WASHINGTON - Huge list prices charged by hospitals are drawing increased attention, but a federal law meant to limit what the most financially vulnerable patients can be billed doesn't seem to be making much difference.
A provision in President Barack Obama's health care overhaul says most hospitals must charge uninsured patients no more than what people with health insurance are billed.
The goal is to protect patients from medical bankruptcy, a problem that will not go away next year when Obama's law expands coverage for millions.
Justin Farman, a nursing student from Watertown in upstate New York, poses for a portrait at his Watertown apartment. Farman was diagnosed with a blood cancer last fall, when he was uninsured, and is now fending off collection agencies pursuing some of the approximately $50,000 in bills he has accumulated due to his illness.
Because the Affordable Care Act doesn't cover everyone, many people will remain uninsured. Also, some who could sign up are expected to procrastinate even though the law requires virtually everyone to have health insurance.
Consumer groups that lobbied for a "fair pricing" provision are disappointed. A university researcher who's studied the issue says the government doesn't seem to be doing much enforcement, and at least one state, Colorado, enacted a stricter rule since the federal statute passed.
Critics say the law has several problems:
-It applies only to nonprofit institutions, which means about 40 percent of all community hospitals are exempted. By comparison, the Colorado law also covers for-profit hospitals.
-It lacks a clear formula for hospitals to determine which uninsured patients qualify for financial aid, and how deep a discount is reasonable. A California law spells out such a formula for that state's hospitals.
-More than three years after Obama signed his law, the Internal Revenue Service has not issued final rules explaining how hospitals should comply with the federal billing limits. Delay doesn't signal a high priority.
"We still hear the same stories about patients who are being sent to (debt) collection," said Jessica Curtis, director of the hospital accountability project at Community Catalyst, a Boston-based advocacy group that led the push for billing limitations. "It's the same behavior that we were seeing before the passage of the Affordable Care Act."
The Obama administration responds that fair pricing is the law of the land, and that hospitals are expected to comply even if the IRS has not finalized the rules. The agency has begun compliance reviews, a spokeswoman said.
The health law "helps to protect patients from hidden and high prices and unreasonable collection actions," said Treasury Department spokeswoman Sabrina Siddiqui.