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Applications to the 2024 Restuccia Health Justice Fellowship are now open!
I live with an 8th grader who is currently taking advanced math. While that may read like a cringey parental humble brag, the context is that I am at a point in my adult life where the struggle to help a kid with their homework is real – after all, I invested in a career in letters, not numbers.
Many weeknights are now spent sitting at the dinner table and staring at a new set of algebra problems while trying to pull any semblance of second-hand instruction from a 13-year-old, which is only slightly easier than counting grains of sand at the beach. But what has struck me lately, aside from absolute values and whatever y=mx+b means, are the ways in which our brains address both torturous math problems and the more torturous problems of inequity we see in the health system.
Identify the problem. Simplify. Solve for x.
2023 felt like a breakthrough year in our progress on addressing medical debt. It was a year where both policymakers and journalists identified the problem of medical debt; our efforts at Community Catalyst, along with our state and community partners in Colorado, Pennsylvania, Georgia, Wisconsin, Maine, Florida, New York, New Mexico and Illinois, worked to simplify the factors of medical debt so that legislators, executive branches, health care administrators and others, could finally solve for x.
There are many more chapters in the book to work through and that will be our homework in 2024 and beyond, but the progress we collectively made in 2023 should be documented, celebrated and built upon. Some of the highlights:
Pressure from the Advocacy Community Moves the Federal Government
2023 was a year of transition for federal health policy; the decision to wind down the public health emergency and the various provisions that helped protect people from medical debt illustrated the need for helpful policies and identified remaining gaps and opportunities for advocates.
In March, supported by 60 organizations, Community Catalyst launched a campaign focused on federal action to protect people from medical debt. The crux of the campaign continues to be focused on actions federal agencies like the Consumer Financial Protection Bureau (CFPB), the Internal Revenue Service (IRS) and Treasury can take like eliminating deferred interest medical credit cards and removing all medical debt from credit reports. The campaign also focused on greater oversight of health systems who can screen patients for charity care, Medicaid and Marketplace coverage to prevent onerous and erroneous debt from being assigned to begin with.
The constant drumbeat from national, state and local advocacy organizations culminated with the delivery of 11,000 petition signatures and a Day of Action in Washington, D.C. Convened by Community Catalyst, people directly impacted by medical debt came together to share their stories with administration officials and push for action.
Participants in our D.C. day of action, calling on the Biden administration to take action to address the root causes of the medical debt crisis.
Though the gears of the federal government can seem to turn slower than most of us would like, in September the Biden administration announced it was taking steps to eliminate all medical debt from credit scores, a central ask highlighted during the launch of our campaign. This effort was noted in a letter from Vice President Kamala Harris sent in recognition of our annual convening in October. Credit scores hold unfortunate power over people’s ability to get a house, car or even a job. While there’s more work ahead, a solid first step is removing the barrier preventing people and families from securing employment, transportation and housing simply because they got sick.
Additionally, in May the CFPB issued a warning about the dangers of medical credit cards and high-interest loans, which are often promoted in doctor and dental offices, as well as in hospitals and emergency rooms, to people that might otherwise be eligible for financial assistance or charity care. These profit-making schemes have been a focus of our ongoing petition work and “Freedom from Medical Debt” campaign which has helped set the table for the administration signaling additional action in the form of a Request For Information that Community Catalyst and our partners responded to regarding the harmful effects of medical credit cards.
A mobile billboard in Washington, D.C. calling on the federal government to take critical action to prohibit the promotion of predatory medical credit cards in health care settings.
Partners Make Big Progress on the Ground
While we have collectively been busy gaining ground at the federal level, several states made significant progress in protecting their residents from medical debt thanks to the work of our partners and their coalitions.
Colorado now requires nonprofit hospitals to report to the public on their community benefit spending; limits the interest rate to 3 percent for medical debt (down from 8 percent); and stops medical debt from being included on credit reports (an action Community Catalyst is pushing at the federal level).
Illinois now requires health care providers to proactively screen patients for financial assistance before sending unpaid medical bills to collections, while this week New York banned the reporting of all medical debt to consumer credit agencies and is considering legislation requiring hospitals to use a uniform financial assistance application.
While the above states are now in the policy implementation and enforcement phase of their work, we continue to work with partners in New Mexico, Georgia, Florida, Pennsylvania, Wisconsin and Maine on influencing local health systems to either improve their policies on financial assistance, billing and collection, or more significantly invest their community benefit fund in chronically underfunded public services and institutions (such as housing, education and transportation) that are vital to community health.
Opening the Door for Comprehensive Coverage
We know there is no singular cause of medical debt outside of “a health system that is built to saddle people with medical debt,” but a lack of comprehensive coverage is a significant factor.
Throughout history, and even after passing the Affordable Care Act, health coverage has been inadequate. Purchasing health care coverage through an ACA Marketplace or your employer has long lacked the given that coverage would cover the entirety of your body and health care needs. This has meant a lack of access to dental care, comprehensive reproductive services and gender-affirming care. These gaps contribute to a significant amount of medical debt, as is the case with insufficient or nonexistent dental care and/or the stripping away of the autonomy people should have to have control over their own bodies.
Sitting in the middle of the open enrollment period is a good time to reflect on how to address this lack of coverage moving forward. In July, along with 50 other organizations, we launched a campaign to expand the core benefits of health coverage plans sold on marketplaces to include dental care, maternity care, gender-affirming care, and support for mental health and substance use disorders treatment. This recently culminated in an announcement last month that the Biden administration is opening the door to make adult dental coverage standard in insurance plans. While there is certainly more to do on the other gaps identified above, we are encouraged that our collective action has moved the administration.
While a lot of progress was made this year, our work here is not “done.” We are currently in the thick of administrative rulemaking as well as state and federal advocacy to ensure these proposed protections become a reality. 2023 was about significant progress, not victory, and the fight is far from over.
Though the path forward is still a long one, we all know how trying advocacy work can be at times and, as a movement, we need to take the time to celebrate and reflect on the amazing work we’ve done together. None of this work is possible without the dedicated people at Community Catalyst, our vast network of community, state and federal partners, and the thousands of people who signed petitions, wrote letters and shared personal stories over the last year. Thank you.