Disapproving A Rule Submitted By the Department of Labor

Floor Speech

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Mr. GRASSLEY. Mr. President, I wish to address an important investigation that has produced significant results for low-income people and that the Republican majority in the Senate helped bring about.

In late December 2014, news reports indicated that a nonprofit hospital chain in Missouri and Kansas, Mosaic Life Care, had been aggressively suing low-income patients. These news reports further indicated that many of these patients qualified for financial assistance and were wrongly placed in collection.

Let me be clear. Nonprofit hospitals should not be in the business of aggressively suing their patients. As recipients of a tax-exempt status, these hospitals have a heightened duty to assist patients in qualifying for financial assistance. That means these hospitals must implement a financial-assistance policy where low-income persons receive free- or reduced-cost care. Further, these types of hospitals must assist low-income persons in ensuring that the proper paperwork for government assistance or private insurance is properly filed. In essence, because of the favorable tax treatment these hospitals receive, they have a duty to help our Nation's most vulnerable.

For these reasons, I began my investigation into Mosaic to determine what, if anything, went wrong. On January 16 of last year, I sent a letter to Mosaic to begin my inquiry. Over the past year, my staff has met with Mosaic representatives, exchanged numerous emails, and had many phone calls to get a better idea of the process at issue. It became clear that Mosaic was lacking the right number of personnel to manage financial assistance intake.

Common sense tells me that when anyone visits a hospital, it is often a scary event under any condition. When we go to hospitals, it is generally because something has gone wrong. In that moment of need, we put our lives in the hands of professionals to help us get healthy. In those moments of pain and fear, we put our trust in medical professionals to give us the right care. In other words, we place our trust in the hospital to have hired the right people. And, as normally happens, after treatment is provided, here comes the bill.

Again, common sense tells me nothing in life is free. Someone, not always the patient, will always have to pay the bill. It is common sense; there is no free lunch. But when it involves low-income persons and a nonprofit charity hospital has provided the treatment, that hospital should provide some type of financial assistance or help to get financial assistance if it is available. That obligation exists simply because of the tax-exempt status.

If you want that status of tax exemption, you are supposed to help those who are less fortunate. So when that bill comes, the hospital must ensure that it has people in place to assist the patient in filing for financial assistance if it is available. If the patient doesn't have any coverage, but his or her income is so low that they qualify for free- or reduced-cost care, the hospital should ensure that patients know help is available.

It is common sense. Employees should explain the process and patients' rights. Tax-exempt hospitals cannot be in business to profit from poor people who may not know what form to file. That is not what Congress intended to happen when we created the tax exemption.

During the course of my investigation into Mosaic, I made clear that they must have adequate personnel. In response to my overtures, Mosaic has hired seven resource advocates to assist with Medicaid, supplemental assistance, and Social Security disability applications. Two additional financial counselors were reassigned to focus solely on assisting patients navigate the financial assistance process. Importantly, Mosaic will hire an additional financial counselor dedicated to its outpatient clinic. Finally, five patient financial service representatives have been assigned with the duty of ensuring the timely processing of financial assistance applications.

These are very important as well as productive steps to take. It just makes sense for a charitable health care institution to help its low- income patients rather than sending debt collectors after them and suing them. It is common sense. You cannot get blood out of a turnip.

Further, during the course of my investigation, I made clear that charging interest on accounts prior to final judgment would further burden the poor. Nonprofits need to take steps to reduce debt burdens, not increase that debt.

In response, Mosaic will no longer charge interest on accounts until a final court judgment. Further, to provide even more opportunity for patients to receive financial assistance, Mosaic has extended its four- statement bill cycle to six. That will allow more opportunities for patients to receive notice of their ability to receive financial assistance. These steps will help patients in the long run.

Again, common sense tells me it is important, and it is important to note that there is a certain amount of self-responsibility to be accepted when someone incurs a bill for services rendered. But that doesn't mean hospitals shouldn't lend a helping hand. Just look at any Medicare and/or health insurance bill that you get. You know then how intimidating that document can be.

The changes I just mentioned are not the end of this, however. I wish to note a much more profound result. I repeatedly urged Mosaic to look at low-income patients already in the collection system or the court system. Over the course of several months, I urged them to consider forgiving their debt when it was obvious that people didn't have the income to pay.

In response, Mosaic instituted a 3-month debt-forgiveness period running from October 1, 2015, to December 31, 2015. Importantly, during this forgiveness period, Mosaic lowered the threshold by which a patient could qualify for financial assistance. When a patient was already in collection or already subject to a court judgment, they could apply for debt forgiveness.

Mosaic recently informed me of the results of their change of policy. The debt forgiveness program resulted in 5,542 financial assistance applications, of which 5,070 were approved. A total of $16.9 million in debt, interest, and legal fees were forgiven. Over 5,000 people no longer have to worry about their debt burden; 5,000 people are free from the vice grip of almost $17 million.

Medical debt is vicious. It is a mental and emotional drain that can bring the strongest among us to our knees. For some patients, they will never be able to pay off their debt.

Mosaic eventually did the right thing. It deserves credit for that. Considering where I started in this investigation, it probably shocks Mosaic that I would compliment them. But I speak from the heart that when they make these changes, they ought to be complimented.

Now, thousands of people have a new lease on life, thanks to Mosaic's meeting nonprofit tax-exempt responsibilities. That is where we are coming from. If it hadn't been for the tax exemption and accepting the responsibilities of tax exemption, there would be no way we could complain about Mosaic.

I wish to point out a lesson to all 535 Members of Congress. That is why oversight is so important. That is why I take my responsibilities as chairman of the Judiciary Committee so seriously. Results matter.

Res. 88.
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