Published by the Students of Johns Hopkins since 1896
May 6, 2021

Protesters advocate for legislation to alleviate burden of medical debt lawsuits

By MICHELLE LIMPE | April 10, 2021

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COURTESY OF END MEDICAL DEBT MARYLAND

The Medical Debt Protection Act of 2021 has passed both chambers and was sent to the governor.

End Medical Debt Maryland held a rally at the Hopkins Hospital Billings building on April 3 to protest against the practice of suing patients over medical debt. End Medical Debt Maryland is a coalition of 58 organizations that are advocating for the Medical Debt Protection Act to be passed at the Maryland General Assembly this spring. 

Numerous Baltimore residents shared their stories of financial and emotional distress incurred from the hardships of medical debt. The protesters also distributed “Know Your Rights” flyers around the neighborhood.

Brig Dumais, coalition chair of End Medical Debt Maryland, emphasized that residents of East Baltimore are most likely to be sued for medical debt, notably Black people, single mothers and low-income essential workers.

According to Dumais, at least 17% of Marylanders currently have medical debt in collections, with the median debt totaled around $944.

“Ending medical debt is not only a patients’ rights issue. It’s a worker’s rights issue. It’s a social justice issue and a gender justice issue,” they said. “We all know that for wealthy institutions, $944 is just a drop in the bucket. For a working family, $944 makes a difference between making rent or having food on the table or not.”

Dumais also highlighted that Hopkins was the top university known for suing and garnishing its own workers’ wages before it stopped authorizing legal action for patients unable to pay debt in April 2020.

“And to make it worse, hospital executives have the audacity to give themselves raises while they’re preying on their patients,” they said.

Baltimore resident Ashley Esposito shared her story during the protest. After struggling to conceive a child, she and her husband had a son after using in vitro fertilization at the Hopkins Hospital. 

She praised the hospital workers for treating her family well but then explained that her joy was short-lived after a hospital billing error resulted in medical debt of over $2,000. 

“I was a new mom at home, resting, trying to bond with my baby and having to deal with debt collectors,” she said. “Patients go to hospitals because they’re broken, and doctors get into medical practice because they want to help broken people. But if the patients are treated properly and doctors’ hands are tied by the finance department, the process is broken.”

Additionally, Esposito stated that she and her family were blindsided by the billing error because they were only informed of the error over a year after the procedure.

Amy Hennen, a lawyer with Maryland Volunteer Lawyers Service, explained some of the information printed on the “Know Your Rights” flyers to the audience. She stressed never to pay for a medical bill immediately because patients will no longer be able to negotiate with the hospital. She also stated that those in debt can apply for Medicaid or appeal for financial assistance from the hospital.

“An emergency room also cannot deny you service for an outstanding bill,” she said. “It’s critical that you know your rights because if you pay the bill, you won’t be getting your money back.”

Salisbury City Councilor Michele Gregory also shared her story at the rally. Though she was not physically present at the event, a representative from her office narrated Gregory’s family struggles with debt and played a recording for the audience.

“We have to keep pushing and fighting for equity in a system that leaves too many behind. Our friends and family are at risk as long as the system we have in place remains,” she said. “When we win this fight, we’ll know that we have the power to move the scales of justice back into power because money doesn’t equal power. People do.”

Kim Hoppe, vice president of communications for Hopkins Medicine, expressed the hospital’s support for the Medical Debt Protection Act in an email to The News-Letter. She affirmed the Hopkins Hospital’s commitment to providing affordable care to all patients, stating that the hospital and Bayview Medical Center have provided $1.4 billion in benefits for those in need. 

“Hopkins has dedicated and compassionate staff members who work with patients of low income to find resources to help pay for care,” she wrote. “We continue to provide the safest, highest quality of care possible for our communities while ensuring that our patients are free from medical debt.”

Additionally, she highlighted that the staff sends resources to patients who need assistance in accessing their private health insurance and applying for financial aid.

Donald Gresham attended the rally on behalf of the Coalition Against Policing by Hopkins (CAPH). He explained that CAPH joined the coalition six months ago and has since collaborated with them on events in response to injustices against people of color. 

He emphasized the importance of these rallies to allow voices of the powerless to be heard. 

“A rally of this nature needs to be done so that folks can hear what other folks are doing,” he said. “I believe that it is going to take time, but we shouldn’t ever give up. Making sure that people know that we are displeased by the unfairness and injustices is important.”

The Medical Debt Protection Act

At the rally, Dumais gave the audience an update on the progress of the Medical Debt Protection Act. Currently, the bill will ban wage garnishments for patients who have free and reduced-cost care. However, amendments made to the bill removed the mandate on hospitals to develop income-based payment plans that do not exceed 5% of a patient’s monthly income

Hospitals will also still be able to sue their patients regardless of the amount since the cap on lawsuits was removed from the bill.

“National Nurses United (NNU) and the [American Federation of Labor and Congress of Industrial Organizations] did a joint study on this and found a patient who was sued for $68,” Dumais said. “You’re really going to tell me that these institutions are going to ruin someone’s home life over $68? I’m disappointed in our legislators who let that happen.”

Valerie Hsu and Lindsey Muniak, communication leads of End Maryland Debt Maryland, spoke to The News-Letter to further explain the coalition’s mission and ongoing work regarding the legislation.

Hsu highlighted that the coalition’s overarching goal is to fight for Americans’ rights to universal health care, but it is now focusing on helping Marylanders first. The organization’s next step is to pass the $1,000 lawsuit threshold that was amended out of the bill.

“It's not the entirety of our vision, but it would really help so many Maryland families who are suffering,” she said. “This legislation exists in tandem with so many other really important campaigns. We are fighting for these crucial pieces to relieve the burdens on Marylanders today.”

Muniak emphasized that the legislation has never prevented hospitals from collecting medical debt, which is a fact that she says has been misrepresented by legislators. Furthermore, she explained that hospitals do not recuperate the entire sum of the debt because they have to pay court fees and other expenses in the process.

“Our coalition was confused by the hospitals’ resistance to instituting this lawsuit threshold and shifting its collection practices to be more patient-focused, which in the long run would also be better for the hospitals,” she said.

According to a study conducted by a health economist at Boston University, the $1,000 threshold on lawsuits would cost each Maryland hospital $7,046 annually. Hsu stressed that these numbers are negligible for hospitals but make a difference for families.

Initially, the legislation also mandated hospitals to record that they have provided patients with oral notice of financial assistance options. However, Muniak reported that this has been amended out, which puts the onus back on the patients to seek out these resources.

Maryland hospitals are considered not-for-profit and are required by law to provide community benefits. These hospitals are given large sums of money purposed for charity care. However, Hsu cited a study conducted by NNU that found that Maryland hospitals had a remaining balance of $120 million in charity funds from 2014 to 2018. 

“And that's about the same amount that we saw in lawsuits during the same period of time,” she said. “So they profited from being required by law to provide charity care, did not provide that amount of charity care and instead sought that same amount through lawsuits.”

With regards to the Hopkins Hospital’s stance, Hsu stated that the suspension on lawsuits is temporary and will only remain in effect for as long as the state of emergency lasts.

“We've been told that they have an informal policy by which they no longer sue patients for debts under $300, but that's not on the books. That's just something that has been indicated to us,” she said. “Everything indicates that Johns Hopkins hospitals will resume filing lawsuits as the state of emergency ends. We really do want to continue keeping up the pressure on the entire Hopkins Hospital system.”

Muniak asserted that it is important for Marylanders to know that their struggles with medical debt are not a sign of personal failure but rather are a result of the systems in place since lawsuit rates have been high among hospitals in the last decade.

House Bill 565 and Senate Bill 514, both of which pertain to the Medical Debt Protection Act, have both been unanimously passed by both chambers and will be sent to the governor.

Muniak expressed her optimism for these amendments and future legislation in support of Medicare for All to be passed. 

“The fact that this bill did have bipartisan support in the way it did, which is extremely rare for legislation at the state level, speaks to something shifting in public thinking about how patients should be protected from predatory practices like these,” she said. 

Corrections: The original article incorrectly stated that all speakers at the rally were from East Baltimore. Two amendments made to the Medical Protection Protection Act were also inaccurately explained. 

The News-Letter regrets these errors.

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