An interview with K.B. Forbes, advocate for the uninsured

A recent study in Health Affairs had some eyebrow-raising data. A nearly decade-old law on the books in California regulating how much hospitals can charge uninsured patients has helped to dramatically reduce their bills. The net price paid by uninsured patients shifted from 6 percent above Medicare rates to 68 percent below Medicare.

I was curious to know what the person perhaps most responsible for passage of that law thought of its effect. That would be K.B. (Kevin Brendan) Forbes, the most interesting person I've ever encountered in healthcare. He is a fiery advocate for the uninsured--and the unlikeliest person to ever hold that job.

Forbes, who was raised in San Marino, California, has worked on both of Pat Buchanan's presidential campaigns, as well as Steve Forbes' (no relation) 2000 stab at the White House. He continues to consult on local and regional GOP campaigns. 

Forbes' mother was the first Latina social worker at L.A. County-USC Medical Center in the 1960s. She spent years gathering intake data on behalf of patients and their families to qualify them for Medicaid and other public insurance programs, work that her son proclaimed "is in my genes."

Through CDLU, (an acronym for Consejo de Latinos Unidos), a small Los Angeles-based non-profit organization that Forbes leads, he conducted the clearest and brashest campaign ever against the billing practices of California's hospitals. In 2004 it led to voluntary measures by the large hospital chains to offer financial assistance to patients with no insurance and modest incomes, and then to the passage of the 2006 law discussed in the Health Affairs study.

Now living in Birmingham, Alabama (there's lots of Republican campaigns to consult for in the South), the ever-accessible Forbes cheerfully agreed to speak with me on short notice. During an exclusive, one-hour interview, he regularly proclaimed when he was shifting between public advocate K.B. Forbes and private citizen K.B. Forbes (much like Stephen Colbert, one version appears to be to the left or right of the other).

But Forbes didn't declare the study vindicated his work.

"Although this person looked at (hospital) data and did standard deviations and all that, treating patients as statistics is what we've been fighting. It is time hospitals stop treating them like Excel spreadsheets," he said. "The point is, how many folks have had their credit damaged? How many have been sent to collections agencies?"

Forbes doesn't want handouts for uninsured patients--just a reasonable break on the full price (the CDLU considers 35 percent above what Medicare pays to be appropriate) and a payment plan.

"Not one patient has ever said they don't want to pay. They want something that is reasonable and a payment they can afford. If you're a smart hospital executive, you'll accommodate that," he said.

Although Forbes praised for-profit chains Tenet Healthcare (a target of the California campaign) and Community Health Systems for being flexible with their uninsured patients and even designing services priced specifically for that population, his advocacy workload only continues to grow.

He said that many hospitals--not-for-profits and religious-affiliated systems in particular--are "bean counters" that systematically hire outside firms to perform revenue enhancement services and ask patients for deposits upfront without specifying what they will be billed.

Meanwhile, private citizen K.B. Forbes is not a fan of the Affordable Care Act (ACA). He called it "a big piece of pork for the hospitals and insurance companies" that also failed to create an adequate safety net for those who need it. And he predicted that a lot of low-income households will pay the tax penalty because it's still cheaper than insurance premiums.

But public advocate Forbes, as always, churned out examples of patients in peril. He provided me a copy of a document Orlando Health in Florida asks patients to sign--essentially a promissory note--when they request charity care. He also told me, his voice rising, about the CLDU intervening in the case of Ronald Reagan UCLA Medical Center asking for $19,500 upfront from the parents of an adult psychiatric patient--money that was refunded when he called the CEO. There were many other tales.

"I know the person (who performed the Health Affairs study) is trying to use hospital data to tell a story, but you need to go out and find the stories yourself," Forbes said.- Ron (@FierceHealth)

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