Health Care Advocates Turn To Lawmakers For Help With Medical Debt

Vermont’s leading healthcare advocate will soon call on lawmakers to approve legislation that would forgive a higher percentage of unpaid medical bills from low-income patients.

About 96% of Vermonters have some form of health insurance, but that doesn’t always mean they can afford to pay for health care.

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Rick McDowell has been a carpenter for over 40 years, and he’s always tried to make sure he has some sort of medicare plan. But during the times he was self-employed, it was up to him to balance the corporate ledger. And McDowell told VPR that Medicare premiums don’t always do the trick.

“And you try to bid on this work – you know, build a deck. And how are you going to include that in the cost when you’re competing with who knows who? McDowell said.

It was during one of those periods of insurance drought, about five years ago, when McDowell discovered he had retinal detachment.

“I ended up – after that retinal detachment – with a bill of around $ 45,000 because I didn’t have insurance,” he said.

“Right now, we probably have a debt of $ 7,000 to $ 8,000, I estimate. Are you trying to pay off that kind of debt? Forget that. “

Rick McDowell, Alta.

The hospital that treated McDowell forgave all but $ 5,000 of that bill.

“I thought it was really generous,” he said. “I thought, ‘Wow’. I couldn’t even believe it.

But that wasn’t the end of McDowell’s health problems. A few years later, shortly after landing a job at Saint Michael’s College with decent health insurance benefits, McDowell suffered a stroke. Insurance paid for most of his care, which included a 16-day inpatient rehabilitation stay, but not all.

“Right now, we probably have $ 7,000 to $ 8,000 in debt, I estimate,” McDowell said. “Trying to pay off that kind of debt? Forget.”

McDowell doesn’t want people’s pity. The 63-year-old Alburgh resident said he was a lucky guy, all things considered.

“And I know there are people out there who have a lot worse situation than me, you know, when it comes to medical debt,” McDowell said. “I’m sure and certain.”

In each of the past six fiscal years, hospitals in Vermont have reported between $ 63 million and $ 85 million a year in unpaid medical debt. That figure doesn’t include unpaid bills that were canceled – about a third of all unpaid bills in a given year – thanks to free care policies that help even the most modest of patients.

Unforgiven debt, however, can lower the finances and credit scores of Vermonters like McDowell, according to Mike Fisher, chief health care attorney for the state of Vermont.

And Fisher said the issue of medical debt raises important questions for the state.

“What does this mean across the Vermont landscape? How many people does this impact? How does this affect them when they try to get care? Fisher said.

Fisher and his colleagues started a project earlier this year in which they solicited the stories of Vermonters who have struggled with medical debt. Hundreds of people, including McDowell, shared their experiences.

“In some ways, I feel like we’ve struck a chord,” McDowell said.

Fisher said his office did not have specific data on how many Vermonters have medical debt or the average bill amount outstanding. But he said the storytelling project exposed a potentially serious consequence of medical debt.

“I don’t think anyone should be able to go without medical care, but… I’m not sure now is the time to inflict financial damage on some hospitals.”

– Kevin Mullin, Green Mountain Care Board of Directors

“You know, a version of ‘Because my daughter has diabetes I can’t or my other child can’t get sick’. And hear person after person say, “Hey, my doctor wants me to get treatment. I can not go there. I just can’t afford it, ”Fisher said.

Fisher said that people’s fear of worsening personal medical debt leads to worsening health problems and ultimately increases the overall cost of health care in Vermont.

“And so I’m looking for ways to provide relief to the people of Vermont who are very stressed in a way that the legislature could actually act on,” he said.

The mechanism that Fisher’s landed on is a bill that would oblige uniform free health care policies in every hospital in Vermont, so patients who meet certain income requirements can be assured of having their medical debt canceled, no matter where they receive care.

Kevin Mullin, chairman of the Green Mountain Care Board, a five-member group that regulates Vermont hospitals, considered the bill.

He said he was “in conflict” over whether or not to support the bill.

“I don’t think anyone should be able to go without medical care, but… I’m not sure this is the time to inflict financial damage on some hospitals,” Mullin said.

Mullin said that Fisher’s right to medical debt deters people from getting more health care. But, the expansion of free care policies in hospitals means they will have to amortize even more income which they don’t lose now because of unpaid medical bills, according to Mullin.

Mullin said more generous free care policies also have effects on the general public, as the money to cover these unpaid bills, he said, has to come from somewhere.

“And the only place hospitals have to move it is on commercial (health insurance) tariffs,” he said.

Karen Nevin lives in Moretown and was involved in Fisher’s Storytelling Project because she wants policy makers to understand how pervasive the problem of medical debt is.

“I had to pay for health insurance in the market at full price without price reduction. To enable this we have taken high deductible plans, ”Nevin told VPR. “And a medical experiment gave us a bill that we had to pay 100% out of our own pocket, and we couldn’t afford it. We couldn’t do that.

It’s just untenable, and the only way to make it right, I think, is to wipe the slate off and start over.

Karen Nevin, Moretown

Nevin works in a small non-profit organization. In the year she had this expensive medical experience, she earned too much money to qualify for insurance grants that might have enabled her to afford a lower deductible plan, but not enough to absorb the direct exposure she incurred with the high deductible policy.

Nevin said the experience only intensified his belief in the need for more systemic changes in America’s healthcare system.

“It’s just untenable, and the only way to make it right, I think, is to kind of wipe the slate clean and start over,” Nevin said.

Start over, she said, and build a system where people can access the care they need without risking their long-term financial security.

Rick McDowell, Alburgh carpenter, agrees with this concept. He said he had family and friends who didn’t care about health care being a human right.

“I mean, people are crying socialism or whatever, but there are a lot of hard working people (who don’t have insurance),” McDowell said. “And it’s not about trying to be a profiteer or anything like that.”

Rather, it’s about making sure that people who can’t afford care, McDowell said, aren’t financially ruined when they have to get it.


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John A. Bogar