Noam N. Levey
Worried that President-elect Donald Trump will curtail federal efforts to tackle the nation’s medical debt downside, affected person and shopper advocates want to states to assist individuals who can’t afford their medical payments or pay down their money owed.
“The election simply shifts our focus,” stated Eva Stahl, who oversees public coverage at Undue Medical Debt, a nonprofit that has labored intently with the Biden administration and state leaders on medical debt. “States are going to be the epicenter of policy change to mitigate the harms of medical debt.”
New state initiatives is probably not sufficient to guard Americans from medical debt if the incoming Trump administration and congressional Republicans transfer ahead with plans to reduce federal assist that has helped tens of millions acquire medical health insurance or cut back the price of their plans in recent times.
Comprehensive well being protection that limits sufferers’ out-of-pocket prices stays the most effective protection towards medical debt.
But within the face of federal retrenchment, advocates are eyeing new initiatives in state legislatures to maintain medical payments off folks’s credit score reviews, a shopper safety that may enhance credit score scores and make it simpler to purchase a automotive, hire an residence, and even get a job.
Several states want to strengthen oversight of medical bank cards and different monetary merchandise that may depart sufferers paying excessive rates of interest on high of their medical debt.
Some states are additionally exploring new methods to compel hospitals to bolster monetary assist packages to assist their sufferers keep away from sinking into debt.
“There’s an enormous amount that states can do,” stated Elisabeth Benjamin, who leads well being care initiatives on the nonprofit Community Service Society of New York. “Look at what’s happened here.”
New York state has enacted a number of legal guidelines in recent times to rein in hospital debt collections and to broaden monetary assist for sufferers, usually with help from each Democrats and Republicans within the legislature. “It doesn’t matter the party. No one likes medical debt,” Benjamin stated.
Other states which have enacted protections in recent times embrace Arizona, California, Colorado, Connecticut, Florida, Illinois, Minnesota, Nevada, New Jersey, New Mexico, Oregon, Rhode Island, and Washington. Many measures picked up bipartisan help.
President Joe Biden’s administration has proved to be an ally in state efforts to regulate well being care debt. Such debt burdens 100 million folks within the United States, a KFF Health News investigation found.
Led by Biden appointee Rohit Chopra, the Consumer Financial Protection Bureau has made medical debt a priority, going after aggressive collectors and exposing problematic practices throughout the medical debt business. Earlier this yr, the company proposed landmark laws to remove medical bills from shopper credit score scores.
The White House additionally championed laws to spice up entry to government-subsidized medical health insurance and to cap out-of-pocket drug prices for seniors, each key bulwarks towards medical debt.
Trump hasn’t indicated whether or not his administration will transfer forward with the CFPB credit score reporting rule, which was slated to be finalized early subsequent yr. Congressional Republicans, who will management the House and Senate subsequent yr, have blasted the proposal as regulatory overreach that may compromise the worth of credit score reviews.
And Elon Musk, the billionaire whom Trump has tapped to steer his initiative to shrink authorities, final week called for the elimination of the watchdog agency. “Delete CFPB,” Musk posted on X.
If the CFPB withdraws the proposed regulation, states may enact their very own guidelines, following the lead of Colorado, New York, and different states which have handed credit score reporting bans since 2023. Advocates in Massachusetts are pushing the legislature there to take up a ban when it reconvenes in January.
“There are a lot of different levers that states have to take on medical debt,” stated April Kuehnhoff, a senior lawyer on the National Consumer Law Center, which has helped lead nationwide efforts to broaden debt protections for sufferers.
Kuehnhoff stated she expects extra states to crack down on medical bank card suppliers and different corporations that lend cash to sufferers to repay medical payments, generally at double-digit rates of interest.
Under the Biden administration, the CFPB has been investigating patient financing companies amid warnings that many individuals could not perceive that signing up for a medical bank card similar to CareCredit score or enrolling in a cost plan by way of a monetary providers firm can pile on extra debt.
If the CFPB efforts stall underneath Trump, states may comply with the lead of California, New York, and Illinois, which have all tightened guidelines governing affected person lending in recent times.
Consumer advocates say states are additionally more likely to proceed increasing efforts to get hospitals to supply extra monetary help to cut back or get rid of payments for low- and middle-income sufferers, a key safety that may hold folks from slipping into debt.
Hospitals traditionally haven’t made this assist available, prompting states similar to California, Colorado, and Washington to set stronger requirements to make sure extra sufferers get assist with payments they’ll’t afford. This yr, North Carolina additionally received approval from the Biden administration to withhold federal funding from hospitals within the state except they agreed to broaden monetary help.
In Georgia, the place state authorities is fully in Republican management, officers have been discussing new measures to get hospitals to supply extra help to sufferers.
“When we talk about hospitals putting profits over patients, we get lots of nodding in the legislature from Democrats and Republicans,” stated Liz Coyle, government director of Georgia Watch, a shopper advocacy nonprofit.
Many advocates warning, nonetheless, that state efforts to bolster affected person protections will likely be critically undermined if the Trump administration cuts federal funding for medical health insurance packages similar to Medicaid and the insurance coverage marketplaces established by way of the Affordable Care Act.
Trump and congressional Republicans have signaled their intent to roll again federal subsidies handed underneath Biden that make well being plans bought on ACA marketplaces extra inexpensive. That may hike annual premiums by tons of and even hundreds of {dollars} for a lot of enrollees, according to estimates by the Center on Budget and Policy Priorities, a suppose tank.
And throughout Trump’s first time period, he backed efforts in Republican-led states to limit enrollment of their Medicaid security web packages by way of guidelines that might require folks to work with the intention to obtain advantages. GOP state leaders in Idaho, Louisiana, and different states have expressed a desire to resume such efforts.
“That’s all a recipe for more medical debt,” stated Stahl, of Undue Medical Debt.
Jessica Altman, who heads the Covered California insurance coverage market, warned that federal cuts will imperil initiatives in her state which have restricted copays and deductibles and curtailed debt for a lot of state residents.
“States like California that have invested in critical affordable programs for our residents will face tough decisions,” she stated.
