North Carolina Gov. Roy Cooper Wants To Blast Away $4 Billion In Medical Debt
Medical debt is a term that should not exist outside of dystopian novels.
Forty-one percent of US Americans have medical debt. By that same token, 59 percent of us are one medical emergency away from financial ruin (and probably more, depending on the medical emergency).
While this may be a truly horrific thing to think about, it’s important to remember that unlike countries where everyone just has healthcare, we have choice! We have the choice between the healthcare plan offered by our place of employment and … I’m not sure what else, but it must be absolutely incredible, given how excited people get about it. I guess I’m not cool enough to know. Also, we have shorter wait times than one (1) of the countries that has universal healthcare (It’s Canada! Though at least they can afford their prescription drugs, eh?), and if that isn’t a good enough reason to pay health insurance companies exorbitant amounts of money so that they can pay people to figure out how not to cover our medical costs, I don’t know what is.
It’s a system that just makes a lot of sense, or so I am told by people who like to tell me they are much smarter and more realistic than I am.
That being said, there’s still all that medical debt — which is not a good thing for people to have, both for their own sake and the economy’s. But we’ve got some nice news about that, at least if you live in … North Carolina?
It’s true! On Monday, North Carolina Governor Roy Cooper announced his plan to knock out practically $4 billion worth of medical debt held by about 2 million lower- and middle-income families in the state.
"Large medical bills from sickness or injury can cripple the finances of North Carolinians, particularly those who are already struggling," Governor Cooper said in a statement. "Freeing people from medical debt can be life changing for families, as well as boost the overall economic health of North Carolina."
"North Carolinians are carrying the emotional and financial burden of debt, and often delay necessary care because of past bills," said state Health and Human Services Secretary Kody H. Kinsley. "Medicaid Expansion gave 600,000 people access to care. Relieving medical debt will get individuals and families into care sooner, bring down the cost of care and give them a fresh start on a healthy and productive life."
The way it will work is the federal government will sign off on a proposal that will provide North Carolina hospitals with “an enhanced amount of Medicaid funds” in exchange for relieving debt and establishing policies to keep people from accumulating medical debt. Should hospitals choose not to participate, they will get the standard amount of Medicaid funds. (Obviously, good government that helps people is dependent on the federal government not being run by absolute monsters. That’s important!)
Here are the standards the hospitals receiving the funds will have to implement:
Relieving all medical debt deemed uncollectible dating back to January 1, 2014, for any individuals not enrolled in Medicaid with incomes at least at or below 350 percent of the federal poverty level (FPL) or for whom total debt exceeds 5 percent of annual income. That 350 percent of the federal poverty level is about $52,000 for a single person and about $109,000 for a family of four.
Relieving all unpaid medical debt dating back to January 1, 2014, for individuals who are enrolled in Medicaid.
Providing discounts on medical bills of between 50-100 percent for patients with incomes at or below 300 percent FPL, with the amount of the discount varying based on the patient’s income.
Automatically enrolling people into financial assistance, known as charity care, by implementing a policy for presumptively determining individuals eligible for financial assistance through a streamlined screening approach.
Not selling any medical debt for consumers with incomes at or below 300 percent FPL to debt collectors.
Not reporting a patient’s debt covered by these policies to a credit reporting agency.
Nice!
This is not, actually, entirely without precedent. In 1946, as a way to address the nation’s severe hospital shortage, Harry Truman signed the Hill-Burton Act, which provided states with funds to build and maintain hospitals in exchange for providing low-income patients with free or low-cost care. The funds were also used to train new doctors and nurses, particularly in treating infectious viruses like measles, polio, and whooping cough before we had vaccines for them. There were definitely a lot of issues with the way the program ended up being implemented that I won’t get into right now, but as it led to the United States reaching its goal of 4.5 beds per 1000 citizens by 1980 and we now have only 2.3 beds per 1000 citizens, hospitals are closing all over the place and there are healthcare worker shortages everywhere, it does seem like it would have been better to fix those very fixable issues than to throw the baby out with the bathwater. But I’m a dreamer! And I digress!
The nice thing about this is that it is simple. It has zero provisions designed to soothe the anxious spirits of those who somehow think that not saddling people with insurmountable debt will discourage them from having jobs or something, which I always appreciate.
It would be marvelous if we could get to a place where the term “medical debt” was relegated to cosmetic procedures and dystopian fiction, but in the meantime, let’s hope to see more of this.
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This really hit home for me this year. I suffered a broken elbow (on Leap Day) which required surgery from which I am still recovering. I didn't seek care for 5 days because A) high pain tolerance, it can't be serious; B) if can avoid doctors, I will. C) I didn't want to miss any work, and I didn't for 3 days.
But it was obvious something was wrong and here we are. I was out of work for 6 weeks and fell into such a depression over it I didn't even remember I had short term disability for about 3 weeks. So, bills piling up and no income for 6 weeks. Thankfully, I have a supportive partner (she works part time, which I am happy about) and funds to tide me over for a while. But it's a 6 week hole that's been dug and when you imagine your account rapidly dwindling with mortgage, car, utility, and other payments it gets scary.
I am grateful for the modern world of medicine and its practitioners. I would think, "What if this happened to me in a remote area and I was self employed or a farmer? What if I was living 100-150 years ago?" Fortunately, unbeknownst to me at the time, the company that employs me paid me anyway because they value me (some vacation & sick time but also extra beyond that). This is the exception and I know how lucky I am. They did not have to do this. I have to pretend to my coworkers that this did not happen.
But it shouldn't be this way in a country where we can fund wars whether US conflicts or not; fund political campaigns that last as long as some wars, it seems; and have people rich enough to buy Kevin McCarthy's used lip balm for $100,000 who work to undermine the health of that nation and its denizens. Don't tell me "we" can't pay for it. We most certainly can.
I have some bitter memories of finding some of my patients on the neuro ward crying secondary to fear of the debt compiling during their hospitalization. Some demanded to be discharged before they were ready to go home simply because they were SO terrified of the tab that was going to come due,
How in the HELL does this provide the sick and injured the calm, comforting, supportive environment required for the acute and critically ill?