An estimated 41% of U.S. adults, or over 100 million people, are grappling with medical debt, a burden that stems from various interactions within the American healthcare system. Despite more than 90% of Americans carrying some form of health insurance, medical debt remains a significant issue. The advocacy group Undue Medical Debt has taken steps to alleviate this burden by purchasing and forgiving $10 billion in medical debt since 2014. However, proposed changes by the Trump administration to reduce health insurance coverage by shrinking government programs could potentially exacerbate the issue.
Doctors find themselves increasingly concerned about the impact of medical debt on their patients. Many patients hesitate to visit emergency rooms due to fears of accumulating debt and enduring long wait times. Dr. Karen Kinsell, a primary care doctor in rural Georgia, witnesses firsthand the financial strain on her patients, including a widower who incurred significant debt following his wife's prolonged hospital stay. Dr. Kinsell notes that pharmaceuticals are not a debt situation; instead, patients simply do not receive the medications they need because pharmacies no longer extend credit.
"Pharmaceuticals are not a debt situation – they just don’t get it," – Kinsell
"The days of [pharmacies] extending credit are way gone." – Kinsell
Medical debt can take many forms, including credit card charges, incremental payments to providers, loans from family members, or transfers to collections agencies. The Biden administration has attempted to mitigate these challenges by finalizing a rule that bans credit agencies from including medical debt in reports. Despite these efforts, doctors like Dr. Anand Habib continue to advocate for better education among physicians regarding medical debt and its implications.
"When you start asking individuals as patients and their families about the ways in which healthcare does not meet their needs – not only medical but financial – if you seek you will find." – Dr. Anand Habib
The current healthcare financing system is seen as undermining the trust between patients and physicians. Eva Stahl remarks on how the business aspects of medicine overshadow doctors' primary responsibilities, leaving patients confused about their insurance and fearful of accruing debt.
"The healthcare financing system is undermining that trust, and it’s something physicians have a big stake in," – Eva Stahl
"The top line is that the business of medicine is overshadowing what they were trained to do, and that really means people are showing up not fully understanding their insurance or very fearful of accruing medical debt," – Eva Stahl
In addition to systemic issues, doctors deal with daily frustrations such as negotiating with insurance companies' utilization review doctors over claim denials. Dr. Habib highlights how these individuals have the power to expose patients to financial hardship and potential poverty due to medical debt.
"That person has the power to determine whether my patients are exposed to financial pecuniary and potentially poverty and medical debt," – Dr. Anand Habib
Despite these challenges, many doctors see an opportunity to advocate for change. They feel compelled to address patients' financial needs, even though they were not trained for such responsibilities.
"Time and again, you see these issues and you realize, ‘I can either be a bystander or I can attempt to advocate’ – even if the political winds are against us’" – Dr. Anand Habib
The Trump administration's anticipated cuts to health insurance programs could further complicate matters. A cabinet-level nominee has expressed support for adding work requirements to Medicaid, potentially forcing people off the program without significantly increasing employment rates.
Meanwhile, doctors like Dr. Kinsell continue to encounter patients who refuse necessary care due to fears associated with accumulating debt.
"not infrequently, refuse to go to the ER" – Dr. Karen Kinsell
"There is this uptick in intensity that is really front and center right now," – Eva Stahl