Medical Debt Is Killing Patients who Deny Costly Healthcare
Emergency Physician and Pennsylvania state representative Arvind Venkat, MD has a detail story to tell about the impact of healthcare upon patients who can not afford the insurance, or are under insured, and opt to deny healthcare. And most can not afford the payments resulting from Medical Debt. This is a good plan and the Pennsylvania House of Representatives on a “bipartisan vote” supported it.
Medical Debt Is Killing Our Patients | MedPage Today, Arvind Venkat, MD
The Story
Prior to the passage of the Affordable Care Act (ACA), approximately sixteen percent of emergency department patients were uninsured. Often their issues were of low acuity, again because they had no other place to see a physician. I assumed it to be the case with this patient. I would treat her presumably musculoskeletal back pain and discharge her. While treating her, I noticed she struggled to walk and clutched her gown across her chest. It was the clutching that really struck me as unusual.
After examining her chest, I saw something unexpected and right out of the medical history books. Her entire left breast was as hard as a rock, consumed by cancer that likely developed over months, if not years. She had severe hypercalcemia and was on the verge of going into cardiac arrest as a result.
After I stabilized her, I gently inquired why she had not sought care sooner. She explained that she did not have insurance, had previously sought care for other conditions, gone into debt, and feared that if she again sought care, her debt would only get worse. While I could alleviate her pain, it was too late for my patient to be cured of her illness, and she died shortly after hospital admission.
This story is all too common in the U.S.
Americans owe at least $195 billion in medical debt as of 2019, with medical debt disproportionately burdening people of color and adults with disabilities. Medical debt is the leading cause of bankruptcy in our country, and thousands use GoFundMe and other sites to raise funds to pay for their healthcare. Only 12% raise the funds necessary to pay for treatment, and it is incomprehensible that such pleas should be the norm. With healthcare spending predicted to increase by 5.2% by 2026, alleviating medical debt is a critical public health priority.
While the ACA expanded insurance access, the number of health insurance plans with high deductibles and co-payments continues to increase, putting a strain on Americans’ finances should they need medical treatment.
Under the Emergency Medical Treatment and Labor Act, hospitals must treat patients entering their emergency department, regardless of their ability to pay. This contributes to billions in uncompensated medical treatment per year. Meanwhile, approximately 25% of Americans struggle to pay their bills. This burden is commonly shifted through rising prices for the commercially insured, making medical debt a problem that affects all of us.
These high bills can act as a death sentence for some Americans as they refuse to seek further treatment, simply due to their medical debt. As physicians, we have a responsibility to treat patients. Legislators, similarly, have a duty to the residents they represent. We have a responsibility to reform the American healthcare system, beginning with medical debt relief, and in a fiscally responsible manner not incentivize the non-payment of medical bills by those who can afford to do so.
As an emergency physician, Pennsylvania state representative, the only physician-legislator in our General Assembly, and the first physician in our legislature in nearly 60 years, I personally believe there is no greater health priority in my state. As such, I introduced the Medical Debt Relief Act.
By establishing the Medical Debt Relief Program in the Pennsylvania Department of Health, this bill would discharge medical debt by using state funds to contract with a medical debt relief coordinator who would partner with hospitals and other healthcare providers Their efforts would identify unpaid medical debt among those who make less than 400% of the federal poverty level or pay more than 5% percent of their annual income in medical debt.
In turn, coordinators would purchase the debt, forgive it, and only then notify the patient of their debt relief. The medical debt is in a distressed status. It can be purchased for pennies on the dollar, similar to what debt collectors do. But unlike debt collectors, the debt is forgiven and not pushed into collections. Similarly, because the medical debt relief coordinator is classified as a charity, the patient does not incur a new tax obligation from this debt forgiveness. My legislation would alleviate medical debt for hundreds of thousands of Pennsylvanians, predominantly aiding residents in rural Pennsylvania, women, and people of color who bear the disproportionate burden of medical debt in collections. This is a win for patients, clinicians, and the public.
Similar efforts to relieve medical debt have worked at the county and municipal level, and states such as New Jersey and Connecticut have budgeted for medical debt relief programs. While previous efforts have used American Rescue Plan funds to finance these efforts, the potential 100:1 return on investment of state dollars makes my proposed approach through the general budget process particularly attractive and impactful.
In addition, my bill would require hospitals to publicize their charity care programs, assist potentially eligible patients with their applications for charity care programs, and hold bills in abeyance until that eligibility for charity care is determined. We have seen multiple stories of non-profit health systems not meeting their charity care obligations, and this part of the bill would address one of the root causes of the accumulation of medical debt. My legislation passed the Pennsylvania House of Representatives on a bipartisan vote and is now the subject of negotiations for inclusion in our state budget.
As an emergency physician, I have far too often seen the gaps in our fragmented and expensive healthcare system. My experience of seeing a patient die due to the accumulation of medical debt is not unique. No one believes medical debt is a good feature of our healthcare system. The Pennsylvania Medical Debt Relief Act can serve as a model for how we can address this crisis in a responsible fashion both to provide direct patient relief and prevent the perpetuation of this American tragedy. I encourage other cities and states to enact similar legislation.
Enough said . . .
https://www.nytimes.com/2023/11/01/health/infant-mortality-rate-rise.html
November 1, 2023
Infant Deaths Have Risen for the First Time in 20 Years
The increases were particularly stark among babies born to Native American, Alaska Native and white mothers in 2022. Rates among Black infants remained highest of all.
By Roni Caryn Rabin
The number of American babies who died before their first birthdays rose last year, significantly increasing the nation’s infant mortality rate for the first time in two decades, according to provisional figures released Wednesday by the National Center for Health Statistics.
The spike is a somber manifestation of the state of maternal and child health in the United States. Infant and maternal mortality, inextricably linked, are widely considered to be markers of a society’s overall health, and America’s rates are higher than those in other industrialized countries.
The rates are particularly poor among Black and Native American mothers, who are roughly three times as likely to die during and after pregnancy, compared with white and Hispanic mothers. Their infants face up to double the risk of dying, compared with white and Hispanic babies.
Overall life expectancy has declined in the United States in recent years, too, affecting white Americans as well as people of color. The declines were driven in part by the Covid-19 pandemic.
The increase in infant mortality comes after a century of public health improvements, in which rates consistently and gradually declined almost every year with few exceptions, said Danielle M. Ely, a health statistician with the N.C.H.S. and the report’s lead author.
The report did not delve into the cause of the increase, but most of the babies born in 2022 were conceived in 2021, when maternal deaths rose by 40 percent because of the pandemic and many pregnant women were taken ill.
“Seeing an increase that hits the statistical significance mark indicates that this was a bigger jump than we’ve had in the last 20 years, and that is something we need to keep an eye on to see if it’s just a one-year anomaly or the start of increasing rates,” Dr. Ely said.
One of the more disturbing findings in the new report was an increase in infant mortality among babies born to women ages 25 to 29. The rate increased to 5.37 per 1,000 live births last year, up from 5.15 deaths per 1,000 live births in 2021. The cause is not known….
https://fred.stlouisfed.org/graph/?g=15a9v
January 15, 2018
Life Expectancy at Birth for United States, United Kingdom, France, Germany and Italy, 2017-2021
https://fred.stlouisfed.org/graph/?g=15a9P
January 30, 2018
Infant Mortality Rate for United States, United Kingdom, France, Germany and Italy, 2017-2021
Again, life expectancy and infant mortality in the United States significantly lag the rates in other high income countries. The difference in rates among G7 countries, with the US lagging, is stark.
The differences are stark:
https://fred.stlouisfed.org/graph/?g=1aVaP
January 15, 2018
Life Expectancy at Birth for United States and France, 2000-2021
https://fred.stlouisfed.org/graph/?g=1aVb2
January 30, 2018
Infant Mortality Rate for United States and France, 2000-2021