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MEDICAL DEBT

Debt resulting from medical bills deters people from seeking future care, which can result in the need for more expensive treatment later on. In addition, medical debt can affect the overall financial security of families and undermine their economic stability. These are some of the findings from The Access Projects work with community organizations across the country to examine the consequences of medically-related debt for individuals and families.


Do you have medical debt?
The Access Project’s Medical Debt Resolution Program may be able to help. We can provide you with information and proven strategies to advocate with medical providers, insurers, and public programs to resolve your medical debt. Please complete our online intake form and you will receive a response from our program within five to ten business days.
Chapter 58 and The Access Project's Medical Debt Resolution Program.
Between September 2006 and April 2008, The Access Project worked with nearly 200 Massachusetts residents who were struggling with medical debt. We provided one-on-one coaching to help people appeal denied claims with insurers, submit bills to public programs, and negotiate affordable payment arrangements with providers. Our goals were to resolve their affordable medical bills and to identify patterns of policies and problems that created medical debt. Our findings and recommendations are contained in the report.  

In Debt But Not Indifferent: Chapter 58 and The Access Project’s Medical Debt Resolution Program


The Access Project Testifies at Congressional Hearing on Medical Bankruptcy & Medical Debt
Mark Rukavina, Executive Director of The Access Project, testified on July 17, 2007 at the hearing "Working Families in Financial Crisis: Medical Debt and Bankruptcy" of the House Committee on the Judiciary Subcommittee on Commercial and Administrative Law. The hearing focused on medical debt as a contributor to personal bankruptcy. In his
testimony, Mr. Rukavina described how the financial burden of health care costs sometimes results in medical debt. He presented information on the prevalence of medical debt, conveyed how it serves as a barrier to health care and explained how it tarnished people's credit He urged regulators to prevent involuntary medical debt from ruining people's credit reports and scores by prohibiting medical providers, and their agents, from reporting such debt to credit agencies.

Rural Health:

Listen to Tom Buis, President of the National Farmers Union, speak about the importance of health care in the challenges facing rural America .

The BARN - (Briggsdale, CO)
If National Farmers Union President Tom Buis is tapped for a post in the Obama Administration - or if he stays in his current spot - expect him to be a strong advocate for rural health issues. Buis calls health care the biggest challenge we face in rural America .
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2008 Health Insurance Survey of California Farm and Ranch Operators
Issue Brief No. 2: Who Experiences Financial Hardship Because of Health Care Costs? (released 11/20/08) shows that while nine in 10 respondents have health insurance, one in five report that insurance premiums and other out-of-pocket health care costs are causing financial difficulties for themselves and their families. These families report spending 37 percent of their income on health care coverage and medical costs. In addition, nearly one third of farmers and ranchers report spending at least 10 percent of their annual income on health insurance premiums, prescriptions and other out-of-pocket medical costs. Farm and ranch operators are especially hard hit because they are often forced to buy insurance on the individual, non-group market, where insurance costs more and often covers less.

Download the press release

For more information on the report, including a Photo Essay of Farm and Ranch Families telling their stories, please go to the California Endowment website at www.tce.org.

Issue Brief No. 1: Overview of Findings provides an overview of the survey findings. The survey found that despite high rates of insurance coverage, farm and ranch families in the state spent, on average, more than $8,500 on healthcare premiums and other out-of-pocket expenses annually, and more than one in ten had debt resulting from medical or dental bills.  People purchasing health insurance on the individual market had significantly higher expenses than those getting coverage through employment. To cover expenses, many used up savings or had to take out loans against their farm or ranch or add to their credit card debt. The report highlights the necessity of developing proposals that will ease the burden of health care costs for self-employed rural residents and small business operators. 

CA Issue Brief No. 1: Overview of Findings

2007 Health Insurance Survey of Farm and Ranch Families
The Access Project, in collaboration with the Center for Rural Health at the University Of North Dakota School Of Medicine, conducted a health care survey of farm and ranch families in Iowa, Minnesota, Missouri, Montana, Nebraska, North Dakota, and South Dakota. The purpose of the survey is to gather information about farmers’ health insurance coverage issues. This information will be shared with state and federal policy makers to help inform them on how to best improve access to affordable health insurance for farmers.

The survey will gather information about health care and health insurance issues for farm families focusing on the cost of health insurance premiums, deductibles and co-payments and other out-of-pocket expenses and any outstanding medical bills.

Issue Brief No. 3: Who Experiences Financial Hardship Because of Health Care Costs? (released 9/16/08) finds that many farm and ranch operators face burdensome health care costs that threaten their future financial well-being. 

The 2007 Health Insurance Survey of Farm and Ranch Operators shows that while nine in 10 farm and ranch operators have health insurance, nearly one-quarter (23%) report that insurance premiums and other out-of-pocket health care costs are causing financial difficulties for themselves and their families. These families report spending an alarming 42 percent of their income on health care coverage and medical costs. In addition, more than four in 10 farmers and ranchers (44%) report spending at least 10 percent of their annual income on health insurance premiums, prescriptions and other out-of-pocket medical costs. Farm and ranch operators are especially hard hit because they are often forced to buy insurance on the individual, nongroup market, where insurance costs more and often covers less.

Download the report

For more information on the report, including a Photo Essay of Farm and Ranch Families telling their stories, please go to the Robert Wood Johnson Foundation website at www.rwjf.org.

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Issue Brief No. 2: How Farmers and Ranchers Get Health Insurance and What They Spend for Health Care (released 12/18/07) examines how farm and ranch operators get health insurance coverage and the amount of their overall healthcare costs including insurance premiums and money spent out-of-pocket for medical services, treatments, products or prescription drugs. It highlights the inadequacies of relying on the private, non-group market to provide affordable, comprehensive insurance coverage to farm and ranch operators

Download the report
Download the press Release
Download the resources List

Windows Media
Listen to the conference call

In conjunction with the release of the report, Iowa for Health Care, the Access Project and the Iowa Farmers Union traveled over 650 miles around the state to nine different cities to bring the specific health care cost and access concerns of Iowa family farmers to the attention of Iowa voters.You can watch the press conference by clicking on the video below:


A report detailing the Iowa specific data was also released. It examines how Iowa farm and ranch operators get health insurance coverage and the amount of their overall healthcare costs. Costs include insurance premiums and money spent out-of-pocket for medical services, treatments, and products.

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Issue Brief No. 1: Overview of Findidngs (released 9/6/07) provides information on insurance status, source of health insurance, health care access, and medical debt for these families. It urges policymakers to carefully consider proposals that will ease the burden of health care costs for rural residents and small business operators. 

Download the report
Download the press release
Download the resources list

Windows Media
Listen to the conference call

A previous study done by The Access Project examining medical debt among Kansas farmers, Losing Ground: Eroding Health Insurance Coverage Leaves Kansas Farmers with Medical Debt is available for download.

For more information on our rural health work, contact Bill Lottero, project manager for this effort, at (617) 654-9911 x237 or email him at blottero@accessproject.org.

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Medical Expenses and Credit Card Debt:
In collaboration with Demos, The Access Project produced a report in January 2007 titled Borrowing to Stay Healthy documenting how low and middle income households are turning to credit cards to pay for medical care. The report findings are based on a national telephone survey of over 1,100 low and middle income households.

Report highlights include the finding that nearly a third (29%) of respondents reported that medical expenses contributed to their current level of credit card debt. In households with medical debt, the average credit card debt was significantly higher (46%) that in those households without medical expenses as a contributing factor in their overall credit card debt.
 
While uninsured respondents had the highest levels of credit care debt, even respondents with health insurance were not shielded from the medical debt problem. These findings, combined with the industry trend of increasing deductibles and other out-of-pocket costs, call into question whether it is prudent to rely on borrowing as a method to pay for needed health care.

For more information on Demos, visit their website at www.demos.org

Borrowing to Stay Healthy
The Plastic Safety Net
Press Release
Medical Debt and Housing:
In January and February 2005, a survey of working families in the St. Louis area asked the question: Do you owe money for medical care? Over half (53%) of these families said yes—they owed medical debt. More striking, more than 50% of those who were struggling to pay off medical bills said they had health insurance when they sought treatment. Almost one-third (31%) experienced housing problems due to their unaffordable medical bills.

This report, Living in the Red: Medical Debt and Housing Security in Missouri tells the personal stories that bring life to the statistics on medical debt. Seven Missouri residents from across the state share their personal experiences telling how medical debt affects their access to health care, as well as their families’ financial and emotional stability. As these stories attest, people with medical debt expect to and want to pay for the medical care they receive, but too often family budgets are overwhelmed by the rising costs of care. 

People with unaffordable medical bills are our neighbors, friends, and colleagues. They work hard to support their families and live in small towns, suburbs and big cities. Nonetheless, each of these individuals was unable to avoid the unforeseen illness or injury that disrupted their lives, caused medical debt, and created financial instability and housing problems. Most appalling, most of these folks had health insurance that failed to protect them from the immense costs of medical care.

Living In The Red
Press Release

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Home Sick: How Medical Debt Undermines Housing Security is based on a survey by The Access Project and its research partners of 1,700 low- and moderate-income taxpayers in seven cities. Nearly half of those people reported having medical debt and, of those, about a quarter said that housing problems resulted from the debt. The most frequent housing problems were the inability to qualify for a mortgage, difficulty making rent or mortgage payments, being turned down from renting a home, and being forced to move to less expensive housing.

Another significant finding was that many people who reported medical debt and subsequent housing problems had health insurance at the time the debt was incurred, suggesting that insurance, in many cases, is not fulfilling its basic purpose of protecting the insured from financial catastrophe. Home Sick details all of these findings, and lays out potential remedies for policy makers, health care providers, insurers and lenders.

Home Sick: How Medical Debt Undermines Housing Security
Survey Partners
Press Release
Teleconference Speakers’ Bios
Teleconference Speakers’ Statements
Personal Accounts
Resource List (people willing to grant interviews to the press in order to provide more background information.)
Executive Summary

November 9th Conference Call Home Sick: How Medical Debt Undermines Housing Security
A discussion about the impact medical debt has on people's access to housing

Windows Media
WMP (56 kbps)

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Other Reports and Publications on Medical Debt

The Consequences of Medical Debt: Evidence from Three Communities (40 p., ©2003)
The Access Project, in collaboration with three community organizations, has completed a report documenting the extent and effects of medical debt. The three organizations are: Champaign County Health Care Consumers, Human Services Coalition of Dade County, Tenants' and Workers' Support Committee of Alexandria, VA

These groups gathered info rmation on the personal effects of debt through interviews with individuals in their communities who have medical debt. In addition, to get a sense of the magnitude of the problem, Access Project staff interviewed representatives of institutions that serve populations with medical debt, either providing health care services, collecting bills, or providing legal and financial counseling. The report details the findings from both data collection efforts.

This work was completed with generous support from the Public Welfare Foundation.
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The Illusion of Coverage: How Health Insurance Fails People When They Get Sick
This report describes how private insurance products fail to protect people from financial hardship and guarantee access to care when they become ill or injured. The Illusion of Coverage discusses insurance characteristics and processes that cause medical debt, people's lack of meaningful choices when purchasing health plans, and the consequences of medical debt caused by inadequate coverage. It also provides recommendations on how to provide people access to comprehensive and affordable insurance products. The report is based on in-depth interviews with 45 people in seven states who accrued medical debt despite having health insurance.

Press Release
Research Partners
Resource List
Teleconference Speakers' Bios
Teleconference Speakers' Statements
Report Executive Summary

Windows Media
Listen to the conference call

Paying for Health Care When You’re Uninsured (18p., ©2003)
The Access Project collaborated with community-based organizations to survey the uninsured about their experiences getting care at local, mainly safety-net, health care institutions. Called the Community Access Monitoring Survey (CAMS), the survey gathered data from over 10,000 uninsured people in 18 states.

Based on the responses of over 6,000 respondents who received outpatient care at local hospitals and clinics, this national report presents findings on the experiences of uninsured patients in trying to pay for their medical care and prescription drugs.

The findings indicate that even at safety-net facilities, which provide the bulk of the care for the uninsured, uninsured patients face great difficulties in paying for care, are often not offered info rmation about financial assistance options, and are frequently in debt to the facility. The findings also indicate that providing info rmation about financial assistance programs makes a difference: the more likely staff offered info rmation, the less likely individuals were to owe money to the facility.

There are also local reports for each participating community that presents the findings for that specific location. All the CAMS related reports are available for download below.

List of hospitals and clinics included in this study
(CAMS Reports from the 24 community sites available in our "Publications" and Language Services sections)
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Community Specific Reports

Idaho
Don't Lien on Me: Why the State's Medical Indigency Care Program is Unhealthy for Idahoans (34 p., ©2001)
A report on Idaho 's County Medical Indigency Care Program. One of the unique provisions of the program is that Idahoans who avail themselves of county assistance for health care have liens automatically placed on their property. This report looks at the damaging effects of this provision, in terms of access to health care and broader financial repercussions, and makes recommendations for reforming the County Medical Indigency Care Program.
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Iowa
How Iowa Farmers and Ranchers Get Health Insurance and What They Spend for Health Care (4 p., ©2007)
This report examines how Iowa farm and ranch operators get health insurance coverage and the amount of their overall healthcare costs. Costs include insurance premiums and money spent out-of-pocket for medical services, treatments, and products.
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Kansas
Heartache in the Heartland: Kansans Speak About the Burden of Medical Debt
Heartache in the Heartland is based on a focus group discussion conducted in February of 2005 in Emporia, a city of 26,000 in eastern Kansas.  It explores the barriers to heath care that result from having inadequate insurance as well as the sources and consequences of unpaid medical bills.
Losing Ground: Eroding Health Insurance Coverage Leaves Kansas Farmers with Medical Debt (18 p., ©2006)
The Access Project partnered with the Kansas Farmers Union to examine medical debt among the farming population.
Playing By The Rules But Losing: How Medical Debt Threatens Kansans' Healthcare Access and Financial Security (30 p., ©2006)
This study investigates both the extent and the consequences of medical debt among low-income Kansans. It reports on findings of a survey conducted in 2005 with 1,058 patients at four community health centers in Kansas.
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Massachusetts
Getting Care But Paying the Price: How Medical Debt Leaves Many in Massachusetts Facing Tough Choices (34 p., ©2004)
This report is based on a survey of 342 clients of two community health centers. It shows that users of the Massachusetts health care system can accumulate debt that causes them to forgo further care, damages their credit and creates housing and employment problems. Forty-one percent of the 342 respondents had medical debt, from a variety of medical providers. The survey also reveals ramifications of medical debt beyond the health care system, such as bad credit affecting ability to rent a home or secure a job, having to increase work hours to make ends meet, or simply having difficulty paying other essential expenses.
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Missouri
Living In The Red: Medical Debt and Housing Security in Missouri (24 p., ©2007)
This report tells the personal stories that bring life to the statistics on medical debt. Seven Missouri residents from across the state share their personal experiences telling how medical debt affects their access to health care, as well as their families’ financial and emotional stability.
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Ohio
Into the Red to Stay in the Pink: The Hidden Cost of Being Uninsured (16 p., ©2005)
This law journal article, a collaboration of The Access Project, the Legal Aid Society of Greater Cincinnati, and Community Catalyst Inc., presents a review of literature and secondary data on the financial consequences of being uninsured. It also relates the personal experiences with medical debt of uninsured residents of Cincinnati . Available with permission of Case Western Reserve University School of Law
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Links
Association of Communities For Reform Now (ACORN)
Connecticut Health Policy Project
Hospital Debt Justice Project
Institute of Medicine Committee on the Consequences of Uninsurance
SEIU Hospital Accountability Project

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Last Updated June 2008