Hollie Murphy works as a certified nursing assistant in Springfield, Oregon. She brings food to patients at Sacred Heart Medical Center, takes their vital signs and helps them to the bathroom.

But back in 2013, she started having her own medical problems. She felt really tired. She was having heavy periods and was anemic. She ended up having a hysterectomy to remove her uterus.

The procedure successfully relieved her problems. But it was considered an elective surgery and Murphy said she didn’t work out the cost beforehand.

Hollie Murphy ended up going bankrupt after being given a $10,000 bill following a hysterectomy. She thinks the nonprofit hospital should have helped her with the bill, in exchange for not having to pay things like property taxes.

Hollie Murphy ended up going bankrupt after being given a $10,000 bill following a hysterectomy. She thinks the nonprofit hospital should have helped her with the bill, in exchange for not having to pay things like property taxes.

Kristian Foden-Vencil/OPB

“I didn’t do the numbers because I figured the health care that I have was good health care to where I wasn’t going to have to have a huge out-of-pocket expense,” she said.

Murphy got her health insurance through her employer, PeaceHealth, for about $300 a month. The insurance did cover a substantial part of her operation. But she was shocked when a bill for the rest — almost $10,000 —landed on her doorstep.

“I was like, ‘Oh my goodness. How am I going to pay for this?’ I tried to work with PeaceHealth on telling them what I could afford a month, and they wanted significantly more,” said Murphy.

PeaceHealth and 58 of Oregon’s 62 hospitals are nonprofits. The idea is that in exchange for avoiding the tax liabilities of businesses, nonprofit hospitals offer community benefits, such as treating patients who can’t afford big medical bills.  

The system made sense when a large swath of the population didn’t have health insurance. But the Affordable Care Act means 95% of Oregonians are now covered. The change in federal law has led hospital revenues to increase dramatically, and charity care to plummet.

Charity care in Oregon dropped by half as the Affordable Care Act came into law.

Charity care in Oregon dropped by half as the Affordable Care Act came into law.

Oregon Association of Hospitals and Health Systems.

When Murphy approached PeaceHealth about her bill, she offered to pay up to $50 per month. But she said PeaceHealth wanted at least a couple of hundred dollars a month.

“It was very hush-hush about their charity care. And it was a lot of paperwork,” she said.

Murphy had a family of three to support on $30,000, but PeaceHealth didn’t give her charity care and sent her bill to collections.

“Because of their nonprofit status, I figured that they would have been more than willing to help out,” said Murphy.

Oregon legislators are now trying to help patients like Murphy with House Bill 3076. Supporters say it would force hospital systems to justify their nonprofit status by providing sufficient “community benefit.”

PeaceHealth changed its charity care policies in 2017 and now gives financial assistance to patients making under 300% of the federal poverty level. For a family of three that’s about $64,000 a year. That’s the same assistance level being proposed in House Bill 3076.

But it’s too late for Hollie Murphy. She ended up filing for bankruptcy.

“Everything got cleared but it has made a … hardship of getting affordable rent. I got recently denied for a house loan,” she said.

Murphy ended up buying a trailer for $500 and paying $500 a month for a spot in a mobile home park.

Hollie Murphy looks after her granddaughter. In 2013, PeaceHealth's Sacred Heart Medical Center did not think Murphy warranted getting charity care for her hysterectomy. She was making about $15-an-hour as a certified nursing assistant.

Hollie Murphy looks after her granddaughter. In 2013, PeaceHealth’s Sacred Heart Medical Center did not think Murphy warranted getting charity care for her hysterectomy. She was making about $15-an-hour as a certified nursing assistant.

Kristian Foden-Vencil/OPB

The Affordable Care Act was supposed to reduce medical bankruptcies like Murphy’s, by giving people health insurance. But Murphy is part of a large group of Americans who bought inexpensive insurance that didn’t cover much and came with costly co-pays and deductibles. So medical bankruptcies remain stubbornly high.

Political leaders like Rep. Andrea Salinas, D-Lake Oswego, are pointing the finger at hospital systems.

“You can’t have on one side, a hospital system saying: ‘We’re a nonprofit, we’re charitable. We do good work.’ Yet normal ordinary people who used to have great health insurance, and used to be able to access it, suddenly go into medical debt and generational poverty because they pass on that debt to their kids,” said Salinas, who chairs the Health Care Committee in the Oregon House

“That’s what I’m mad about. And then the hospitals not stepping up voluntarily and not actually fulfilling their charitable mission.”

But Salinas said she can’t condemn all hospitals. Some, like St. Charles in Madras, put close to 20% of their 2017 operating revenues into community benefit. That compares to others, like PeaceHealth in Cottage Grove, that only put in 2%.

PeaceHealth said it provides more community benefit at its three other Lane County hospitals, bringing its total community benefit for 2017 to 12% of operating expenses.

To clear up such confusion, House Bill 3076 would make all hospital systems meet with the Oregon Health Authority, so the agency can assign a minimum amount to spend on community benefit.

MAP: What Percentage Of Oregon Hospitals' Revenue Went To Charity Care In 2017

Data source: Oregon Health Authority, 2017.

Salinas said the bill would also limit the interest that hospitals and collection agencies can charge.

“If you’re seeing 20% or 24% interest on your medical debt for care that you couldn’t afford in the first place, you’re certainly not going to be able to afford the interest on top of it,” Salinas said.

Felisa Hagins, with the Service Employees International Union Local 49, has spent the last seven years working to increase what hospitals spend on charity care. She said people don’t realize that hospitals should provide a sizable amount of community benefit in exchange for not paying taxes.

She said hospitals, even those with religious affiliations, don’t feel like nonprofits.

“When you walk into a nonprofit health care facility and you’re standing there with your child who has a fever … What they should be asking you is: ‘Can you pay for this?’ And when you say: ‘I don’t know, I just need help,’ they need to take the responsibility to get you that help. And that’s what this bill does,” said Hagins.

PeaceHealth officials emphasize it has changed its financial assistance policies and now offers discounts for medically necessary care and for uninsured patients. They also say they have streamlined financial assistance processes and expanded eligibility.

In fact, PeaceHealth and Providence are the only two hospital systems, out of 58 nonprofits in Oregon, to support House Bill 3076.

The rest are taking a neutral stance.

Sean Kolmer the with the Oregon Association of Hospitals and Health Systems, said his members are willing to set a floor for financial assistance. But they’re not sure about having to meet with the Oregon Health Authority to decide community benefit.

“There’s a new program proposed in the bill that no one’s ever done before. And I think there’s just a lot of unanswered questions,” said Kolmer.

Last year, the legislature passed a bill requiring hospitals put up signs and links, telling patients about their assistance programs. It’s been well received by patients. Meanwhile, time is running out for this charity care bill. It’s passed the house but has yet to reach the senate floor.