Reporting on America’s medical debt crisis

By April Dembosky/California Health Fellowship

Health care debt now affects 100 million people in the U.S., with families cutting back on food, clothing, and medications, some even selling or taking out second mortgages on their homes, in order to pay enormous medical bills.

Hospitals are driving the trend by limiting who qualifies for charity care, then pursuing aggressive tactics for collecting bills, including suing patients or refusing to treat people until they've paid off outstanding charges.

As bad as medical debt is, it's worse than you think. It's not a bug, it's a defining feature of what American health care does.

KFF Health News Senior Correspondent Noam Levey

Levey encouraged reporters at his Health Journalism 2024 panel to tell the stories of people in their communities touched by medical debt, and to investigate the systemic forces driving the problem.

These stories can be found in rural and urban areas, including those anchored by academic medical centers. People who are fully insured can also be impacted by medical debt, explained Nikki Yuill, a social worker who has been overseeing a team of oncology professionals taking live calls at the Leukemia & Lymphoma Society in San Antonio for the last 30 years.

"I have never seen the level of medical debt and financial toxicity that I'm seeing right now in my career, ever," Yuill said.

In addition to draining families of their resources and burdening future generations, she said medical debt is also robbing people of their dignity. She often hears callers on the other end of the phone express shame over debt that snowballed simply because they got sick: "I've always paid my bills. I take pride in my credit score," they tell her. "Now everything is gone."

Sara Collins, senior scholar and vice president of health care coverage and access at The Commonwealth Fund, said that among those who are insured, the growth in medical debt is fueled by the growth in medical costs, primarily inpatient hospital prices, which has caused insurers to raise premiums. Employers, in turn, have tried to manage the increase in premiums by passing more cost sharing on to employees in the form of co-pays and higher deductibles, or through narrow networks that push more patients to out-of-network providers.

Meanwhile, insurers are denying more claims, increasing requirements for prior authorization, and committing more billing errors that patients don't know they can contest.

"Consumers are caught up in the middle of complexity," Collins said. "They have so little agency because they don't understand their rights."

Levey encouraged reporters to highlight the policies and behaviors of providers, from hospitals to ambulance companies to dentists. Reporters should ask hospitals for their financial assistance and billing and collections policies, spotlighting practices like putting patients on 24-month payment plans, sending bills to collections, or refusing to perform follow-up treatments or surgeries until patients pay prior invoices.

April Dembosky is the health correspondent at KQED Public Radio in San Francisco and is at work on her first book. She was a 2024 AHCJ-California Health Journalism Fellow.