Target: Medical Bills

updated 10/06/2003 at 01:00 AM EDT

originally published 10/06/2003 01:00AM

When the knock came at the door, Maria Mejia automatically feared it was a bill collector. She'd run up $160,000 in uninsured hospital expenses having her diabetes treated, and Tenet Healthcare Corp. had been demanding that the Mexican immigrant cough up the money, which she didn't have. "She was sure she was going to prison," says her son Victor. But K.B. Forbes, the man outside her modest home in Santa Ana, Calif., that day in January 2002, wasn't after his pound of flesh. He was there to help Mejia, now 56, take on Tenet, the nation's second largest for-profit hospital chain. "You have to go after the big guys," says Forbes, "if you want to effect change."

Lately Forbes has been doing a lot of both. In the past two years he's made it his mission to force the medical-care industry to reform what he believes is a national scandal: While hospitals cut deals with insurers that deeply discount the cost of treatment, they routinely charge uninsured patients the full price, which can be as much as 10 times higher. For the 41 million Americans who are uninsured, that can mean being billed $21,000 for ankle-reconstruction surgery, which might cost an HMO patient only $3,600. In January, under pressure from Forbes, Tenet agreed to start charging the uninsured the same amount it bills HMO patients, pending approval by federal regulators. (There are complex laws governing how hospitals set their prices.) "K.B. Forbes has identified a very real problem," says Dr. Peter Lurie, deputy director with the consumer advocacy group Public Citizen. "Those with the least ability to pay for health care wind up being charged the most."

Forbes (whose initials stand for Kevin Brendan) brings both a special passion and an unusual résumé to his effort. The activist, now 36, grew up in one of the few Hispanic families in mostly affluent San Marino, Calif. His father, Walter, 78, was a printer and a former union organizer. But it was from his mother, Gladys, 73, a social worker who had emigrated from Chile, that he says he inherited his do-gooder spirit, especially when it comes to issues involving the Hispanic working poor. "I love my Latin culture," says Forbes, who speaks fluent Spanish, "and I'm always for the underdog."

For much of his career, Forbes hitched his activism to the bandwagons of conservative politicians Pat Buchanan and billionaire Steve Forbes (no relation), for whose presidential campaigns he served as communications director and press secretary. Then two years ago he became interested in health care after he heard about the sister of a friend who had suffered a broken ankle in a car accident and run up $23,000 in medical bills. Forbes began to study the fine print of hospital charges and was shocked to discover how much more the uninsured, mostly working poor who don't qualify for Medicaid, were required to pay. Not to mention the sometimes aggressive tactics, such as putting a lien on homes, that hospitals used to collect. "Some of the stories he's told me are horrifying," says Pat Buchanan. "He's become a one-man army for these people."

Forbes decided to form a group, Consejo de Latinos Unidos (Council of United Latinos), which he operates out of a donated office in East L.A., to lobby for change. He deployed all the hardball tactics that had served him well in his previous career—filing lawsuits and badgering the media for coverage. "I learned a lot from politics," says Forbes, who draws a modest salary from his donor-financed organization and lives in a town house in Las Vegas with his twin sister, Kathleen, a casino staffer. "You learn about the power structure and how to get attention."

In February 2002 Forbes launched a multifront assault on Tenet, enlisting Mejia and nine others to file suit, while at the same time jawboning company executives behind closed doors and threatening them with a torrent of bad publicity. In the end Tenet capitulated. As Harry Anderson, the company's VP for communications, ruefully told one trade publication, "Health care has not experienced anything like this." But for people like Pascual Bivera, 39, who got a bill for $29,000 after a three-day hospitalization for the flu in 2000, Forbes's relentless advocacy has been a blessing. Says Rivera, whose bill was subsequently settled after Forbes intervened: "There was no way we could have done this alone."

Now Forbes is targeting HCA, the Nashville-based hospital chain that, with 200 facilities, is the nation's largest. Thanks to his pressure, HCA recently announced that it intends to implement a sliding scale of discounts, depending on the patient's income level—but that is not enough for Forbes. And he's not about to give up. "It gives me a tingle," he says, "to know I can do some good."

Bill Hewitt
Maureen Harrington and Champ Clark in Los Angeles

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