Unpaid medical bills are a significant stressor for many, which is no surprise given the rising cost of prescription drugs and health insurance premiums. When people can’t afford these rising costs, they incur medical debt when receiving necessary medical care, which can have some serious consequences. Medical debt can lower credit scores, making it harder to obtain loans or employment; it can hinder one’s ability to afford basic necessities such as food or rent; and it can cause high levels of stress. Given these outcomes, advocates and community members know that people need to be protected, so they’re fighting for change. 

With limited federal protections against medical debt and aggressive billing practices, advocates and community members are taking the lead to push for strong protections at the state level. They’re drafting policy solutions with input from those most harmed by medical debt, while building strong coalitions to empower community members to take on powerful opposition. It takes a lot of coordination and foresight to secure protections against medical debt, but advocates are finding the path forward and securing significant legislative wins in several states across the country. Community Catalyst is partnering with state and community advocates from five states to understand the key strategies of these successful advocacy campaigns to end medical debt. Over the course of 2022, we’ll review these strategies in a series of case studies in order to provide guidance for other states looking to solidify similar protections. Here’s what we’ve published so far. 

This brief describes the key drivers of medical debt, ramifications of unpaid medical debt, current federal protections, and key considerations for successful state campaigns. Through the lens of five equity-focused principles, we examine state-level consumer protections and introduce a series of case studies describing successful campaign strategies from a range of states. The state-specific case studies further analyze the effective strategies used by advocates through detailed accounts of their successful campaigns. 

The first case study details the medical debt campaign in Maryland. All hospitals in Maryland operate as not-for-profits with an obligation to provide low-cost or free medical care to people with low incomes. Yet, sixty percent of bad debt in Maryland is owed by people with low incomes, meaning, many of those who qualify for the reduced costs are not receiving them. Hearing countless stories of people struggling with medical bills, Maryland advocates sought additional data to drive home the importance of ending medical debt. This included advocating for a poll in the fall of 2020 which revealed the racial disparities of those most impacted by medical debt and the broad public support for legislative change in their state. This case study details how advocates in Maryland secured some of the strongest protections in the country through the smart use of data and community engagement, as well as their plans to monitor implementation moving forward.  

Standing up against aggressive hospital billing isn’t new for Colorado advocates. Back in 2012, Colorado passed legislation requiring hospitals to offer financial assistance to people with low incomes while also establishing some provisions to screen patients for eligibility and offer payment plans. Advocates knew they needed to build on this win to strengthen patient protections, but the influence of lobbying by hospital interests made further progress challenging for years. Overcoming this obstacle required a creative approach from Colorado advocates to bring those harmed by medical debt to the table, negotiate with hospitals and provider groups, and ultimately secure a legislative win in 2021 that will better meet the needs of their community. This case study highlights the importance of engaging early in the process with people who are directly impacted by policy and administrative practices, as well as potential stakeholders and opposition, to ensure meaningful policy wins. 

In the past few years, New York brought the number of uninsured people to historic lows, but advocates knew people still continued to face high out-of-pocket costs that often led to medical debt and aggressive debt collection practices. To understand the scope of this issue and explore possible policy solutions, advocates conducted an in-depth policy analysis and organized community focus groups prior to drafting legislation. With an informed understanding of the complexities of medical debt in New York, advocates were then able to work with state legislative champions to draft a robust package of bills targeting their state’s specific drivers of medical debt. Through coalition building, robust communications strategies, community engagement, and a lot of determination, New York state has been able to enact several medical debt provisions. 

Our hope is these publications will provide guidance on overcoming opposition and solidifying protections against medical debt at the state level. Successful health policies rely on empowering those facing structural oppression and building strong coalitions to support people in exercising their power to call for change. Medical debt is a serious problem for many, and to ensure we are building robust protections while empowering our communities, we must learn and build from successful strategies in other states. To read these case studies, and follow upcoming publications, please see our landing page where we will post updates throughout the year.