NUHW on leading edge of fight to preserve charity care
by Sal Rosselli
In five decades of leading healthcare worker unions, one of the most troubling changes I’ve seen has been the transformation of “non-profit” Catholic hospitals from being run by nuns dedicated to caring for the poor to being run by corporate executives focused on profiting from the poor.
Perhaps the most extreme example is Providence, the nation’s third-largest Catholic hospital chain with 51 hospitals and more than 900 clinics, including six hospitals in California where NUHW represents more than 2,000 workers.
Last year, the New York Times published a damning exposé documenting how Providence paid millions of dollars to McKinsey and Company to develop a strategy, dubbed “Rev-Up,” to maximize collections from patients, even poor patients who should have qualified for charity care.
A former NUHW Executive Board member, who worked in the emergency room of Providence’s Santa Rosa Memorial Hospital, told the Times about having to approach patients as soon as the doctor had left their bedside. “Here are people coming in at the worst moment of their lives, and I’m asking them to empty their wallets,” she said.
Providence was founded by nuns in the 1850s with a mission to serve the “poor and vulnerable.” Currently, it stands accused by Washington State Attorney General Bob Ferguson of violating state law by using debt collectors to pursue more than 55,000 accounts — totaling more than $73 million — from patients who should have qualified for free care.
While Providence demanded payments from its poorest, most vulnerable patients, it has avoided more than $1 billion per year in taxes, according to the Times, because of an IRS exemption that requires it to provide services, such as free care for the poor, that benefit the communities they serve.
Providence CEO Rod Hochman, who made $10 million in 2020, had the gall to tell an industry publication in 2021 that “‘nonprofit health care’ is a misnomer.”
“It is tax-exempt health care,” he said. “It still makes profits.”
NUHW Whistleblowing on Providence’s Charity Care
Four years before the New York Times story was published, NUHW stood alone sounding the alarm about Providence’s charity care practices.
As a condition of Providence’s 2016 merger with St. Joseph Health in California, then-California Attorney General Xavier Becerra required that Providence provide $72 million in charity care per year at 13 of the former St. Joseph Health hospitals, including the six where NUHW represented healthcare workers.
Not only did Providence fail to meet its charity care requirements, but in 2018 it petitioned Becerra to sharply reduce its requirement to provide charity care at St. Mary’s Medical Center in Apple Valley, even though the hospital reported a $49 million operating profit the previous year. Providence officials claimed that because more Californians had insurance under the Affordable Care Act, the need for charity care had diminished, ignoring its responsibility to provide free care for all who qualified.
NUHW researchers documented that in the first full year following the merger, despite reporting total profits in excess of $280 million, Providence St. Joseph Health hospitals in California fell short of its charity care obligations by $20.7 million.
In a July 5, 2018, letter to Attorney General Becerra, I conveyed the concerns of NUHW members that Providence was already out of compliance with the merger agreement.
“We are concerned for the well-being of (Californians) living in the service area of each (Providence) hospital that has failed to meet the charity care requirements,” I wrote. “At a time when many Californians still lack insurance or have inadequate insurance, we need hospitals to meet their charity care obligations under state law.”
Attorney General Becerra rejected Providence’s request to reduce its charity care obligation at St. Mary’s, but that clearly didn’t stop Providence from ramping up efforts to collect millions of dollars from its poorest patients, many of whom qualified for free care.
According to the Times, in 2018 before Rev-Up got underway, Providence spent 1.24 percent of expenses on charity care — less than the industry-wide average of 2 percent. By 2020, charity care accounted for less than 1 percent of Providence expenses.
At Santa Rosa Memorial Hospital, employees were ranked based on who brought in the most cash from patients,according to the Santa Rosa Press Democrat. Jenifer Conte-Hernandez told the paper that she was inundated with calls and letters from Providence seeking payment after her 18-year-old son was struck by a car.
Worker Power helps providence patients
Providence workers are doing a lot more to combat their employer’s greed than talking to journalists. After Providence and Adventist Health announced that they were merging their hospitals in Northern California, NUHW members joined with their RN colleagues to fight the plan, arguing that the merger would result in less care and higher costs for patients.
Our union documented that Providence had violated the charity care requirements from its merger with St. Joseph, and, in 2019, Attorney General Rob Bonta rejected the merger, saying through a spokesperson that “we found this proposal falls short of protecting consumers.”
At Petaluma Valley Hospital, NUHW members and their registered nurse colleagues are leading the fight to save the hospital’s acclaimed birthing center, after Providence announced it intended to renege on a commitment to keep it open through 2025.
“My trust is gone, I can’t trust you at all,” Hospital Board Member Cheryl Negrin told Providence executive Laureen Driscoll, following a worker rally to save the birthing center.
Providence’s greed has been exposed. The fight to protect patients and caregivers is far from over. NUHW members will continue to be on the front lines, not only in working with local allies to hold Providence accountable to the communities it serves, but also in continuing to press for a Medicare for All healthcare system. With Medicare for All, everyone will have affordable, comprehensive insurance so they can access the care they need.