Medical debt affects one in four people in the United States, yet there is a lack of transparency about the inner workings of the collection or billing of this type of debt, according to a Society for Advancing Business Editing and Writing panel on Oct. 13.
The panel, sponsored by the Commonwealth Fund and moderated by Noam Levey, a senior correspondent at KFF Health News, brought experts together to speak on the way medical debt is affecting Americans, and where reporters should look for stories.
About 63% of those with medical debt cut spending on everyday items like food and clothing, according to data Levey presented during the panel.
“One of the most chilling things that we found was that 20% of people say they don’t expect to ever be able to pay it off,” Levey said.
Alexander Adia, a doctoral student in Health Policy at the UC Berkeley School of Public Health, said medical debt can also cause individuals to turn toward suboptimal housing that can have environmental consequences if mold or other health hazards are present.
Levey also said the most common factor associated with high levels of medical debt isn’t poverty or insurance, but chronic disease.
“There’s arguably no other fact that’s more revealing that you think that the people who are most burdened with debt and all of the stress and dislocations that are associated with that are the people who are also facing the most serious illnesses-cancer, heart disease, diabetes, etc.,” he said.
But medical insurance is less protective than what researchers initially thought, Levey said. He said more people with debt have insurance than those who don’t, but there is a lack of historical data on the topic.
“Healthcare debt in America is a problem for both the insured and the uninsured,” he said.
People can turn to credit cards or borrowing money from family and friends to relieve the pressure immediately, but Levey said this can impact close relationships.
Ray Kluender, an associate professor at the Harvard Business School and the Berol Corporation Fellow, said consumers can lose protections if they put debt on a credit card rather than a different tool provided by the state to offer temporary relief. This is because in the providers’ perspective, the debt is paid and is no longer medical debt, but credit debt.
“Medical debt is not consensual,” he said. “When I’m going to the hospital, I don’t know what the diagnosis is going to be, much less the treatment, and how could I have any idea what these two things are going to cost?”
Adia said journalism is an essential part of research in medical debt, collecting anecdotes of how people react and the impact of getting in debt.
“Reporting has that unique strength in being able to help,” he said. “Being able to just even just see the human impact of what this does to folks and how this changes household decisions.”
Story tips from the panelists
Kluender said a topic that journalism could have a major impact on is covering the revenue cycle practices for different health care providers, and how hospitals and doctors work within the systems.
“We have very little visibility into how they’re identifying patients for collection versus trying to screen them for financial assistance program eligibility,” he said. “We have very little visibility into whether they’re employing debt collectors to collect on their behalf or selling the debts onto debt collectors.”
Specifically, Maanasa Kona, an associate research professor at Georgetown University’s McCourt School of Public Policy, said she wants to see more investigations into third-party vendors that enter agreements with hospitals to handle their billing system.
Levey said government-owned and state university hospitals would be useful to look at to acquire the contracts or lending arrangements on who owns the debt and those who collect it, because those medical facilities are subject to public records laws.
She also said looking at whether protections proposed by states in legislation that have become law are actually keeping people from harm.
Adia referenced the No Surprises Act, which is supposed to protect patients from unexpected billing by directing the money toward a government-approved system, but he said prices have actually inflated after it was enacted. And doctors have used the law to profit off of their practice, which has created large backlogs in the government process, per the New York Times.
In May, the act was reformed to reduce the number of invalid disputes that are entered into the system, according to the Centers for Medicare & Medicaid Services.
“I don’t think we’ve heard nearly enough about how these laws are working on the ground and what actual impact they’re having, and which pieces of these protections are working better than others, and which ones should states be focusing on more so than others,” Kona said.
