Health Law (HL)

Having private or public health insurance does not eliminate consumer medical debt because plan design, provider price variation, and patients who experience transitions in coverage, for example, also impinge on an individual’s ability to timely pay for medical care. In Massachusetts, the Special Commission on Provider Price Variation suggests that residents of the Commonwealth would benefit from improved strategic plans to combat unsustainable healthcare costs, to address price variation among providers, and to resolve existing market dynamics. See The Special Commission on Provider Price Variation, Price Variation Report (March 15, 2017). Available at: http://www.mass.gov/anf/budget-taxes-and-procurement/oversight-agencies/health-policy-commission/ppv-report-final.pdf. “Market-driven solutions have limited ability to address prices, price variation and the volume shift to higher priced providers.” Id. at 327. Regulatory actions could limit healthcare costs and spending, which are otherwise not effectively controlled by market-based solutions alone. Id. at 327.

Consumers are also partly to blame, gravitating unnecessarily to teaching hospitals or other high-priced providers rather than relying on the quality of care found at local or rural facilities that may be medically appropriate. In addition, insurance carriers meet the demands of providers with greater bargaining power by offering elevated reimbursement rates and directing insureds to these in-network providers, thereby reinforcing the market clout of certain medical conglomerates.

The “burden of health care spending can have particularly serious consequences for low and middle income residents, leaving little room for other necessities and increasing financial pressure to make ends meet. Among [Massachusetts] residents between 138 and 300 percent of the federal poverty level in 2015, (between roughly $28,000 and $60,000 for a family of three), 15 percent reported that out-of-pocket health care spending was more than 5 percent of their income, 24 percent reported having difficulty paying medical bills, and 21 percent said someone in their family went without needed medical care due to cost in the past 12 months.” The Massachusetts Health Policy Commission, 2016 Annual Health Care Cost Trends Report (February 2017) at p. 20. Available at:   http://www.mass.gov/anf/budget-taxes-and-procurement/oversight-agencies/health-policy-commission/publications/2016-cost-trends-report.pdf.  

Systemic procedures to reduce the burden of medical debt must invoke multi-stakeholder interests and cooperation from the public and private sectors, including medical providers, health plans, employers, and consumers. A reasonable common ground for redressing these fundamental challenges must include diverse stakeholders – federal and state governments, the market sector, nonprofit hospitals and other medical providers, and public, private, and individual payors.

Consumer Reports recently examined the relationship between publicly-supported healthcare programs under the Affordable Care Act (ACA) and personal bankruptcy filings on a national level. The article documents a fifty percent (50%) decline in debtor cases filed voluntarily under the U.S. Bankruptcy Code from 2010 through 2016, which coincides with ACA enactment and implementation. See Consumer Reports, How the Affordable Care Act Drove Down Personal Bankruptcy, (May 2, 2017). Available at: http://www.consumerreports.org/personal-bankruptcy/how-the-aca-drove-down-personal-bankruptcy/. Now as Senate GOP members continue redrafting the American Health Care Act (AHCA) -- or a revised legislative version – it is essential once again to consider access to healthcare coverage and medical debt. 

Lorianne M. Sainsbury-Wong | MBA Civil Litigation Council Member | MBA Health Law Section Council, Past Chairperson 
Health Law Advocates (HLA), One Federal Street, Boston, MA 02110 | 617-338-5241 | sainsbury_wong@hla-inc.org.

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Note: This article was prepared in my personal capacity. Any opinions expressed here are my own and do not necessarily reflect the views of the Massachusetts Bar Association (MBA) or of my employer, Health Law Advocates (HLA), One Federal Street, Boston, MA 02110 | 617-338-5241 | sainsbury_wong@hla-inc.org.

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