An Open Letter to Mission-HCA in the Time of COVID-19

By Deborah Miles and Stephanie Swepson Twitty –

Sadly, money—who has the ability to pay and who does not—often determines the quality of healthcare a person receives in our society.

With COVID-19 spreading in our communities, that reality has the potential to threaten the health and lives of every one of us.

That’s why, on March 24, a group of organizations that fight for equity in healthcare wrote a letter to the leaders of the Mission hospitals and HCA, the for-profit corporation that bought the hospitals last year. In it, we urged them to streamline their requirements for giving free or reduced-price care to people treated for COVID-19.

We did not ask that they change the financial formulas they apply when deciding who gets financial assistance. But we urged them to suspend any other requirements, such as the care the patient receives would normally be classified as “emergency services,” whether the patient can provide any up-front payment, or whether certain paperwork has been submitted.

Further, we asked that HCA state publicly that financial need alone will entitle COVID-19 patients to free or reduced-price services. It’s critical that patients and their doctors know there is no reason to hesitate for even an instant in seeking needed hospital care.

Why is this appeal necessary in the first place?

Because HCA has introduced restrictions and procedures that have nothing to do with financial need—as they are allowed to do under the sales agreement. Before the coronavirus struck, the new requirements had confused and frustrated doctors and patients. In this time of pandemic, confusion can spell disaster.

The good news is that the federal relief package recently signed into law includes $100 billion to help hospitals absorb the costs of fighting COVID-19. That should make it easier for hospital systems, including HCA, to do the right thing. We call on them again, in the following letter, to do it.

Dear Hospital Leader,

Like you, we—who advocate for the health of our communities—have thought deeply about the extraordinary challenges our medical system and our society face with the onslaught of COVID-19. We appreciate the enormity of the task in front of you, and we thank you for the heroic efforts you and your staff are making to mitigate this disaster.

Most of us have no competence to advise you in medical matters and would not presume to do so. However, many factors will determine whether our region is equal to the challenge of COVID-19 or incurs deep and lasting damage. One critical factor is ensuring that severely ill patients swiftly and seamlessly get appropriate hospital care—regardless of their ability to pay.

Therefore, we are asking [you] to review [your] policies on uncompensated care and to suspend any requirement (beyond income guidelines) for patients seriously ill with COVID-19. We fear that not to do so will dissuade some patients from seeking timely admission.

Further, we urge you to state unequivocally and publicly that any uninsured or underinsured patient treated for COVID-19 who qualifies under the hospital’s income guidelines will receive free or reduced-price care. We feel it is vital for both patients and providers to feel secure that no other restriction or procedural requirement will impinge on that guarantee. Otherwise, misperceptions and uncertainty may complicate an already unprecedented public health emergency.

We feel strongly that, in the current crisis, this is not merely a matter of benevolence. It is a matter of public health. A single day that an infected person spends in the community when that person should be in a hospital risks preventable deaths, additional transmission and unabated spread. And the hospitals, more than anyone, will feel the brunt.

We understand that the policy changes we seek may represent a significant financial burden, and we are ready to support legislation or other measures that would help offset your losses.

We also are eager to disseminate any useful information—hopefully including the policy statement outlined here—to the far corners of our communities.

Now, more than ever, all of us must work together for the common good. We hope you will receive this proposal in the spirit of collaboration in which it is offered.

Please respond without delay to any of the signatories listed below. As you are keenly aware, every hour is precious in fighting this pandemic—and the action we are advocating—is a vital aspect of that fight. We hope to help you spread the word in coming days that your organization is on board.


The Health Equity Coalition; SEARCH (Sustaining Essential and Rural Community Healthcare); Center for Community Self-Help; Carolina Jews for Justice West; Applied Culture Group; Pisgah Legal Services; Racial Justice Coalition; YWCA of Greater Asheville; Coming to the Table, Asheville Chapter; Communities for Older Adult Health (COAH); Former Mission Health board member Robert Kline, MD

Deborah Miles and Stephanie Swepson Twitty are co-chairs of the Health Equity Coalition.


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