Consumers and Hospitals Cooperate to Create National Model for Hospital Charity Care and Patient Billing 

Boston, MA, April 6, 2006. Consumer advocates and New York’s hospital industry have joined together to support a landmark law that will protect thousands of New Yorkers from damaging medical debt. The terms of the bipartisan agreement, which are contained in a bill awaiting Governor Pataki’s signature, include a cap on how much hospitals can charge low-income uninsured patients. Individuals with incomes at or below the federal poverty level ($9,800 for one person) will only be subject to a nominal payment, while bills for patients between 100% and 250% of the poverty level will be based on a sliding fee scale. In addition, hospitals will be able to charge uninsured patients under 300% of poverty no more than the rates they charge their largest group payer. Up to now, hospitals typically have charged the highest rates to those least able to afford to pay — the uninsured.   These rates have been substantially higher than the cost of providing services as documented in a recent report released by Citizen Action of New York.

“Our organization has been monitoring hospital billing practices and state policies across the country for years, and this law will provide some of the strongest consumer protections to date,” said Susan Sherry, Deputy Director of Community Catalyst.  “The ongoing pressure by consumers and, ultimately the cooperation between consumer activists and hospital leaders that led to the law’s passage should serve as an inspiration for other states. It should also inform the current efforts in Congress to ensure that non-profit hospitals, in particular, are providing adequate benefits to their communities.”

The roots of this law can be traced, in part, to the work of a group of local activists on Long Island. The Long Island Health Access Monitoring Project (LIHAMP), under the leadership of Dr. Rose Guercia, a retired pediatrician, and Donna Kass, a retired physical therapist. In 2001, the group published a report on how difficult it was for Long Island residents to get financial assistance with their hospital bills. “That report was a wake-up call for a number of our local hospitals” said Guercia. “Most of the hospitals did not have financial assistance policies.” Several hospital leaders agreed to sit down with LIHAMP members  and the result was concrete improvement in their policies. The advocates knew, however, that even the best policies require ongoing monitoring, a task that would be challenging for a  community group to undertake. So, LIHAMP developed and successfully promoted county ordinances that would require all hospitals to inform patients that financial assistance was available, and would also require them to file an annual report with the county detailing how much financial assistance they have provided over the year.  Said Kass, “We thought it was important to formalize some of the requirements.  All of our local hospitals are receiving significant tax exemptions from the federal, state and local governments, and also receive funds to explicitly support services to low income residents.” 

Long Island hospital leaders agree with their state colleagues in acknowledging that transparency and consistency are important. “For hospitals, signing on to this legislation was the right thing to do.  We are here to serve the community, and when we listen to it and work with it on important issues like this, we are doing a better job fulfilling our mission,” explained Kevin Dahill, president of the Nassau-Suffolk Hospital Council on Long Island.

This new law has also been championed by consumer advocates working in other parts of the state. “Our 2003 survey of charity care policies at 70 hospitals across New York documented the need for this legislation. While most of those hospitals paid lip service to having charity care policies, when it came right down to it they couldn’t say what those policies contained” said Richard Kirsch, Executive Director of Citizen Action of New York. “Voluntary guidelines just don’t work.” 

Forty five million people in the U.S. have no health insurance, and many more have coverage that’s inadequate. Cuts in the Medicaid program in many states will put even more people in jeopardy. There must be a health care safety net to catch these people, not just to protect their health, but also to protect the public health. “There is no question that this bill will strengthen New York’s safety net, and it demonstrates a real commitment on the part of activists, hospitals, and legislators from both parties to work cooperatively on an issue that challenges all of us” said Community Catalyst’s Sherry. 

Since 1999 Community Catalyst has worked with local health advocates across the country who are pressing hospitals to adopt community responsive charity care policies. For more information on hospital free care, including Community Catalyst’s Patient Financial Assistance Principles and its comprehensive report on hospital free care, Not There When You Need It: The Search for Free Hospital Care, visit:


Community Catalyst ( is a national advocacy organization that builds consumer and community participation in the shaping of our health system to ensure quality, affordable health care for all.

The Long Island Health Access Monitoring Group is an all volunteer community-based group established to expand access to health care for the uninsured and undersinsured of Long Island.

Citizen Action of New York ( is a statewide membership organization that works for economic, racial, social and environmental justice.