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By Antoinette Kraus
In a medical emergency, most of us don’t think twice about going to the hospital. And yet, even if we have health insurance, a trip to the Emergency Room can mean hundreds, thousands, or even tens of thousands in medical bills that we couldn’t possibly have anticipated.
In October of 2020, Terry Anne, a 65-year-old retired retail worker from Philadelphia, began having chest pains. Thinking she might be having a heart attack, she called an ambulance and was taken to the nearest hospital. It turned out to be a COVID-19 infection, and she was kept in the hospital for five days, receiving multiple infusions of medication and ongoing care. A few weeks later, she received a $32,000 bill for her hospital stay, even though she had health insurance.
Years later, she’s far from paying off the bill and still making monthly payments in addition to her other monthly medical costs, like an inhaler for a chronic respiratory condition.
Medical debt is not a choice. It’s often not possible or advisable to opt out of care without risking serious health consequences, and patients often find it impossible to find out how much a procedure, hospital stay, or medication will cost in advance of receiving care. Like Theresa, most Pennsylvanians can’t afford unexpected bills that result from being sick or injured, so medical bills quickly turn into medical debt.
Medical debt doesn’t just hurt Pennsylvania families financially; it can have serious consequences for their future health. According to a study released in 2021 by Altarum, high costs of care and the fear of incurring debt means that nearly 1 in 2 Pennsylvanians delay or avoid medical care, instead waiting until a health concern becomes a costly emergency or is no longer easily treatable. And those in debt risk being turned away when they seek care.
A Kaiser Family Foundation report found that 1 in 7 people with medical debt said they’ve been denied access to a hospital, doctor, or other provider because of unpaid bills.
Medical debt is not rare, and debt can result from seeking both routine or emergency care. Kaiser Health News estimates that 10.5% of Pennsylvanians — well over a million people — have medical debt that is already in collections. And the cost of seeking care is only growing. Since 2015, hospital prices have increased as much as 31% nationally, growing more than four times faster than most workers’ paychecks.
Lawmakers in Pennsylvania need to look seriously at solutions to the medical debt crisis.
The medical debt relief program recently introduced by Democratic state Rep. Arvind Venkat, a physician from Allegheny County, would offer relief to some Pennsylvanians already experiencing medical debt by forgiving certain types of debt that would otherwise result in predatory practices by collection agencies.
Venkat’s bill, HB78, is a good start and it’s only the first step in finding a solution to the medical debt crisis. Lawmakers should go much further by addressing the design and enforcement of existing programs aimed at keeping Pennsylvanians out of debt when they seek medical care.
The vast majority (91%) of hospitals in Pennsylvania are tax-exempt non-profit organizations, and as a result, they are required by law to provide financial assistance for people who are unable to afford their medical care. Most Pennsylvania hospitals also receive federal and state dollars to provide free or discounted care for low-income Pennsylvanians who are uninsured or whose insurance does not cover the entire cost of their care.
Yet, many Pennsylvanians simply aren’t made aware that these financial assistance programs exist when they go to the hospital for care, or they find that there’s too much red tape to access them. Pennsylvania lawmakers should take simple steps to make sure more Pennsylvanians get connected to these existing programs so medical debt is prevented in the first place.
Regulations that govern hospital financial assistance programs haven’t been updated in decades, and even more importantly, they are rarely enforced.
Gov. Josh Shapiro’s administration should move swiftly to update regulations and proactively enforce those regulations in order to prevent the medical debt crisis from growing even more severe.
The General Assembly should pass Venkat’s bill without delay, along with new legislative solutions that prevent medical debt from occurring in the first place, by streamlining financial assistance programs and removing red tape that limit access.
Without action from Harrisburg, more and more Pennsylvanians may find themselves drowning in debt simply because they were sick and sought care at their local hospital.
Antoinette Kraus is the executive director of the Pennsylvania Health Access Network. She writes from Philadelphia.
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