Resolving medical debt crisis goes beyond Medicaid expansion, certificate of need reform

A Republican Supermajority in the North Carolina Senate and a Republican Supermajority in the North Carolina House of Representatives in the 2023-24 Congress will depend on whether House Bill 1039 goes to the floor in either House. It may be a factor of something. or deal with at all.

Proponents of Medicaid expansion cite studies that predict between 450,000 and 650,000 North Carolinians will be eligible for Medicaid.

The goal of the Certificate-of-Need (CON) process is to limit unnecessary duplication of services within the community.

Proponents of CON reform say new competition (mainly from independent for-profit providers) will lead the nonprofit health system to lower prices for many procedures.

But state treasurer Dale Folwell said both efforts simply address the symptoms of the overall health care debt problem without offering a potential cure.

Instead, Folwell continues to point to HB1039, entitled “The Medical Debt Disarmament Act,” filed on May 24.

A bipartisan bill, introduced in Folwell’s will, stalled in the House Banking Committee after a single informational hearing.

Folwell said he believes it is “very likely” that HB1039 will be addressed during the 2023 session.

Folwell’s primary interest in HB1039 is oversight of the state health plan, which has more than 727,000 participants, including current and retired state employees, teachers and legislators. He is North Carolina’s largest purchaser of medical and pharmaceutical services.

According to the bill and Folwell’s statement, the bill’s mandate is to “set parameters for the provision of charitable health care, limit the ability of large medical facilities to charge unfair interest, support families and fight poverty.” , creating laws to protect consumers, lowering interest rates and employing unfair tactics in debt collection.”

HB1039 contains language that can provide free medical services and significant financial discounts to certain low-income households.

“We all know something is wrong,” Folwell said.

Growing awareness of the financial burden of medical debt has drawn attention to Folwell’s advocacy at the state and national levels.

For example, he was heavily quoted in a recent NPR national article on the subject.

Health care debt affects not only the uninsured or underinsured, but also those with employer-based or federal health care replacement insurance, says Folwell. It says it faces unrealistic payment expectations.

“Healthcare debt will continue to be an issue regardless of Medicaid expansion,” Folwell said. “Revenue cannot solve the cost problem.

“Some people are afraid to get the medical care they need when they need it because of what might happen to them from a medical billing perspective.

“The complexities of reforming required certificates and expanding Medicaid really have less to do with people’s credit scores and the weaponization associated with medical debt,” said Folwell.

That it has an interesting mix of 39 conservative and progressive co-sponsors, including Reps. Given that the medical debt law could set a precedent.

The House Banking Committee debate on June 7 lasted about 40 minutes and delivered little punch when it came to bad faith accusations by the health care system.

Cumberland Republican Rep. Jon Soca says the weaponization of health care debt includes a hit to consumers’ credit scores if they can’t pay their medical bills in the time the health care system deems timely. He questioned Folwell’s claims.

Subject to the health care system’s debt collection and bad debt policies, patients who are determined to be able to pay their bills should sell their accounts to debt collectors within a few months of the payment request being made. I can.

Rep. Ed Goodwin (R-Chowan) has said that poor people seeking care in hospitals are being shunned from charitable care options and that “medical credit cards” are being used to pay for medical bills. Focused on concern.

Goodwin said he was told some hospitals were touting medical credit cards as an option “to pay for gas, groceries, or whatever you want.”

Goodwin said the option would force hospitals into the debt collection business, eventually hiring third-party debt collectors who receive incentives for a portion of the debt they pay.

Szoka questioned the accuracy of Goodwin’s presentation and said he was unaware that medical credit cards were allowed for non-medical purchases.

Folwell said a lower credit score due to debt could lead to higher interest rates on major purchases.

In most cases, medical debt is not included in determining your credit score if it remains with your healthcare provider, but it is counted if your account is turned over to a debt collector.

HB1039 sets a collection standard for healthcare systems, Goodwin said.

“This bill will ensure that they (poor patients) are treated with more respect than they are now,” Goodwin said.

Since the only committee hearing, Folwell has continued to speak out about his medical debt concerns, including at a Sept. 7 presentation in Asheville and an Oct. 17 presentation in Elizabeth City. He has plans for additional events.

Folwell said despite lack of progress in Congress, the initiative has gained support from grassroots and advocacy groups.

“We are grateful that these organizations are finally paying attention to reports that have been coming out of accounting firms for almost a year,” says Folwell.

Folwell called on health system executives who were unwilling to attend public forums to discuss health care debt and philanthropic health care policy.

“Anyone trying to politicize this by talking about Democrats or Republicans clearly doesn’t know they’re on the wrong side of history.

Mitch Kokai, a senior policy analyst at the John Locke Foundation, a conservative think tank, said that HB1039 has such a bipartisan sponsor and Folwell’s endorsement is a big deal for North Carolina overall. would keep it on the fringes of the health care reform debate.

Kokai said HB1039 “is not directly related to discussions about expanding Medicaid and reforming required certifications, but policymakers are likely to link major health legislation going forward.”

“If nothing else, concerns about the questionable use of health care debt could serve as a bargaining chip in ongoing negotiations on other proposed reforms.”

The NC Healthcare Association reiterated that it has not taken a position on HB1039.

“Federal law already addresses some of the bill’s requirements, and the NC General Assembly passed legislation in 2013 that addresses many of the state-specific issues related to fair billing and collection practices. , is the first high-level view.”

The NCHA says the hospital’s philanthropic care spending and investment activities for the benefit of the community are “transparent and accountable.”

“North Carolina nonprofit hospitals submit annual audits to state and federal tax authorities, who determine that the hospitals are meeting their tax obligations.

“Failure to comply could lead to the revocation of the hospital’s tax exempt status, which never happened in North Carolina.”

In a comment provided to NC Policy Watch, the NCHA said it had “serious concerns that this bill would cause hospitals to absorb millions of additional dollars in uncompensated care.” .

“It can result in increased costs of care for others.”

In a separate statement sent to the press, the NCHA said:

“They actively work with patients to help them understand their medical insurance coverage and financial obligations. do my best.”

Regarding unpaid bills, the NCHA said, “The Federal Internal Revenue Service has established an extensive set of procedures and waiting times that hospitals must follow before taking last resort collection actions.

“To suggest that hospitals ‘weaponize’ their medical debt is nothing less than a political showoff. “

Rep. Donnie Lambeth, R-Forsyth, and a leading health care expert on the House of Representatives said it was “too early to tell what legislation will or will not be introduced.”

Lambeth said he has mixed feelings about the medical debt issue.

“Medical debt is a serious problem not just in North Carolina, but nationally,” Lambeth said.

“But when you buy a product or service, you have an obligation to pay for that service, and medical services are no exception.

“Systems typically work with individuals or families to help manage the medical expenses used,” Lambeth says. “

Lambeth, the former CEO of North Carolina Baptist Hospital, was a major supporter of Medicaid expansion in the House, including introducing legislation in the recent Congress.

“The expansion will certainly help a lot because it adds coverage to many people who have no coverage,” Lambeth said.

“The expansion will go a long way in helping health care providers recoup the costs of treating those in need.”

Joyce Krawick, Republican Sen. Forsyth and a leading proponent of required-certificate reform in the Senate, said, “Citizens are responsible for all the debt they owe, including health care. ‘ said.

“But there are a lot of people who simply can’t meet that obligation. There are a lot of people who can’t afford insurance right now but who can qualify for Medicaid under the expansion.”

Krawiec says her main concern is “there are a lot of errors in the medical bills that we have to deal with. We are aware that there are credit issues due to medical billing errors.”

“We must continue to find ways to reduce healthcare costs and improve access. Reform of required certifications is one way to support this process.”