In the United States, health concerns that land someone in the hospital or require multiple visits to the doctor can be a taxing experience on emotional, logistical and financial fronts.
But for about 17% of Marylanders facing medical debt, these struggles get compounded, leading to additional stressors that can further impact health outcomes, particularly for Black families and patients, according to economic policy organizations.
“[Medical debt] really does impact everyone on some level. It doesn’t impact folks equally,” according to Berneta Haynes, senior attorney for National Consumer Law Center. “It does have a disparate impact based on race and income.
Haynes participated in a webinar hosted by Economic Action Maryland this month, aiming to shine a light on how medical debt disproportionately impacts communities of color.
Economic Action Maryland conducted a poll in October 2020 surveying Marylanders, and found that 12% of survey participants had a medical debt they could not pay. In addition, 26% of participants stated that they would be unable to pay for an unexpected $500 medical bill out of pocket.
Marceline White, executive director of the organization, said that the average costs of a four-day hospital stay is about $14,200.
“It’s expensive to go to the hospital,” she said during the webinar.
White explained that when people have medical debt hanging over them, problems can compound and result in credit issues and even lead into other health concerns as patients delay medical care.
“We saw this particularly during the COVID pandemic. People did not go to hospitals to get treatment because they were afraid. They already had a medical bill they already medical debt,” she said.
Haynes, with the National Consumer Law Center, echoed White’s concern about people delaying hospital visits during an interview with Maryland Matters.
“People start making risky decisions related to their health,” Haynes said. “They start foregoing necessary health care visits that can then worsen whatever condition they may currently have — and snowball into more medical debt down the road.”
Which is a particular concern when it comes to the higher rate of Black families facing medical debt.
According to data from the Urban Institute, which tracks various forms of debt and how they impact Black communities, about 13% of communities of color in Maryland have medical debt, compared to 9% of white communities.
According to the most recent U.S. Census data from 2020, 48.7% percent of Marylanders are white and 29.5% are Black. About 21.9% of Marylanders are some other race or a mix of two races.
Another factor leading to medical debt can be whether a patient has insurance or not. Haynes explained that Black communities tend to have higher rates of various chronic illnesses but also may not have insurance, which can lead to medical debt
“Even in the states that have expanded Medicaid, like Maryland, we still see that Black folks are more likely to be uninsured, more likely to lack access to hospitals and health care providers nearby, so they have to go to providers that are out of network,” she said. “More likely to see higher maternal fatality rates. All kinds of cancers are highly concentrated in Black families. All of that makes Black people more likely to accrue medical debt than other groups.”
Both Haynes and White said Maryland’s efforts to reduce medical debt should be be a role model for other states.
The Medical Debt Protection Act, which took effect without being signed by former Gov. Larry Hogan (R) in 2021, issued a handful of protections for patients facing medical debt.
Under this law, hospitals are not permitted to request arrest warrants on patients if they are trying to collect medical debt.
“I don’t think it ever crosses people’s minds that a medical debt can lead to your arrest,” Haynes noted.
The 2021 law requires hospitals to check a patient’s eligibility for financial assistance before filing a lawsuit. In addition, hospitals are required to refund patients if they are deemed eligible for financial assistance within 240 days of billing.
“Maryland would be seen as one of the states that is doing the most,” White said. “But we still see, despite that effort, thousands and thousands of people falling through the cracks for a variety of reasons. And again, disproportionately affecting Black and Brown communities.”
Part of the issue to how patients get medical debt in the first place is the lack of knowledge that non-profit hospitals are required to provide financial assistance, also referred to as charity care, for low income people under the federal Affordable Care Act.
With charity care, hospitals may provide free or discounted services to eligible low-income patients who cannot afford services,
But hospitals may have different qualifications for who is considered “eligible” for financial assistance.
“That means from hospital to hospital, the threshold for when you qualify for financial assistance will differ. You may qualify for one hospital in the Baltimore area and not in another hospital in the Baltimore area,” according to Haynes.
For example, Lifebridge Health’s financial assistance policy says that it “provides hospice care at a discount to eligible patients of limited means whose household income is between 300% and 375% of the Federal Poverty Guidelines for the patient’s family size,” according to its website.
But Medstar’s financial assistance policy says that “partial financial assistance for medically necessary care provided to uninsured and underinsured patients with household income between 201% and 400% of the FPL.”
Haynes says that one of the most impactful way to address medical debt would be to set an income floor for all hospitals under the ACA. But she also urges lawmakers in Maryland and across the United States to consider policies that can specifically help with the inequity in medical debt that Black families and patients face.
“I think a little bit of both would be the right approach,” she said.
“But I think it’s also important for lawmakers to figure out how to prioritize relief for Black families…or at least be aware that the legislation that they are introducing may have a specific impact on Black families and Black folks,” she added.
By Danielle J. Brown
Reed Fawell 3 says
This should be no surprise. Exactly the same thing happened with higher and k-12 education, as is happening now with medical care. Here again we can thank our very own Federal Government.
Matt LaMotte says
Hate to “politicize” this issue but have you seen the Republican agenda for dealing with these circumstances? That’s right; they don’t have one! As a matter of fact, if the current Reps in Congress get there way, access to many health benefits are going to end this Fall!
I recently spent the weekend at Easton’s UMM Hospital and couldn’t have been more impressed with the effort and attitude of the understaffed, overworked staff there (from maintenance folks to doctors!). Healthcare is one of many crises we as a Nation are dealing with today. But, it’s fixable. Just sayin’…
Reed Fawell 3 says
Maryland Matters always defines problems in terms of race, focused on blacks mostly. It’s as if the poor or less well off whites, Hispanics, Asians and whoever else don’t suffer from these massive federal programs with their massive waste of monies. Here is where the politics comes in.
Problem is for old Joe Biden, this is a huge Democratic program from top to bottom. Remember “you can keep your own doctor, and your cost will go down, and everybody will be covered for free even,” promised Joe’s Biden’s sidekick Barack Obama. But look who is getting rich off of it now – the hugely powerful medical and drug lobby, along fat cat DC politicians and government types working the system, making great sums of money off of most everyone in America.
Sound familiar?
Its just like the already affluent folks who now get richer and richer off poor and middle class students, and everyone else who is a student or parent – the already wealthy colleges and universities, with their bloated Administrators, elite professors, and big time corporate tech, non profit, green energy and military industrial complex that get cut rate research off universities paid in part by the students’ loan debt and tuition payments who gain no benefit at all, just a big bill along with a mostly rotten and otherwise useless education.
Uncle Sam has become a scam artist in cahoots with his powerful friends living off the people who can least afford it. American’s poor and middle class are rapidly becoming serfs in the style of 18th century Russia. We all need to wake up to what is really happening in America.
Reed Fawell 3 says
Today’s WSJ contains a very fine article by Bobby Jindal titled “Doctors office Care at Hospital Prices” that explains how “Consolidation of medical practices brings dishonest billing that costs patients and taxpaper’s billions … and how “large hospital systems (buying up private practices) have exploited our nations outdated billing systems to foist gigantic bills on Americans.”
According to Jindal, Republican Senators Mike Brawn and John Kennedy and Democrat Maggie Hassan, in coordination with the a US House of Representative Committee, all following the state of Indiana’s lead, is working to fix this problem of dishonest billing under medicare, an effort that would save patients and taxpayer’s between $346 Billion and $672 Billion over next decade.
Lets watch this legislation and see who in the US Congress opposes it.