LEILA FADEL, HOST:
Under federal law, all nonprofit hospitals are supposed to offer reduced or even free medical care for patients on a limited income, but many of them don't. That disparity was highlighted in a recent TikTok video that's gone viral. The video helps you figure out if you qualify for what's called charity care. Sally Herships and Dan Weissmann of The Indicator from Planet Money have more.
SALLY HERSHIPS, BYLINE: Jared Walker didn't set out to become a TikTok star. He was working his way through college in Portland, Ore., managing a couple of trampoline parks.
DAN WEISSMANN, BYLINE: And one day, in the course of a half hour, he got word of two major events for his family - an aunt's death from cancer and one of his cousins had given birth to a baby who was not only premature, but needed lifesaving heart surgery. Both big news in their own right, but also potentially huge, bad financial news.
JARED WALKER: I mean, the bills hadn't even come through yet, but everybody was - that was a big part of the conversation. I just thought, well, that seems dumb (laughter). Like, why are we talking about that?
HERSHIPS: He also thought, we are probably not the only family having these conversations today. And he started wondering, could he help some of these other families out? He thought, could I get a bunch of people to chip in a dollar a month and pool that money to help a different family every month pay their medical bills? It seemed like something kind of cool that he wanted to try.
WALKER: But I didn't think I'd be devoting my freaking life to it (laughter). It was just, like, this is just going to be a fun little side project.
WEISSMANN: And after a couple years...
WALKER: I just decided, OK, if I'm going to do it, I'm going to freaking do it.
WEISSMANN: Yeah, he quit the trampoline park. At first, he didn't even take a salary.
WALKER: I mean, I was bartending at night and just hustling around, trying to get some money (laughter) wherever I could.
WEISSMANN: And then Jared met a local lawyer who told him about the charity care law.
WALKER: And I'm thinking, what the hell have I been doing this whole time? We're changing our model real quick (laughter).
HERSHIPS: The new model he came up with - instead of raising money, he would help people apply for charity care.
WEISSMANN: So over the next couple years, Jared helped scores of families around his hometown of Portland, Ore., navigate those applications successfully. But then, as this year was beginning...
WALKER: My little sister, Grace, was like, yo, you need to get on TikTok. And so I was at the office late one day and made a TikTok (laughter).
WEISSMANN: Yeah. And the next morning...
WALKER: The video had, like, 50,000 views. And then in the next, like, 10 minutes, it had 100,000 views.
HERSHIPS: Jared ends that video inviting people to get in touch if they want help with their own medical bills. And he has heard from thousands of people.
WEISSMANN: Keith Hearle consults with hospitals to help them comply with IRS rules on charity care. And he says hospitals take all kinds of approaches to charity care, and many of them do do a good job. But here's the complication.
KEITH HEARLE: There's definitely a tension between mission and margin.
WEISSMANN: Even nonprofit organizations need a business plan.
HEARLE: If you give away too much, that means the hospital may actually lose money. And over time, that means the organization won't grow and be able to meet community needs down the road.
HERSHIPS: Keith says there are some hospitals that go out of their way to find people who qualify for charity care, and there are also actual business reasons for hospitals to do this.
HEARLE: Why are we going to spend the money (laughter) - staffing, collections agency, all that, those resources - to go after collecting bills where we just know that it's unlikely that we're going to actually collect anything?
WEISSMANN: In other words, trying to squeeze blood from a stone has a lousy profit margin. But it seems some hospitals are still working that model or trying to, seeing as there's still plenty of work for Jared and his volunteers.
For NPR News, I'm Dan Weissmann.
HERSHIPS: And I'm Sally Herships.
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