Tag: Medical debt

How to pay less for your hospital care
If your income is low, you might be able to pay less for your hospital care. Among the many elements of the Affordable Care Act is a requirement that nonprofit hospitals provide financial assistance to patients with limited means. Kaiser Health News reports that most people do not know about this law that can keep them from medical debt.

Most hospitals in the US are nonprofit. Under federal law, these hospitals must forgive your hospital bills if you make less than a certain income. But, there are a lot of people who qualify for “charity care,”–full or partial help paying for their treatment–who do not know they are eligible.

Jared Walker founded an organization, Dollar For, that helps people get the charity care to which they are entitled and avoid medical debt.

What should you do to apply for charity care? Find out what your hospital’s policy is. It likely won’t be on the hospital website’s home page or easily searchable on its website. To find the hospital’s policy online, try googling the name of the hospital and “charity care” or “financial assistance.”

Once you find the policy, you should also have an application. If you can’t find the policy through a simple google search, call the hospital and ask for a copy of it, along with an application.

Are you eligible for charity care? Hospitals all have different policies. For example, one hospital might charge you nothing if your income is below 200 percent of the federal poverty level. It might lower your out-of-pocket costs if your income is between 200 and 300 percent of the federal poverty level. You probably will need to show proof of income.

What if you’re not eligible? You should still apply if your income is low and you can’t afford the cost of care. For example, if the hospital’s policy only covers uninsured people but your costs with insurance are super high, it’s still worth applying. It’s also worth applying if your income is higher than the cut-off, but you can’t afford your hospital costs. In these and all cases, write a letter to accompany the application that explains your financial situation.

How long do you have to apply? Under federal law, you have about eight months (240 days) from the date of your hospital bill to apply for financial assistance, and your hospital might give you much longer. Unfortunately, that could be after the hospital has sent your bill to collection. (A hospital can hire a collection agency to try to collect the money you owe as soon as six months after it first bills you.)

What if a collection agency is going after money from you for your hospital care? Let the agency know that you have applied to the hospital for charity care. And, ask the hospital to call off activity by the collection agency.

What’s the best way to send my application and letter? Hand-deliver or fax them in order to be sure the hospital receives your letter and application and that they do not get lost in the mail. If you opt to fax them, see if your public library will fax them for you. You can also fax them through an online app.

To be sure, getting charity care is not the easiest undertaking. But, it’s worth the effort. You could save yourself thousands of dollars and avoid medical debt.

Here’s more from Just Care:
October 19, 2021
Medical debt is far greater than originally understood
The New York Times reports on new research revealing that medical debt is far greater in the US than originally thought. The amount of medical debt is particularly high in states that refused to expand Medicaid.

The JAMA study reveals that, pre-pandemic, collection agencies held $140 billion in medical debt. More than one in six Americans owe money for health care services to collection agencies. On top of that, millions more Americans owe money to health care providers, which has not been sent for collection yet.

While people hold all kinds of debt, medical debt represents the largest portion of debt that Americans hold. Because so many Americans are either uninsured or functionally uninsured–insured but unable to pay the deductibles and copays to access needed care–medical debt is to be expected.

Hospitals increasingly sue patients to collect the huge out-of-pocket costs virtually every American must pay. The lawsuits lead to additional costs, such as legal fees. And, credit card payments often lead to large interest payments.

In states that have expanded access to Medicaid, fewer people with low incomes have medical debt. Overall they owe $375 less than people in states that have not expanded Medicaid. Medicaid tends to reduce or wipe out medical bills that could lead to debt.

Senators Raphael Warnock, Jon Ossoff and Tammy Baldwin have introduced legislation that would permit federal expansion of Medicaid in all 12 states that have not expanded it. While this would help millions of people, it would also give more money and power to the health insurance industry, which would see its business expand significantly.

Rising medical debt offers another compelling argument for Medicare for all. Good health insurance both promotes access to health care and provides economic security. Lack of good health insurance can keep people in medical debt their entire lives, hurting people’s credit ratings and causing profound stress. Too bad Congress does not tend to respond to compelling arguments.

Here’s more from Just Care:
July 27, 2021
Hospital prices demand government attention
In an opinion piece for the Financial Times, a surgeon, Nisarg Patel, argues that hospital prices are the big problem with our health care system. Hospital prices demand government attention.

Hospitals spend crazy amounts on new glamorous buildings, fancy lobbies with luxurious stone finishes and all types of vegetation, PR, and executive compensation, driving up their prices. He’s right that “it is the prices stupid,” (as well as the administrative costs,) that are responsible for astronomical health care costs. But, Patel fails to acknowledge that Medicare for all is the only solution.

Patel writes that hospitals have become big businesses. At the same time, they have been huge beneficiaries of federal dollars, our taxpayer dollars. During the coronavirus pandemic, they received literally billions of dollars in aid.

Much like Wall Street after the great recession in 2008, which had become too big to fail, Patel argues that our healthcare system has become so large that it cannot serve patients’ needs any longer. It’s “too big to heal.” Hospitals have extraordinary influence in Congress. Many also have monopoly pricing power.

Hospital prices have more than doubled in 20 years, writes Patel. Inflation has averaged 60 percent over that same time period, less than half hospital price growth. These prices account for more than three times what the US spends on prescription drugs. And, collection agencies now hold $140 billion in medical debt.

Unless hospital prices come down, more people are going to be pushed into medical debt and poverty when they develop complex and costly conditions, even if they have insurance. Premiums are rising, as are deductibles and copays.

The biggest hospitals are cutting deals with the big insurers. These big hospitals, in turn, are crowding out the smaller ones. And, there’s little evidence that consolidation in the hospital industry improves health outcomes or benefits our health in any material way.

Patel offers three ways to protect against growing hospital power and address these challenges:
1. Medicare should discourage, rather than encourage, hospital consolidation; Independent physicians should not be burdened with so much paperwork; Data on health care quality and cost should be available for public scrutiny.
2. Government should promote investments in independent primary care and specialist care, as well as community clinics and other non-hospital based care.
3. Government should block hospital mergers.
Patel’s proposals are all band-aids. They will not begin to fix out-of-control health care costs in the short or long-run. They are also not more likely to become law than Medicare for all. One incremental step on the hospital side that would make a difference is all-payer rate-setting. Much like drug price negotiation, it would rein in costs.

The only real solution to crazy high health care costs, if we care as a country about guaranteeing access to health care for everyone, keeping people from medical debt and improving health outcomes, is Medicare for all.

Here’s more from Just Care:
July 26, 2021
For-profit hospitals are causing rising medical debt and personal bankruptcy
Axios reports new findings, in partnership with Johns Hopkins, that medical debt continues to rise. Rising medical debt should come as no surprise as insurers shift more costs onto patients through deductibles, coinsurance and more. People who need hospital care are hit with some of the largest medical bills, at times driving them into medical bankruptcy.

Nearly six in ten people in debt (58 percent) in the US are faced with collection notices because of a medical expense. Hundreds of thousands of people have been forced to file for medical bankruptcy.

Some hospitals sue patients. Others get liens on their patients’ income. The hospitals might claim a portion of a personal-injury settlement.

Ten hospital chains are extremely litigious. Their lawsuits comprise 97 percent of all cases against patients. Two Virginia hospitals are the biggest offenders: VCU Medical Center in Richmond and University Hospital in Charlottesville. They claim to have now stopped suing patients.

As it is, many hospitals charge significantly more than their cost for the services they deliver. More than half (57%) of the top 100 hospitals charge at least five times more than their cost. And, some charge ten times more than cost. Chippenham Hospital in Richmond, Virginia has the highest markup. Even when hospitals don’t collect the full amount of their bills, they find that charging higher prices leads to higher revenue.

People generally cannot and do not price shop for hospital care. They go to the hospital with which their doctors are affiliated. Moreover, information on the cost of their care is generally not available in advance of a procedure. (Federal law requires hospitals to post their prices, but most are not doing so and people cannot know in advance, let alone control, which ancillary tests and procedures they will receive.)

Here’s more from Just Care:
June 16, 2021
People prefer public insurance over private insurance
A new study published in JAMA finds that people with public insurance say they fare better than people with private insurance when it comes to access to care, costs and satisfaction. The study confirms what the polls show, that the public supports a public health insurance option. That said, it does not break down people’s preferences as between traditional Medicare and Medicare Advantage. Only traditional Medicare is true public insurance, without a for-profit insurer coming between patients and their doctors.

The study treats both traditional Medicare, government-administered insurance, and Medicare Advantage, private insurance offered by the federal government, as public insurance. Unfortunately, the data is not available for the researchers to distinguish between them as far as people’s experiences are concerned. But, traditional Medicare is far more cost-effective according the MedPAC. People with traditional Medicare also have better access to care than people in Medicare Advantage.

The researchers believe that Congress should be focused on lowering people’s out-of-pocket health care costs. However, little research has been undertaken on the different experiences people have with the health care system depending on the type of coverage they have. That said, Medicare and VA coverage tend to be the least costly and the most comprehensive.
Dr. Salomeh Keyhani, one of the researchers explains: “While the conventional wisdom is that private coverage is better, our findings suggest that Americans have better experience with Medicare and VA/military coverage. The findings are especially interesting as private insurance tends to cover individuals that are younger and healthier.” Put differently, you might think that people with fewer health care needs would have better experiences with the health care system than people who use it more; that is not the case. Public insurance is preferred.

People with employer coverage tend to have less health security because their jobs can change at any time and with them, their health insurance. They also tend to face even higher deductibles and copays than people with public insurance. Consequently, they tend to value their health insurance less than people with Medicare.

The same can be said for people who buy their coverage through the state health insurance exchanges or, on their own, through some other channel. They are less satisfied with their coverage than people with Medicare.

The situation is different with Medicaid as compared to employer coverage or individual coverage. People with Medicaid struggle more to see a doctor. And, they struggle more to pay for their health care.

But, medical debt is more prevalent among people with private insurance of whatever type. And, overall, people with private insurance have worse experiences with the health care system than people with public insurance. It has largely been the case over the last several decades that people with Medicare are more satisfied with their coverage and costs than working people.

Of course, generalizing about people with Medicare is a mistake. Older and disabled Americans with complex and costly conditions often struggle significantly to have their care needs met if they are in a Medicare Advantage plan or in traditional Medicare without supplemental coverage, which picks up most or all of the deductibles and copays. Only people with traditional Medicare and supplemental coverage have comprehensive protection from financial risk if they need costly care.

Here’s more from Just Care:
June 9, 2021
Debt among older Americans increasing in good part because of health care costs
More older Americans are facing debt now than 20 years ago, reports the Employee Benefits Research Institute (EBRI). And the size of their debt is twice what it has been. One principal reason: Health care costs.

Medicare only covers about half of a typical person’s health care costs, in large part because it does not pay for long-term supports and services. Expanding and improving Medicare for everyone in the US would help reduce debt significantly for older adults. Not only would it cover health care costs in full, without copays and deductibles, it would cover long-term care. Expanded Social Security benefits would also help tremendously.

The government and businesses once helped to support older people in retirement to a far greater extent than they do today. Medicare covered a larger proportion of people’s health care costs and people did not have to rely as heavily on their Social Security benefits for basic needs as they currently do.

According to EBRI, “American families with heads just reaching retirement or those newly retired are more likely to have debt — and higher levels of debt — than past generations.” The EBRI data show that 68.4 percent of older adults 55 and older faced debt in 2019, up from 53.8 percent in 1992. Fifty-seven percent of older adult heads of household between 65 and 74 carried debt in 2016. In 1998, 47 percent of them carried debt.

The proportion of older adults 75 and older with debt is higher than it has been since 1992. In 2019, 51.4 percent of heads of household who were 75 and older carried debt. In 2007, 31.2 percent of them carried debt.

Total debt for 50 to 64 year olds increased by 50 percent between 1992 and 2016, from $80,000 to $120,000. But, for all people 55 and older, average debt decreased a bit from $88,245 in 2010 to $82,481 in 2019.

Older adults represent about 12 percent of people filing for bankruptcy. That’s five times the percentage of older adults who filed for bankruptcy 25 years ago.

As wealthy people age, their debt tends to fall. As people with less wealth age, their debt tends to grow. And mortgage and credit card debt are most prevalent among people 70 and older.

Blacks and Hispanics and people with low incomes are at severe risk of economic insecurity as they get older. They are more likely than white Americans to spend 40 percent of their income paying off their debt. They are most likely to have credit card debt and loan debt to pay for basic needs.

Older adults also often have student loan debt to pay off. It can be their student loans or their kids’ loans.

Here’s more from Just Care:
January 26, 2021
Coronavirus: Hospitals sue patients to collect payment
It’s bad enough that tens of thousands of Americans have become gravely ill as a result of the novel coronavirus and that tens of thousands more Americans have died. It’s horrifying that hospitals are now suing many of these people to cover the cost of the care they received. Because tens of millions of Americans are uninsured or underinsured, people who survive the virus, and their families, are not unlikely to face medical debt for the rest of their lives. Federal assistance programs are not protecting them.

Caitlin Owens reports for Axios that the Community Health Systems hospitals in Florida, Texas and Arizona are suing hundreds of patients to collect payment on medical bills ranging from $1,000 to more than $125,000. Many of these people are out of work and cannot afford to make even small monthly payments, let alone pay their full bill.

In one case, a patient had no insurance and made the hospital aware of that. He tried to leave the hospital, so as to avoid getting a large bill. But, the hospital would not let him. And, though he asked for financial relief, he could not get any. He has a part-time job and cannot afford to pay the hospital bill.

Note: The Trump administration directed some money appropriated by Congress for coronavirus relief to fund a program that is supposed to protect the uninsured from the cost of COVID-19 care. But, the program does not appear to be working a lot of the time. Hospitals and other health care providers can bill the federal government directly for COVID-19 care when it is the primary reason for hospitalization, and the federal government will reimburse hospitals at the Medicare rate. The New York Times reports that, in many cases, patients have an underlying condition and COVID-19 is not the primary reason for hospitalization. Still, there are many cases where hospitals and other providers inexplicably are choosing to bill their patients rather than the federal government.

Hospitals typically claim that they only sue patients after serious consideration, when they feel they have no alternative. But, whatever the hospitals’ considerations, the health care system is deeply flawed. Most of the time, Americans being sued are responsible for excessive health care costs over which they have no control and which they cannot afford.

Of course, hospitals need to be paid. But, they should be paid on a global budget, through the government. In that way, they would be guaranteed funds to provide care no matter the financial circumstances of their patients. And, patients could get the health care they need without worry about indebting themselves and their families.

The health care market is nothing like the market for other consumer goods, and payment for services should not work like those markets. People have little choice regarding the health care services they receive or the price they are charged for these services. Fortunately, people with traditional Medicare are protected from financial risk so long as they have supplemental coverage; people with private health insurance too often have little protection, and the uninsured have none.

Imagine if a restaurant could bill you for food they served that you never requested; now, imagine if they could charge you $250 for an entree and $175 for dessert. If you think that’s not analogous, hospitals can and do charge patients wildly inflated rates, such as $18 for a band-aid and $69,000 to set a broken bone.

Here’s more from Just Care:
August 24, 2020
Medicare for All addresses racial injustice
Our health care system disproportionately hurts people of color. African Americans and Latinx, in particular, struggle to get access to affordable health care. Corporate health insurers can’t provide good affordable coverage. Medicare for All would address this racial injustice.

Our market-based health care system has helped foster racial inequities in the US. Latinx and African Americans are more likely to be uninsured than white people. Today, nearly one in five Latinx (19 percent) are uninsured and more than one in ten African Americans (11.1 percent) are uninsured. About 7.3 percent of white people are uninsured.

Not surprisingly, almost a third of African American adults under 65 are in medical debt. They also struggle to afford needed health care, often delaying treatment.

Co-sponsors of Medicare for All legislation in Congress and policy experts spoke on Capitol Hill last week about how Medicare for All is critical for addressing racial biases in our health care system and promoting racial equality.

“We have a burden of our health care system that does disproportionately affect black and brown folks … and poor communities,” U.S. Rep. Pramila Jayapal (D-Wash.) said at the event. For example, today, African-Americans are three times more likely than whites to die in childbirth.

Back in July, the NAACP, League of United Latin American Citizens (LULAC), United We Dream and seven other national organizations representing people of color sent a letter to Congress supporting Medicare for All. Medicare for All guarantees health care as a right. And, universal healthcare is “a racial justice necessity because communities of color, in particular, suffer from a lack of access to affordable health insurance.” Today, “racial bias mars the entirety of American healthcare.”

Here’s more from Just Care:
March 2, 2020
Thousands of Americans with medical debt arrested each year
We know that millions of insured Americans live with hundreds or thousands of dollars of medical debt. A Pro Publica story by Lizzie Presser (my daughter) uncovers how Americans with medical debt can end up arrested and sometimes jailed. It is a scathing indictment of our dysfunctional and cruel health care and legal systems.

Among the story’s horrifying takeaways: In Coffeyville, Kansas and in many other communities in states across the nation, judges give medical bill collectors the power to decide who is arrested — debtors who are too poor to pay their medical bills and too sick to make a court appearance. And, they may summon people to court multiple times a year, though it is against the law in Kansas to haul poor people with disabilities into court for nonpayment of medical debt more than once a year. In short, lacking legal advice, many people spend time and money they don’t have in their county courthouse.

To be clear, most states don’t allow contempt charges to be used for nonpayment of medical bills. Some say it is unconstitutional.

Presser is careful to explain that the non-profit hospital and city ambulance service, which are responsible for most of the medical debt collection actions in Coffeyville, operate at a loss. And, they are at risk of not surviving in poor communities because so many Americans can no longer afford to pay their share of their health care bills, even with insurance. Three local hospitals in the surrounding community Presser visited were shuttered not too long ago. If the only remaining hospital closed its doors, it could endanger even more lives.

Perhaps the only positive takeaway from the piece is that the die-hard Republican judge responsible for issuing dozens of bench warrants against people with medical debt who failed to appear for court hearings acknowledges the need for universal coverage. “What we have isn’t working,” he said. “As a lifelong Republican, I would probably be hung, but I think we need health care for everybody with some limits on what it’s going to cost us.”

It’s curious that the current debate around health care reform focuses so heavily on the need to allow people to keep their private insurance. Private insurance has never contained costs. What’s worse, it is leaving millions in medical debt. Democratic presidential candidates support a public option, unlike proponents of Medicare for All, leave people in medical debt and without predictable health care costs.

Here’s more from Just Care:
October 22, 2019
Without ACA, how many sick people will die?
Before people began getting health insurance under the Affordable Care Act (ACA), the Commonwealth Fund projected that as many as 84,000 people were dying each year because they lacked access to care. In fact, the Commonwealth Fund ranked the U.S. at the bottom of its list of wealthy nations on preventable deaths–96 for every 100,000 people in 2006-07. With health care costs continuing to rise way faster than inflation, we need to consider how many sick people will die after the Republican leadership repeals the ACA?

Stat news reports that organizations representing patients with costly conditions fear that ACA repeal will undo health care protections that people in poor health need. Their particular focus is on how to keep insurers from refusing to cover people with pre-existing conditions. That’s just the tip of the iceberg.

What’s likely to happen once the ACA is repealed? It wouldn’t be surprising if the Republicans allowed insurers to revert to their old ways: If so, insurers will sell expensive policies that leave people with inadequate coverage when they need costly health care and will likely deny coverage to people with costly health care needs or charge exorbitant premiums, very high deductibles and/or very high copays.

Here’s what people without employer coverage and not yet eligible for Medicare should likely expect from commercial insurers:
- Coverage will be unavailable to many people with costly conditions. The Republican leadership has no plan to mandate that everyone have health insurance coverage. As a result, to save money, many young and relatively healthy people will likely take a gamble and go without health insurance, driving up health care costs for everyone else and inevitably leading insurers to impose huge cost-sharing responsibilities on people with pre-existing conditions. The Republican leadership is considering a plan that would require insurers to cover people who are switching out of one health plan to another, but that’s of little help if the coverage is unaffordable or inadequate.
- Coverage will be unaffordable for many people. The Republican leadership does not want to provide subsidies to help offset premium costs for people with incomes under 400 percent of the Federal Poverty Level as the ACA does. Nor do Republicans want to regulate prices or provide automatic coverage to everyone in the country through a tax system that covers most of the cost of health care, as Medicare does for people over 65 and people with disabilities. Moreover, Republicans don’t want to limit the amount insurers can charge people through a cap on their administrative costs and profits, as the ACA does. Since commercial insurers are unable to rein in costs and aim to deliver their shareholders as high profits as possible, we can expect them to impose far higher cost-sharing on their enrollees than they do today.
- Coverage will be inadequate for many people with costly conditions. Even if people can get coverage, people who need a significant amount of health care are likely to find their health plans don’t meet their needs. The Republican leadership is unlikely to mandate that health plans cover essential benefits, or that health plans cover as much care as people need, or that health plans impose a cap on out-of-pocket costs, as the ACA does. Without these mandates, health plans are likely to do what they did prior to the ACA–sell policies that offer only limited coverage, leaving people with costly conditions to forego needed care or pushing them into medical debt and often bankruptcy.
Neither the Republican leadership nor the Democratic leadership in Congress say they approve of “death panels.” It might be time to ask our representatives the difference between a health care system that denies needed health care to its citizens and a death panel.

Here’s more from Just Care:
February 16, 2017