Two years ago, Alicia Hamilton was pulled from the airplane she'd been traveling on and rushed to a Nevada hospital. Far from her California home and unable to stop vomiting, she was told her gallbladder would have to be removed. After 10 days and two surgeries, she left the hospital owing $53,000, she said. Had she been insured, she-typically speaking-would have been charged less than $16,500 for the same care, according to figures taken from the federal registry and calculated by Consejo de Latinos Unidos, a nonprofit advocacy group.
Hamilton was one of about 30 sign-holding, slogan-chanting protestors that circled the corner across the street from the Manchester Grand Hyatt hotel downtown last Friday.
"I'm not a derelict person or someone trying to get out of paying," she said. "I'll pay the bill, but only a fair bill."
Organizers with Consejo, protesting what they say are unfair hospital charges for the uninsured, hoped to get their message out not only to those driving past the spectacle, but also to the Hospital Association of America, which was holding a leadership conference in the Hyatt.
"We're sick and tired of the hot air coming out of the AHA," said Consejo Executive Director K.B. Forbes, who led the demonstration.
According to a series of Consejo reports authored by Forbes, uninsured patients may be charged more by America's hospitals than what an HMO would be billed for the same treatment, a fact supported by the Kaiser Family Foundation. Consejo estimates that an uninsured patient in San Diego would typically pay two to three times more than an HMO. In other parts of the state, the disparity is between four to five times more.
While insurance companies have the leverage to negotiate discounts, the uninsured are left to pay full price for their treatment or risk ruining their credit or being targeted with lawsuits, Forbes said.
"It is unfair. It is immoral," he added. "However, it is not illegal in the eyes of the federal government, and that is why we are putting public pressure on [the hospitals]."
In December 2003, the AHA, a national organization representing hospitals, released guidelines and procedures for its members to review in order to provide better healthcare to the uninsured, including making care more affordable and ensuring "fair and balanced" billing and collection practices. Spokesperson Alicia Mitchell said that 4,250 out of approximately 4,800 hospitals nationwide have pledged to follow the guidelines.
But 19 months later, Consejo advocates say they're still waiting for real change, naming Tenet Healthcare-which owns Alvarado Hospital, located just east of San Diego State University-as the only corporation to take significant steps toward correcting the problem.
Forbes called on the AHA to take a firm stand against its members that still employ aggressive billing and collection practices, including placing liens on the homes of unemployed patients.
More than one out of every six-or 44.7 million-non-elderly people in America is uninsured, according to a 2004 report by the Kaiser Family Foundation. In California, the percentage of non-elderly adults without insurance was even higher.
Murky language in federal legislation made offering across-the-board discounts a sticky practice in the past, Mitchell said, adding that lowered rates could be seen as an inducement to attract patients to one hospital over another, which would be illegal under the Medicare system.
But hospitals have been given clarification, and now many are working to offer free care and discounts to uninsured patients, she said.
Forbes said Consejo is focusing on San Diego for future action and plans to return within the next few months to put pressure on other targeted healthcare organizations.