Up to $49 billion unpaid by uninsured for hospitalizations

An earlier version of this story misstated the ability of uninsured Americans to pay their hospital bills.

WASHINGTON — Uninsured Americans — including those with incomes well above the poverty line — leave hospitals with unpaid tabs of up to $49 billion a year, according to a USA TODAY analysis of government statistics.

On average, uninsured families can pay only about 12% of their hospital bills in full. Families with incomes above 400% of the poverty level, or about $88,000 a year for a family of four, pay about 37% of their hospital bills in full, according to the Department of Health and Human Services study.

"This report shows that even higher-income, uninsured families are struggling to meet the high costs of health care," Sherry Glied, assistant secretary for planning and evaluation at Health and Human Services, said in a statement. "No family should bear the burden of being one illness or accident away from bankruptcy."

Researchers also found that most uninsured people have "virtually no" savings and that about a third have no financial assets.

Health and Human Services released the report as the White House defends the federal health care law passed last year, which was intended to address growing health care costs as well as ensure all Americans can afford health insurance. Republicans have pledged to repeal the federal health care law, saying that government should not take away individual choices and that the law will cost too much. Glied said the study shows the importance of health insurance for all Americans.

Paul Winfree, a senior policy analyst at the conservative Heritage Foundation think tank, disagreed, saying the study showed how Americans can exploit the system. "With ($88,000), families should be able to buy insurance," he said. "They choose not to."

He said that while he realizes hospitalizations tend to be expensive, Americans need to look at their spending and saving habits.

Jack Hadley, senior health services researcher at George Mason University in Fairfax, Va., pointed out that uninsured people are charged as much as two-thirds more than what insured people are charged because insurers are able to negotiate prices.

His research has found that privately insured individuals don't end up paying higher premiums to make up for the uninsured because hospitals that serve lower-income families don't have a lot of patients with insurance. He said the government pays about 75% of those unpaid hospital bills either by direct payment or through a disproportionate payment of Medicaid.

"It affects taxes, not premiums," he said. "The privately insured are still paying for it."

Jim Tallon, president of the non-profit United Hospital Fund, said the federal health care law's mandate that most Americans be insured is a step in the right direction. Hospital officials are "nervous" about proposed medical cuts in the House budget, he said.

"Most of the major hospital associations were supportive of the Affordable Care Act for this reason," he said. "They were willing to take some cost reductions in Medicare payments, and in return, the government would insure 32 million people."