement supporting HB 1039.

Related:Mission Health raises employee pay by $22 million; what about union members?

“HB 1039, which aims to protect North Carolina health care consumers, is a good bill with several strong provisions establishing minimum standards for charitable care, requiring transparency in charitable care policies and hospital rates , and establishing limits on certain billing and collection practices,” Stein said in a June statement, which Jones read during the public hearing.

“The bill needs to be improved by strengthening my office’s authority to enforce this and other consumer protection laws against hospitals and violations.”

Brevard Mayor Maureen Copelof speaks during a medical debt forum with North Carolina State Treasurer Dale Folwell at AB Tech on September 7, 2022.

Folwell and his Sept. 7 co-speakers pointed to systemic failures and what they called predatory business practices that obscure and inflate bills, potentially pushing individuals and households into debt.

Copelof spoke of numerous interactions with Brevard residents who arrive with stacks of bills they don’t understand or don’t feel justified.

A woman came to see her recently with a wad of bills for her husband’s medical care.

“I’m afraid my husband will see these bills and it will kill him,” the woman said. Copelof helped her call hospital management, who found that billing had sent the expenses directly to the patient instead of their insurance company or Medicare first.

After:“We Are the Mice”: Brevard Public Forum Reveals Disturbing Local Stories About HCA Healthcare

Copelof said many of his constituents have had experiences where the process was either predatory or simply irresponsible, which they discussed at recent public hearings hosted by Copelof and others trying to fix health care options. local health.

“The stories we hear are heartbreaking,” Folwell said. “I applaud the mayor for sitting down with people, not just sympathizing with people, but sympathizing with them.”

Several medical professionals and people who have come into contact with the system spoke briefly on September 7.

“I would suggest that no one just follows the system because it doesn’t work,” said Emily Paterson, who works with the Patient Safety Action Network. She has a child who had a “preventable adverse event” in the state.

Emergency physician Dr. Mitchell Li speaks at a medical debt forum on September 7, 2022.

“We were charged for it. We paid all the bills,” she said. The family scoured the country for answers, but found only layers and layers of problems. She cited a book called “Never Pay the First Bill,” by medical journalist Marshall Allen. “(Allen) explains it best to me. He writes ‘The system isn’t broken. It works as intended: it’s hugely profitable, with CEOs earning tens of millions of dollars.’

Folwell thinks the “disarmament” bill would reduce those benefits and make life easier for those who have less.

Among other things, he explained in a May 23 press release, when he publicly endorsed the bill, it would be:

  • Mandate charitable care for patients at 200% of the federal poverty level.
  • Hold debt collectors in abeyance during insurance calls for underinsured patients.
  • Protect family members from medical and nursing home debt incurred by a spouse or parent.
  • Ask for detailed receipts for payments.

“Everyone knows something is wrong, especially in western North Carolina,” Folwell said.

However, Mission Health spokeswoman Nancy Lindell said the issues Folwell and others addressed may not be as prominent in the region due to its current debt litigation practices.

“As of 2019, HCA Healthcare does not report to credit bureaus and we do not pursue litigation activities involving suing patients,” Lindell said. “This includes Mission Hospital and all Mission Health hospitals.”

While the issues of medical debt and predatory and confusing practices are not exclusive to WNC, they may be further compounded by the dominance of Mission Health owner HCA Healthcare.

After:Judge in 1st HCA antitrust lawsuit, Mission says ruling likely in ‘coming weeks’

After:Asheville and Buncombe file lawsuit against HCA/Mission Health, who vow to retaliate

Five entities — the cities of Brevard and Asheville, Buncombe and Madison counties, and six people from the WNC area — sued HCA and Mission in three different lawsuits and in less than a year starting in August 2021.

Each of these lawsuits alleges anti-competitive and monopolistic practices that give the hospital corporation the power to determine how costs are created and contained.

“Why would (the system) work? Paterson said, hypothetically. She said she’s worried people won’t be heard when it comes to billing issues or the hospital’s weaknesses. “It’s not something we did wrong,” she said with tears in her eyes.

It wasn’t that she was a bad mother, she said, it was that the system was broken.

“If we get a really huge bill for a terrible result, what we need to do is share our stories. … I spent years thinking I was the problem and I don’t want anyone else to think that.

Related:‘Stupid and dangerous’: Forum examines competition from 3 hospitals for more Buncombe beds

Andrew Jones is an investigative reporter for the Asheville Citizen Times, part of the USA TODAY Network. Reach him at @arjonesreports on Facebook and Twitter, 828-226-6203 or [email protected]. Please help support this kind of journalism with a subscription at the Citizen Times.


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John A. Bogar