Americans are drowning in medical debt. Here’s how our leaders can help you

Today more than 100 million Americans live with medical debt totaling almost 200 billion dollars. A recent study found that this debt leads to increased rates of eviction, food insecurity, and poor health outcomes, regardless of health insurance status or income. If the debt is generalized, it is also unevenly distributed; disproportionately colored patients carry one’s burden. It’s a story we’ve heard too many times before, and it’s time for our nation’s leaders to act.

This month, Consumers for Quality Care (CQC) marked Health Literacy Month by educating consumers about medical debt and what they can do to avoid falling victim to it. Congress and the Biden administration can implement common-sense reforms to help keep Americans from sinking deeper into medical debt.

Congress has sought to tackle a major source of medical debt — surprise medical bills — in 2021. The law without surprise protects patients from being billed when unknowingly treated by an out-of-network provider at an in-network facility. However, a recent survey found that 20% of patients have continued to receive surprise bills since the law came into effect earlier this year. Song Luy, for example, ended up with a surprise bill after getting blood work from a lab he was referred to by his network doctor’s office. The lab was in the same building but off the grid.

Congress also covered prescription drug costs this year Inflation Reduction Act. Now is the time for lawmakers and regulators to address other cost drivers in the healthcare ecosystem, such as the lack of transparency in hospital pricing, the lack of standards to ensure that not-for-profit hospitals uphold their commitment to patients and communities; and health insurance practices that pass on high out-of-pocket costs to patients.

Predicting bills is impossible when you don’t know how much medical visits, treatments or procedures will cost, and too often patients are forced to make a choice between not seeking treatment or risking a potentially astronomical medical bill. All Americans should be able to smartly buy the care they need, but just 16% of hospitals nationwide have been found to be fully compliant with a federal price transparency law. Regulators must hold hospitals accountable for non-compliance.

Many US hospitals are non-profit, which means they are organized as charities and, in exchange for significant tax breaks, they are legally obligated to provide affordable care in their communities. However, there are no federal standards against which charitable care is measured. American hospitals regularly not informing patients they might be eligible for charity care and send medical bills to low-income patients who are eligible for charity care, creating more medical debt for those who can least afford it.

Choosing the wrong insurance plan can also lead to crippling medical debt. The steady rise of plans with high deductibles, coinsurance, and copayments that typically have lower premiums means that patients seeking care often end up with large bills due to the plans’ high costs. Carla and John Jordan had a high-deductible plan and, after a series of medical crises, they could not afford their deductible and went bankrupt.

Short-term limited-duration insurance plans (STLDI plans) — also known as “adverse plans” — are exempt from many Affordable Care Act (ACA) requirements and may exclude coverage for pre-existing conditions, have limitations dollar value on covered services, and are not required to cover preventive services, among other substantial consumer risks. The Trump administration issued a rule extending the maximum period that STLDI plans can be offered from three months to one year, with the possibility of renewal for up to 36 months, causing unwanted plans to proliferate. So far, the Biden administration has failed to crack down on these rudimentary and inadequate health care plans.

Americans with chronic conditions best treated with prescription drugs also need to be careful about the insurance plan they choose. Co-payment adjustment – ​​or accumulator adjustment – ​​programs (CAAP) allow insurers to prevent drug cost-sharing coupons from counting towards patients’ deductibles or capping total benefits. out-of-pocket expenses, leaving them with unexpected costs at the pharmacy counter when their coupons run out. Annabelle Gurwitch counted on co-pay assistance to pay for her cancer drugs, and when her insurer contracted with a CAAP, her co-pay assistance no longer applied to her deductible, leaving her to pay a large drug bill. Unfortunately, the Biden administration overturned a federal rule that would have put an end to this malpractice by insurers.

As consumers head to open ACA enrollment on the heels of Health Literacy Month, they should carefully consider their coverage options so they can make the best possible decision for themselves and their families and mitigate the risk of incurring medical debt. But this burden should not be borne solely by patients. All policymakers – especially federal legislators and regulators – must address the root causes of medical debt to ensure that every American can access affordable, quality health care.

James P. Manley is a Democratic broadcaster with more than two decades of congressional experience. He served as a senior communications adviser and spokesperson for former Senate Majority Leader Harry Reid (D-Nev.) and the Senate Democratic Caucus. He sits on the board of directors of Consumers for quality care. Follow him on @jamespmanley.

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John A. Bogar