Summary and Analysis

High Prices and Medical Debt Go Hand-in-Hand

Health care in the United States is the most expensive in the world by far and the reason is simple – health care providers keep increasing the prices of services. Hospitals, which represent the largest component of health care spending, have an outsized influence on medical debt in their communities through their policies and behavior. As a result, the United States is experiencing a growing and urgent medical debt crisis. While it is widespread, the impact of high prices and medical debt are disproportionately felt by Black and Latinx families, women, people with no health insurance, and people with low incomes. 

For more than 15 years, Community Catalyst has led the fight to eliminate medical debt in the United States. A central part of our work to put people over profit is ensuring that advocates across the county have tools and people with lived experience have a platform to shape policies.  

This State Policy Compendium project takes a cross-country view into how different states are using, or not using, policy levers at their disposal to slow heath care services price growth and therefore reduce medical debt. By collecting these policies in one place, advocates can compare the policies of different states and identify where their state government can be pushed to improve.  

16% Increase in health care prices from 2016 to 2020. As of 2022, over 100 million people in the U.S. are experiencing medical debt.

Read the Executive Summary Here
Map of the United States ranking all 50 States and D.C. their low, medium or high impact of Hospital Prices on Medical Debt. States are shaded with orange to represent a "low" rating, beige to represent a "medium" rating, and green for a "high" rating.
Twenty-seven states have an overall rating of “low,” indicating significant shortcomings in several of the policy categories. Seventeen states have “medium” rankings, and seven states were rated “high.” Colorado was the only state rated “high” in all five categories.

Explore state-by-state rankings >>

Read specific state policy summaries >>

Methodology

Methodology

Community Catalyst identified five areas of policy that have the potential to reduce or grow medical debt, depending on any given state’s approach. The areas are financial assistance and free care, prescribed discounts/caps on charges, billing and collections, facility fees, and price transparency. 

We rate a state’s policies in each of the categories as “low,” “medium,” or “high,” based on criteria including the scope of entities to which a rule applies, the specificity and extent of its requirements, and the strength of its enforcement mechanism. The ratings for each of the categories were then combined to produce an overall, composite rating for every state.

Read our Methodology >>

Man dressed in suit speaks into microphone with three people in the background at a roundtable of health advocates in Washington, D.C.
WASHINGTON, DC – SEPTEMBER 13: Samuel Camacho of Ohio and Alysia Cutting of Georgia speak at a roundtable on Capitol Hill on September 13, 2023 in Washington, DC. Health advocates and community members gathered in Washington D.C. to push the Biden administration to take additional action on medical debt in an event hosted by Community Catalyst, a national organization fighting for race equality and health justice. (Photo by Tasos Katopodis/Getty Images for Community Catalyst)
Take Action

Take Action

States have the power to curb excessive hospital prices and protect patients from medical debt. Advocates can use the compendium to guide policy change that, at a minimum: 
  • Require all hospitals to provide free or discounted care to uninsured/underinsured patients with incomes under specified levels; 
  • Require all hospitals to limit the prices charged to patients below a specified income threshold to Medicare levels or lower; 
  • Require that hospitals screen patients for eligibility for free or discounted care, unless the patient specifically declines screening; 
  • Prohibit the most harmful collection actions, including wage garnishment, home foreclosures and property liens, adverse credit reporting, and denying medical care due to outstanding bills; 
  • Limit or prohibit facility fees;  
  • Require broad and accessible publication of hospital prices; and 
  • Robustly enforce all of these requirements, using, for example, financial penalties, licensure authority, and private rights of action. 
Acknowledgments
This work was made possible by generous support from Arnold Ventures.  

We thank authors Robert Seifert, Policy Researcher and Independent Consultant, Miriam Straus, Senior Policy Analyst at Community Catalyst, Sheila Philips, State Advocacy Manager at the Center for Community Engagement in Health Innovation, Michael Matson, Policy Analyst at Community Catalyst, and Quynh Chi Nguyen, Associate Director for the Center for Community Engagement in Health Innovation for their leadership in conducting state policy research and analysis.

We also thank Community Catalyst colleagues Brandon Wilson, Senior Director of the Center for Community Engagement in Health, Michael Miller, Senior Advisor of Strategic Policy, Amrit Cheng, Director of Storytelling and Content Strategy for their policy insight and content presentation.

Resources

Medical Bills: Everything You Need to Know About Your Rights Photo of partner sitting on a brown couch, looking at the camera and smiling. The person has long dark hair and is wearing glasses and a dark blue button shit.

Medical Bills: Everything You Need to Know About Your Rights

Affordability, Medical Debt, Health System Innovation
A Path Toward Ending Medical Debt: A Look at State Efforts

A Path Toward Ending Medical Debt: A Look at State Efforts

Affordability, Medical Debt, Health & Economic Justice
Principles for Improving Community Health and Economic Stability Through Hospital Policies

Principles for Improving Community Health and Economic Stability Through Hospital Policies

Affordability, Health System Finance, Medical Debt
Case Study: State Campaign to Protect Marylanders from Medical Debt

Case Study: State Campaign to Protect Marylanders from Medical Debt

Affordability, Medical Debt, Health & Economic Justice, People Over Profit
Patient Complaints Are a Crucial Tool for Improving Health Care

Patient Complaints Are a Crucial Tool for Improving Health Care

Affordability, Medical Debt, Coverage & Care, People Over Profit