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Medical debt relief isn’t just about policy. It’s about people
When I was a medical student in Boston, my father — who lived in California — had a heart attack. He was hospitalized for a few days and received a stent in one of his heart’s arteries. The procedure went smoothly, and he was discharged without complications.
Four days later, the medical bills arrived. The total? $126,000 — four times my father’s annual income. “If the heart attack did not kill me, this will,” he told me.
My father’s experience is far from unique. Approximately 79 million Americans struggle with medical bills or paying off medical debt. This burden disproportionately falls on lower-income earners, racial minorities, parents and those in poor health. When faced with medical debt, households cut back on essentials like food and clothing, and every year, over half a million Americans are pushed into medical bankruptcy.
Despite a 98.3% health insurance coverage rate in Massachusetts — one of the highest in the nation — its residents are not immune to this phenomenon. A recent survey by the Center for Health Information and Analysis found that 1 in 7 Massachusetts residents struggles to pay family medical bills, and 1 in 8 reported that their family holds medical debt. Black residents and those with a family member who experienced a gap in coverage during the year were the most likely to report medical debt.
Medical debt stems from two primary factors: high medical prices set by health systems that wield immense negotiating power due to market consolidation, and high patient cost-sharing, which results from underinsurance (the more common factor in Massachusetts) or lack of insurance altogether. Massachusetts has the second-highest family insurance premiums in the country, and some of our hospitals set prices significantly above those Medicare pays for the same service.
While the Massachusetts Health Policy Commission — the independent state agency working to improve the affordability of healthcare — has recently taken steps to slow the rise of hospital spending and pricing, meaningful reform can take time. So policymakers must act now to protect patients from the financial devastation of exorbitant medical bills in the meantime.
The federal financial assistance policy requires all tax-exempt hospitals to establish a written policy offering free or discounted care to qualifying patients. This policy exists because nonprofit hospitals receive billions in tax breaks each year. In 2021 alone, U.S. nonprofit hospitals benefited from $37.4 billion in tax exemptions. In return, they are required to provide community benefits, including financial assistance.
Yet, every year, low-income patients like my father receive medical bills they should never have gotten — bills that, in some cases, push families into bankruptcy.
This happens because hospitals have broad discretion in designing their financial assistance programs. And while these policies are supposed to be widely publicized, they are often inaccessible or poorly communicated to patients. Applying for financial assistance is also prohibitively burdensome. These gaps — enabled by lax federal regulations — weaken one of the few medical safety net programs in America.
Recognizing these failures, states across the country have taken action. In Illinois and Maryland, patients enrolled in means-tested programs like the Supplemental Nutrition Assistance Program (SNAP) and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are automatically eligible for free care, eliminating bureaucratic hurdles. Maryland and Colorado require hospitals to use a standardized financial assistance application, simplifying the process for patients (in Massachusetts, each health system uses its own form, creating unnecessary confusion). In Oregon, hospitals must report detailed annual data on financial assistance provided, accounts sent to collections, and lawsuits filed over medical debt, ensuring transparency and accountability.
Massachusetts can and must follow suit. In January, legislators filed HD. 3094 and SD. 1676, bills that would modernize the state’s outdated financial assistance laws. This legislation would begin the process of standardizing financial assistance applications across hospitals, establishing clear rules for presumptive eligibility, mandating transparency by requiring annual reporting on application denials and approvals, and ensuring greater accountability in how hospitals provide financial assistance.
As these bills move through the legislature, I think back to my experience as a medical student. After jumping through endless bureaucratic hoops, I was able to help my father apply for financial assistance. In the end, the hospital forgave about $120,000 of his bill. Without me, he told me, he would have filed for bankruptcy.
Now, as a resident doctor in Boston, I see patients who share my father’s fears. Many worry about how they’ll pay their hospital bills. I do what I can — I connect them to a social worker, I give them an email and a phone number they can contact for help — but I often wonder: How many people actually get the help they need? How many end up with an unexpected bill? How many cut back on essentials or spiral into financial ruin because hospitals fail to provide patients with assistance?
Our legislators have a choice. They can look away or they can act to protect our most vulnerable, and to make Massachusetts a leader in health care once again. This isn’t just about policy. It’s about people. It’s about families like mine.
Massachusetts cannot wait any longer. Pass these bills.
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