Guest Commentary: Patients not consumers — My family’s medical debt story

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In summer 2006, my husband Chris sought emergency medical treatment at Peninsula Regional Medical Center in Salisbury for severe chest pain. While he was on the operating table for a routine cardiac catheterization, Chris had a stroke. He was one week shy of his 32nd birthday. The difficult months that followed were made worse by the hospital’s aggressive debt collection practices. Our family’s experience has led me to support the Medical Debt Protection Act, currently making its way through the Maryland General Assembly as HB565/SB514.

As introduced by Del. Lorig Charkoudian (D-Montgomery) and Sen. Brian Feldman (D-Montgomery), this legislation would restrict some of the most harmful medical debt collection practices by Maryland hospitals. It would have protected my family from intense financial and emotional stress during one of the most difficult times in our lives.

The stroke ravaged four areas in the speech center of Chris’ brain, leaving him unable to speak, read or write in its aftermath. He spent nearly a month in the hospital before he was released to continue the slow and intensive recovery at home. We struggled to adjust to our new circumstances. Chris had been the sole source of income for our family while I devoted my time to caring for our three children under the age of 12, the oldest of whom is severely disabled.

Bills began arriving While Chris worked with physical therapists to regain the essential functions the stroke destroyed, bills from his hospitalization began to arrive. Despite a robust health insurance plan through my husband’s employer, we incurred thousands of dollars in debt over the course of his lengthy hospital stay. With Chris unable to return to work during his recovery and the short-term disability benefits quickly running out, I had trouble pulling together the funds needed to afford basic living expenses. The bill notices quickly became more aggressive. Soon, a knock on the door yielded an ultimatum: pay your debt in full or we will take you to court. The hospital offered no option for a repayment plan, only a firm demand that we were unable to meet. PRMC filed a lawsuit against Chris while he was still in recovery, and immediately after he returned to work, the hospital began to garnish his wages. Enormous portions of our sole income were seized by the hospital with each new paycheck. It seemed impossible to catch up.

Not unusual struggles My family’s story is not unique. From 2009-2018, Maryland’s nonprofit hospitals, whose stated missions are to serve and care, filed 145,746 lawsuits against their own patients. These lawsuits were overwhelmingly over low-sum medical debts, the median sum sought just $944. This amount is negligible for a well-funded hospital that receives millions of dollars in tax breaks and subsidies annually to offset the cost of providing charity care (with many millions left unspent each year). But for families like mine, it can be the difference between making rent and facing eviction.

It was a shock to face a lawsuit from the same hospital whose medical staff had been so wonderful to us.

The doctors at PRMC saved my husband’s life, and the therapists gave him his life back. But the hospital administration treats its patients as sources of profit, with callous indifference to their circumstances. In an area like the Eastern Shore where health care access is limited, PRMC (now TidalHealth) is one of few options. How can we be consumers when we have no choice? If the Medical Debt Protection Act becomes law this year with its key provisions intact, it would establish critical protections for families like mine struggling against the most punitive aspects of hospital lawsuits. If passed without weakening amendments, this legislation would require hospitals to work with patients to develop income-based repayment plans that do not exceed 5% of the patient’s monthly income. Had my family been given the option to repay our debt in such reasonable installments, we never would have been sued, and having a better handle on the payment process would have spared us a lot of stress.

Do no harm The legislation also seeks to prohibit wage garnishment of patients who qualify for free or reduced-cost care, liens on primary homes, and lawsuits over small-sum debts of $1,000 or less. While the Medical Debt Protection Act does not forgive medical debts — hospitals can still pursue collections on debts of any size — it is a first step in ensuring urgent protections for Maryland families. I’ve heard that legislators want to scale back these protections to appease the Maryland Hospital Association. We can’t let them do this. The crisis of the current moment is too great: during a global pandemic, patients should feel freedom to pursue care rather than fear the costs. Over 16% of Marylanders have medical debt in collections today (that number increases to 20% in communities of color). What happens when they cannot pay?

Marylanders are counting on our representatives in the General Assembly to lead in passing the Medical Debt Protection Act this session with all of its key provisions intact. Maryland families deserve a hospital system that treats them with dignity and care. After all, our health care providers, whether individuals or hospital systems, must first do no harm.

The writer represents District 4 on the Salisbury City Council. She is a member of End Medical Debt Maryland, a statewide coalition of 57 labor, faith, community and disability rights organizations and many volunteers who believe the health care system plunges too many families into cycles of debt. This content was republished with permission from Maryland Matters. Sign up for Maryland Matters’ free email subscription at marylandmatters.org.