If you've ever felt aghast looking over a hospital bill -- somehow sure the numbers couldn't possibly be right -- you're not the only one. According to a 2004 study, published by the journal Health Affairs, those lacking health insurance are charged an average of 2.57 times more by U.S. hospitals than those with insurance, a discrepancy that has been steadily increasing since 1984.



Texas is no exception. In fact, residents of Dallas, Houston, and the rest of the state are more likely to be uninsured than the average American, as just over 25% of Texans lack coverage. In some areas of the state, it's closer to one in three, and that doesn't include those considered under-insured, or those insured by government programs.

Like many in Texas, a good percentage of uninsured Americans are working individuals who can generally support themselves and their families, but who cannot afford to keep pace with the rising cost of health care. Health insurance premiums have increased an average of 15% over the last five years, more than triple the inflation rate. One-third of companies did not offer coverage in 2004, and even when it was offered, there was no guarantee that employees could afford the premiums.

"That's me exactly," said Anne, a 27 year-old city employee in Kansas City, Missouri. "I couldn't afford the premium, so I had to get this low-cost, ridiculously low-coverage plan that will basically only help me if I get in a car wreck."

Employee spending on health care increased an average of 143% between 2000 and 2005. It does not seem a coincidence, then, that rates for the uninsured have also jumped the most since 2000. The problem is further exacerbated by what has become a cyclical predicament, particularly in cities like Dallas and Houston: uninsured residents of rural areas, where there is lower quality care and less access to financial aid programs, travel to the city for their medical needs, which can then be covered by hospital or county programs. This, in turn, drives up the average charge of any given service provided by those hospitals, which contributes to increased costs for health insurance companies, which then raises premiums.

What all this translates into, unfortunately, is even higher bills for those who are barely getting by as it is if something does happen.

Sound unfair? Advocacy groups think so too. More than 60 class-action lawsuits have been filed over the issue. In response, the American Hospital Association (AHA) has instituted a voluntary policy to charge poor and uninsured patients less, but the results have yet to be seen. Some question whether the recommendations are applied at all by most of the hospitals, including those in Texas, and the fact it's not mandatory is a problem.

Gerard Anderson, director of the Center for Hospital Finance and Management at Johns Hopkins University's School of Public Health -- and study author -- has served as an advisor for several lawsuits already. He encourages advocacy groups to move forward with legal action. "The mark-up on hospital care for these individuals, especially for those who can afford it least, is unjustifiable," said Anderson.

The highest discrepancy was found in the amount for-profit hospitals charged, versus estimated costs by Medicare. This all makes slightly more sense after learning that, generally, hospitals in the association determine costs by a list called the chargemaster, which is, technically, the same for everyone. Insurance companies then negotiate with hospitals on behalf of their clients to reduce these charges. It is widely believed hospitals, as many other businesses would, however, greatly inflate initial costs in anticipation of this negotiation.

"When a hospital presents a bill that has charges on it, those charges are the same for everyone. What is different is how much insurers may negotiate in terms of discounts with hospitals," Amber Coyle, AHA policy analyst said.

The American Hospital Association also claims the research is inaccurate, that it is out-of-date and methodologically flawed. Hospitals needed the U.S. Centers for Medicare and Medicaid guidance to institute discounts for the uninsured, said AHA, which did not exist when the study was conducted.

The claim is that hospitals were unsure if they could charge different patients different amounts before this guidance, but many advocates contend it does not take bureaucratic policy to know that charging those who are financially less capable of paying more is simply wrong and counterproductive.

The only issue opposing groups seem to agree on is that increasing the number of those with coverage would dramatically deflate the situation. This could be done by extending government programs, including Medicaid -- which is currently experiencing drastic cuts and instituting more affordable private health insurance policies. Either way, until then (or "if then"), keep yourself healthy, whether or not you're insured.

What affects your health also will eventually affect your bank account.