A listener fighting the good fight

Dan: Hey there —

A few weeks ago, we put out an update about charity care. That’s the commitment by hospitals to lower or just forgive bills for folks who can’t pay them. And our story was partly about how much less charity care hospitals give out than their own policies say they should.

And a few days later, I got an email from a listener.

Joey: I’m Joey Ballard, and I’m an internal medicine resident.

Dan: Joey sent me a link: The American Medical Association — or AMA, the country’s largest group representing doctors, and for a long time one of the most powerful lobbying groups in the country — had just passed a resolution supporting legislation that would require hospitals to do more.

Joey said he was the original author of that resolution. He had proposed it as a medical student.

And he had gotten the idea from listening to… this podcast. We talked. Joey says he’s listened to every episode, since early in med school — and he sees it as a supplement to what that curriculum provides.

Joey: I feel like you really have to seek out other sources to understand the system and sort of what I’m actually joining and what I’m facilitating as a physician… I mean, the podcast, like, really did that, and sort of helps peel back this other layer and sort of show more what it’s like for patients that I don’t always get to see from my perspective.

Dan: This is, I am sure you can imagine, music to my ears.

And now, he’s pushing for more changes, closer to home — at the institution where he’s doing his residency, the University of Illinois at Chicago. I wanted to bring you a little bit of his story to close out this year.

This is An Arm and a Leg — a show about why health care costs so freaking much and what we can maybe do about. I’m Dan Weissmann. I’m a reporter and I like a challenge so the job we’ve chosen on this show is to take one of the most enraging, terrifying, and depressing parts of American life and bring you something entertaining, empowering, and useful.

This is not the only time Joey has proposed a resolution to the AMA. And it’s not his only success.

Joey: I’ve had four that have been adopted by the AMA, which is pretty, yeah, pretty exciting. And then I’ve had over 10 for Indiana, the Indiana State Medical Association. Um, so yeah, that kept me busy for sure.

Dan: In Joey’s first year of med school at Indiana University, IU, he joined the med-student division of Physicians for a National Health Program — a membership organization that’s been advocating for single-payer health care for almost 40 years. The med-student version is Students for a National Health Program, SNaHP for short.

Joey: I was pretty lucky. IU is actually the largest med school in the country. In terms of enrollment. And so we had a pretty strong Snap chapter, that had a lot of great events that really piqued my interest early on.

Dan: Joey says SNaHP encouraged students to get involved with state medical societies, to help noodge the AMA towards supporting single-payer health care. Joey jumped in.

Joey: And then like through that, I was like, oh, like, it’s not just single payer. I can sort of use this for any kind of thing in medicine I want to highlight or bring up

Dan: In his first years of med school, Joey had proposed four resolutions that got adopted by the Indiana State Medical Association, including one supporting policies that would prevent some people from getting kicked off Medicaid. . By early 2023, he was ready to set his sights on the AMA itself.

Joey: and that’s when I started like reaching out to other student contacts and figure out how does this work? How do I actually do this for the AMA in the first place?

Dan: The answer turned out to be: Posting a suggestion on a dedicated online forum for student AMA members.

Joey: I had posted several and the charity care one was the one that by far and away got the most feedback and people reaching out to me saying that they wanted to work on it and thought it was important.

Dan: That was almost two years ago. Next came months of online collaboration with other students — Google docs and group chats — to draft and refine the resolution itself.

Here are a few highlights from what they came up with:

* Requiring nonprofit hospitals to check to see if any given patient qualifies for charity care BEFORE sending them a bill.

* Close some loopholes in the federal law: Currently, the law only requires hospitals to HAVE a charity care policy, but it doesn’t set even a minimum standard for how generous that policy has to be. And there’s no mechanism to monitor or enforce even that requirement.

The resolution says enforcement penalties should even include the loss of tax-exempt status — which is often worth many, many millions of dollars to nonprofit hospitals.

They worked for months, and there were lots of steps ahead.

A big one was a vote by AMA’s student section — November 2023. Then — seven months later — the AMA itself asked a panel called the Council on Medical Service to consider the proposal and make a report.

And the Council made a tweak: Instead of saying the AMA should “advocate for” policies like this, the Council’s version said the AMA should “support” them.

Joey: …Which is an important distinction in that it’s not taking active measures to actively seek out these changes or reach out to lawmakers to draft these kinds of things.

Dan: “Support” is more like, if someone else is pushing this, they can add us to the list of supporters.

Then in November 2024, the AMA’s house of delegates considered the committee’s report.

Guess what? Not only did they back the resolution, they changed “support” back to “advocate for.” I asked the AMA what that meant they’d actually DO next. A spokesman told me he couldn’t disclose their legislative strategy, so fair enough.

The meeting was in Florida this year, so Joey — in the middle of residency in Chicago — wasn’t able to be there.

Joey: these meetings that are days long, you know, different places of the country. It’s especially as like residents that like, I don’t have the time to be able to do that.

Dan: Joey says residency doesn’t leave him as much time as med school did, to work on AMA resolutions at all. But seeing the resolution pass? That was big.

Joey: that inspired me to be like, okay, what can I do now? It was like, I feel like I need to take a look at what my institution is doing and what we can improve from that perspective.

Dan: He’s started working on a proposal to get his hospital, the University of Illinois at Chicago, UIC to screen all patients for charity care before sending a bill, and to swear off practices like suing patients over bills they can’t pay, and seeking to garnish their wages. He says he’s been picking up support as he goes, starting with individual colleagues and other doctors …

Joey: …and then the big one is our union.

Dan: Residents at UIC are unionized. Joey says he brought up his pitch at a recent union meeting. His idea is a letter to the chief medical officer, with as many signatures as possible. The union said he could add them to the list.

Joey says he hopes to have that letter ready in a few weeks. Then what? He’s not sure.

Joey: There’s things we talked about during the union meeting that, you know, because UIC is a public institution, that there’s a lot more ways that it’s accountable and ways that we can find out things. Which I’m sure we’ll explore. But… optimistic for now.

Dan: And he’ll keep at it.

Joey: I do find like extreme meaning in my day to day, um, as a physician, but I feel like this advocacy work is just something that’s even in some ways like deeper, and like means more to me.

Dan: It means so much to me to know that doctors like Joey are making this their work. And it means a lot to me personally that people like Joey are finding the work we do here useful.

In his initial note, Joey asked me where he might look for certain pieces of data.

I sent him what I had, and forwarded his note to a couple people. One was Eli Rushbanks, who leads research and policy at Dollar For, the folks who have taught me the most about charity care.

And the other was Luke Messac, the doctor and historian who wrote the book on some of these issues “Your Money or Your Life: Debt Collection and American Medicine.” You might’ve heard Luke on this show when his book came out in 2023.

They both wrote back to Joey right away. Luke also wrote to thank me for introducing him to the folks at Dollar For.

I hope we can keep on making connections for people fighting the good fights. There’s a lot of good fights to be had.

If you’re catching this the day we release it or the next day — it’s the END of 2024. And our year-end fundraiser is still going.

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The place to go is arm and a leg show dot com, slash support

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We’ll be back in January with more new episodes.

Till then, take care of yourself.

This episode of An Arm and a Leg was produced by me, Dan Weissmann, with help from Emily Pisacreta — and edited by Ellen Weiss.

Adam Raymonda is our audio wizard. Our music is by Dave Weiner and Blue Dot Sessions. Gabrielle Healy is our managing editor for audience. Bea Bosco is our consulting director of operations.

Lynne Johnson is our operations manager.

An Arm and a Leg is produced in partnership with KFF Health News. That’s a national newsroom producing in-depth journalism about health issues in America and a core program at KFF, an independent source of health policy research, polling, and journalism.

Zach Dyer is senior audio producer at KFF Health News. He’s editorial liaison to this show.

And thanks to the Institute for Nonprofit News for serving as our fiscal sponsor. They allow us to accept tax-exempt donations. You can learn more about INN at INN.org.

Finally, thank you to everybody who supports this show financially.

IN FACT: Here are the names of just some of the people who have pitched in, just in the last few weeks! You ready?

[names]