For a brief moment, imagine that you are a mother of three loving children whom you take care of to the best of your ability, despite living in a one-bedroom rental space. Unfortunately, one of your children has scabies, a rash that is an infestation of mites on the top layer of skin where they burrow and lay eggs; it is spread from person-to-person by direct exposure with an individual who has the disease, such as household members. To take the best precautionary steps, you take your three children to a pediatric doctor in hopes of treating the entire family before the scabies further spreads. However, your doctor only prescribes medicine for two of your children, the two that do not have scabies – yet. Your third child, with the scabies, cannot receive a prescription since their account has been locked due to unpaid bills surrounding their health issues. This is just one of many examples of a wealthy nonprofit health system taking advantage of its patients.

Allina Health System (Allina Health) is a large nonprofit system throughout Minnesota and Wisconsin where it manages more than 100 hospitals. Allina Health details on its homepage that, “Health care can be complicated but it doesn’t have to be.” However, do Allina Health’s words mean anything?

An investigative New York Times article discovered that Allina Health had not allowed patients to seek or receive care if they have unpaid medical bills. Not only that, but for patients to finally receive the care they truly need, their entire bill must be paid off. This policy was suspended in March 2020, but started back up in April 2021. Staff were instructed to withhold care, and even cancel appointments if a patient is in at least $4,500 of debt.

Since Allina Health is a nonprofit hospital system, it didn’t have to pay $266 million in taxes. However, in exchange of its nonprofit status, the Internal Revenue Service (IRS) requires Allina Health to help its community which requires providing free and/or cheaper care to individuals with low incomes. The IRS did not set a minimum low-income amount that Allina Health could use as a guide which resulted in Allina Health spending less than half of one percent of its assets on its deal with the IRS.

The issue at hand only involves patients who required treatment from specialists and clinics, not the hospitals. Per federal law, hospitals are required to treat those who come into its emergency room, notwithstanding whether or not the patient will be able to pay the bill at the end of their care. However, the Emergency Medical Treatment and Labor Act does not explain how patients should be treated when they are receiving other kinds of care.

It should be of no shock that many individuals nationwide are in debt, especially medical debt. In Minnesota, where the majority of Allina Health hospitals are, 109,000 individuals in the state are in medical debt, totaling to $148 million. For a moment, recall the deal that Allina Health had with the IRS. Allina Health’s annual revenue is around $4 billion, and it could have wiped out the entire medical debt of Minnesota if they had upheld the end of their deal. Instead, the nonprofit did not have to pay taxes and it did not benefit their community, rather it served as a detriment.

Although money plays a large role in this issue, the immeasurable impact that this had, and continues to have, on families in the Midwest is detrimental and could be life-altering. Physicians of Allina Health have even come out and spoken against the nonprofit’s predatory practice. One doctor said that, “Nobody wins when patients can’t get preventive care.” Other employees of Allina Health have also shared their own experiences; a receptionist detailed that the computer system itself would not let her schedule appointments for patients in debt even if she wanted. Adding on, if an employee cancels an appointment, but the patient later pays off the bill, the canceled appointment is not restored. One Allina Health patient, JoLynda Anderson, had her appointment canceled due to her debt, and was enrolled into monthly payment plans. Even with the payment plans ready to go, Anderson could not attend the appointment since all her debt had not yet been paid off; she had been waiting for this appointment for nearly four months. Allina Health says that prior to taking away a patient’s care, its employees will call and send many letters about the patient’s debt before they reach the debt threshold. However, just because they notify the patient does not mean that it is a measure put into place for the patient’s best interest.

Minnesota Attorney General Keith Ellison is actively looking into the situation and urges those affected by Allina Health’s “aggressive billing practices” to contact his office to further understand whether any laws or agreements have been breached. Allina Health hospitals have a zero tolerance policy for abusive, harassing, oppressive, false, deceptive or misleading language when looking at medical debt. Keith Ellison is working hard to create a conversation and ask the hard questions that Allina Health does not want to hear.

Personally, I believe that as a nonprofit organization, Allina Health should not be taking advantage of patients who are vulnerable due to both their low-income status and health issues. What could possibly be the solution? Unfortunately, I do not see a definitive “fix” for this issue. There cannot be one solution since patients in the past have been subject to this predatory practice and nothing will change what they went through. Liz Reyer, a Democratic representative of Minnesota said it best: “[T]hey’re [patients] not buying nice new clothes or a nice new car; they’re taking care of their health.” Money cannot fix the problems of the past. However, money continues to be the most important factor for Allina Health.

***

It sure seems as if Allina Health should update their home page. It cannot say that, “[Y]our [patients’] health is our top priority” if they refuse patient care the moment money is brought into the equation.

The quick-paced nature of the healthcare field is at play with this topic. In the midst of writing this blog post, the New York Times published an article entitled “Nonprofit Health System Pauses Policy of Cutting Off Care for Patients in Debt.” On June 9th, 2023, Allina Health announced that it would stop withholding patient care from those in debt as it takes a closer look at its policy. This is a large triumph; however, there is still one major fault. Although Allina Health is temporarily halting its predatory practice, it will not restore the care that has been withheld from patients in the past.

Matt Hoffman, an Allina Health physician, said that the stoppage of withholding care has given him hope that Allina Health will make the requisite changes that are needed. He hopes that Allina Health does the right thing and reinstates patients who have been affected.

I hope that Allina Health’s new policy change is not a scheme of false hope. After all, Allina Health stopped this particular practice when COVID-19 started to pick up. However, it was later put into practice again. I have low expectations for Allina Health, and it is only a matter of time before it upsets individuals once more if it continues its predatory practice.