LOS ANGELES — Los Angeles County has launched some of the formidable efforts within the nation to deal with medical debt, focusing on hospitals for his or her function in feeding a $2.9 billion drawback.
For over a 12 months, the nation’s most populous county has labored on a complete plan to trace affected person debt and hospital assortment practices; increase invoice forgiveness for low-income sufferers; and purchase up and forgive billions in medical debt — an effort helmed by its Division of Public Well being.
Although LA County isn’t the primary authorities entity to confront this disaster, what units it aside is the way it casts medical debt not as a political concern, however as an pressing public well being menace as prevalent as bronchial asthma and diabetes.
“Nobody in the county of LA who is facing economic limitations should have that impact their ability to get the kind of health care, the kinds of services and support that we all need and are essential to optimal well-being,” public well being division director Barbara Ferrer mentioned at a medical debt symposium April 10.
Mona Shah of Group Catalyst, a nationwide well being fairness and coverage group, referred to as the county’s efforts daring — tackling the basis causes of medical debt, along with offering fast debt reduction, with enter and participation from well being plans, hospitals, group organizations, and authorities companions. Shah mentioned the county’s inhabitants of about 10 million provides to the importance of its initiative.
However on the eve of the symposium, the native hospital affiliation referred to as on the county to revise its plan.
“We believe the proposed DPH [Department of Public Health] debt relief program and data collection effort will only burden hospitals with unnecessary requirements, without ultimately helping to address the underlying issue,” wrote George Greene, CEO of the Hospital Affiliation of Southern California, in a letter to the LA County Board of Supervisors.
Most of the county’s suggestions would require hospitals to vary their processes and add reporting duties. As an example, the county is asking hospitals to tell it when affected person debt is shipped to collections and urgent hospitals to enhance entry to monetary help packages. Though state legislation requires hospitals to supply help, affected person advocates say many don’t make it straightforward for sufferers to entry.
Adena Tessler, LA County regional vp for the hospital affiliation, advised KFF Well being Information the trade supplies ample monetary help and that the county is placing an excessive amount of emphasis on hospitals’ function within the debt disaster, when different sectors of the well being care system, akin to insurers, ought to share the blame.
Tessler mentioned the county plan ought to embody all gamers, together with well being plans, supplier teams, and ambulance suppliers.
“Medical debt is a problem, and we want to be a part of the solution,” Tessler mentioned. “But hospitals are not the only source of medical debt.”
Medical debt impacts 4 in 10 adults within the U.S., in keeping with a KFF Well being Information evaluation. LA County discovered, in its personal evaluation this 12 months, that about 785,000 residents had been burdened in 2022 with a complete of $2.9 billion in medical debt.
The county evaluation reveals that medical debt disproportionately impacts folks of coloration, low-income folks, and households with kids. Having medical debt greater than doubled the chance that sufferers would delay or forgo well being care or prescriptions or be liable to shedding housing or going hungry.
Nationally, a handful of states have handed guidelines to restrict medical debt assortment or bolster hospital monetary help insurance policies. Some jurisdictions have relieved residents of debt. Connecticut, Colorado, and New York enacted legal guidelines within the final two years to ban medical debt on credit score reviews, which may depress credit score scores and make it tougher for sufferers to get a job, hire an house, or safe a automotive mortgage. California lawmakers have proposed related laws, and the federal Client Monetary Safety Bureau can be growing a algorithm.
“It’s a huge public health problem,” mentioned Naman Shah, medical and dental affairs director on the public well being division. “We in public health try to shift the determinants of health. Those are things that impact health deeply and impact people widely. Medical debt fulfills both of those. It’s important that we see this as a health issue, and not just a regulatory issue.”
The division made preliminary suggestions final spring, then additional developed them with the backing of the Board of Supervisors, which described medical debt as “pervasive” and “causing financial, mental, and physical harm … especially to those from historically marginalized communities.”
Shah mentioned that whereas the division continues to take hospital enter and has addressed a number of the affiliation’s “misunderstandings,” officers are shifting forward with the plan. Tessler agreed the main focus is on collaboration, not halting the county plan.
Over the subsequent a number of months, the county plans to attain hospitals based mostly on monetary help accessibility and supply them with templates and pointers to make monetary help much less complicated and fewer burdensome for sufferers.
States akin to Washington, Oregon, and Maryland have developed related supplies for hospitals.
The county’s targets additionally name for different debt prevention methods, together with working with plans and suppliers to higher educate shoppers to keep away from shock billing and out-of-network prices.
Shah mentioned he was shocked by the timing of the hospital affiliation’s letter, particularly since county officers and hospital representatives met a number of occasions earlier than the April symposium. He agreed you will need to deal with all sources of medical debt however mentioned hospitals are an inexpensive place to start out. Practically 75% of adults with medical debt owe some or all of it to hospitals, in keeping with a 2023 City Institute evaluation.
“We want to get the most bang for our buck,” Shah mentioned. “The largest bill that a patient receives is not a dental bill. It’s not an office bill. It’s a hospital bill.”
This text was produced by KFF Well being Information, which publishes California Healthline, an editorially unbiased service of the California Well being Care Basis.