As healthcare costs weigh on patients, states could play a bigger role, report finds
Recent Commonwealth Fund reports outline the nation's grievances with rising healthcare costs and the greater role states could take in protecting those most at risk.
The healthcare industry continues to be a major source of criticism for Americans, with state-level requirements for financial assistance and protections against medical debt leaving many patients at risk of significant financial burdens, according to recent reports from The Commonwealth Fund. A national survey of nearly 26,000 adult respondents revealed that the cost of health insurance premiums, cited by 42% of respondents, and high out-of-pocket costs, mentioned by 36%, were the top concerns. These grievances were shared across political affiliations and types of insurance coverage.
While respondents believed the federal government was best positioned to address these issues (51% for premiums, 41% for out-of-pocket), insurance companies came in third (28%, 36%). State governments ranked last in respondents' choice, with only 9% for premiums and 11% for out-of-pocket.
Recent reports highlight that despite state laws' intent to protect patients and providers, gaps remain—leaving patients unprotected and providers unaccountable. For example, among the 21 states that require hospital financial assistance, five limit this support to the uninsured, leaving underinsured patients unprotected. Immigration is another concern, with only five states explicitly prohibiting discrimination against immigrants in determining assistance and three excluding undocumented immigrants entirely.
States' protections often do not extend to medical debt that converts into general consumer debt or to settings and services delivered outside hospitals. Procedural and administrative challenges also hinder patients' ability to access state-directed protections.
Although nine of the 21 states requiring hospital financial assistance also have appeal pathways for denied assistance, patients are at a disadvantage in legal disputes with providers or collections agencies due to organizations' easier access to legal resources. Many patients are unaware of their rights or unable to take action due to default judgments. States could require creditors to prove that patients are ineligible for protections instead.
However, the current status quo for state enforcement and oversight is underdeveloped, and many states collect little to no information on hospital compliance. Few penalties strike the right balance, either being too small to affect behavior or too substantial, such as licensure revocation, to warrant regulation. Researchers recommend a private right of action—allowing patients to directly sue violating hospitals or debt collectors—to enhance compliance despite limited public enforcement resources.
Well-designed medical debt laws can help patients navigate coverage gaps and avoid financial consequences, and states can strengthen these protections by broadening eligibility for financial assistance and extending medical debt protections to more categories of medical debt.
Written by urgent.news from Fierce Healthcare's reporting — not their text. Machine-written — may contain errors; check the original before relying on it.
