Dec. 14, 2023

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50 State Compendium Shows Patchwork of Medical Debt Protections

Report Reinforces Need for Stronger Federal Action and Enforcement to Address the Medical Debt Crisis in America

You can view the 50-state analysis here.

(BOSTON, MA) – A new compendium resource from Community Catalyst illuminates a state-by-state patchwork of medical debt protections and hospital billing practices. It demonstrates the need for stronger state and federal action and enforcement to address the medical debt crisis that impacts 4 in 10 adults in the United States across five core policy areas: financial assistance and free care, prescribed discounts/caps on charges, billing and collections, facility fees, and price transparency.  

The “Compendium of State Policies to Curb Hospital Prices and Reduce Medical Debt” takes a cross-country view into how different states are using, or not using, policy levers at their disposal to reduce medical debt. Collecting these policies in one place gives advocates a tool to compare the policies of different states and to understand which states have the most advanced policies and which are lagging.

  • Colorado was the only state in the country to get “High” ranking in each area. Joining Colorado as states with overall “High” rankings are California, Illinois, Maine, New York, Oregon and Washington. The top states not only have strong protections on the books but also strong enforcement to ensure hospitals are providing charity care to those who are eligible, have transparent prices, include safeguards for people around billing and collection policies, and more.
  • On the other side, sixteen states rank “Low” in every category examined: Alabama, Arkansas, Hawaii, Iowa, Kansas, Kentucky, Michigan, Mississippi, Missouri, New Hampshire, North Dakota, Pennsylvania, Utah, West Virginia, Wisconsin and Wyoming.

Full state rankings, policies and methodologies can be found here.

“Medical debt is a uniquely American problem. And the underlying issue behind medical debt is simple: health care is inadequate and far too expensive,” shared Mona Shah, senior director of policy and strategy at Community Catalyst. “Exacerbating this are bad actors and lax enforcement of state and federal protections that allow people to be unfairly saddled with massive debts.”

Advocates can use the compendium to guide policy change that hinders excessive hospital prices and protect patients from medical debt, such as limiting or prohibiting facility fees, requiring publication of hospital prices, requiring screening of all patients for eligibility for free or discounted care, and more. 

“As health care costs continue to grow more expensive, states should be using all the tools at their disposal to curb hospital prices and ensure that health care is affordable and accessible,” said Quỳnh Chi Nguyễn, associate director for the Center for Community Engagement in Health Innovation at Community Catalyst. “We hope that advocates use this compendium to encourage their state governments to pass policies that protect people from medical debt.”

The new resource makes clear the burden of medical debt can vary wildly across state lines, creating a situation where people are saddled with unreasonable debt simply because of where they lived when they got sick. States have the power to curb excessive hospital prices and protect patients from medical debt, but people with medical debt need help now.

The analysis reinforces the need for stronger federal action, as defined by a growing coalition of more than 60 organizations, calling on:

The IRS and Department of Treasury to:

  • Bolster financial assistance policies to prevent people from incurring medical debt in the first place.
  • Regulate excessive charges from non-profit hospitals who are obligated to provide charity care or financial assistance to patients.
  • Protect people from harsh billing and collection practices like foreclosures, wage garnishment, and bank account seizures.
  • Strengthen enforcement of regulations to be considered and receive tax breaks as a non-profit hospital.

The Consumer Financial Protection Bureau to:

  • Prohibit medical debt from showing up on credit reports by enhancing protections in the Fair Credit Reporting Act.
  • Eliminate deferred interest in medical credit cards (often referred to as “buy now, pay later”).
  • Undertake aggressive enforcement against unfair, deceptive, and abusive hospital practices which can prevent debt from being waived or forgiven by hospital policies.

Additional background:

  • An alarming four in ten adults have some kind of medical debt in this country, and the burden is disproportionately carried by adults without insurance, women, Black and Latinx adults, parents, immigrants, and those with lower incomes. Nearly 27 percent of Black households and just under 19 percent of Latinx families hold medical debt.
  • Hospitals and health systems often exacerbate existing inequities with policies that put profits over patients. Even non-profit hospitals, which are exempt from paying most taxes because they are supposed to operate for charitable purposes, often do not provide the “community benefit” they promise and sometimes use aggressive collection tactics for people with medical debt.
  • A recent survey from The Commonwealth Fund found that delaying or skipping health care due to high costs makes people sicker. More than half of working-age adults said they experienced a health problem worsening as a result of skipping or delaying care due to costs.
  • Take action by signing our petition and ask the Biden administration to help individuals and families with medical debt.


About Community Catalyst:

Community Catalyst is a national organization dedicated to building the power of people to create a health system rooted in race equity and health justice, and a society where health is a right for all. We’re an experienced, trusted partner to organizations across the country, a change agent to policymakers at the local, state, and national level, and both an adversary and a collaborator to health systems in our efforts to advance health justice. We partner with local, state and national organizations and leaders to leverage and build power so that people are at the center of important decisions about health and health care, whether they are made by health care executives, in state houses, or on Capitol Hill. Together with partners, we’re building a powerful, united movement with a shared vision of and strategy for a health system accountable to all people. Learn more at