As an international student, there was an unspoken pact between us, if you ever find yourself in need of medical help, don’t Uber an ambulance. The reason? The fear of receiving a medical bill you couldn’t pay, even with student health insurance.
This apprehension stemmed from the unpredictability of hospital costs and how patients often face unexpected out-of-pocket expenses. Many of us found ourselves hesitant to seek medical attention, choosing to delay or skip it altogether. Our reluctance was further fueled by confusion surrounding hospital financial assistance or charity care (free or discounted care) and ignorance of the support that might have been available to ease the financial burden.
The fear is not unique to international students; it’s a widespread issue that affects communities across the state, especially people of color and those with lower incomes. Black, Native American, Latino, and immigrant populations are disproportionately affected by medical debt due to discrimination in employment and education that affects access to health insurance and/or other protections against medical debt . All this exacerbates existing economic and health inequalities.
In Connecticut alone, nearly 280,000 people unable to pay high medical bills face financial ruin within a system that prioritizes profit margins over basic well-being. Medical debt is not just a financial inconvenience, but a systemic problem rooted in disparities in income, wealth, and access to health care. Unlike planned debt such as mortgages, medical debt often arises unexpectedly from a one-time medical expense such as an accident or other medical emergency. People burdened with medical debt face less access to credit, a greater likelihood of bankruptcy, and the inability to meet basic needs such as food or rent. In addition, they feel compelled to skip necessary medical care to avoid incurring additional bills they cannot pay.
What’s more troubling is that while the IRS requires not-for-profit hospitals to offer hospital financial assistance, many eligible patients are unaware of these programs. In turn, they face lawsuits or collection agency harassment over bills that hospital financial assistance should have covered. In 2020, Connecticut hospitals spent $339 million less on financial assistance and community investments compared to the tax breaks they get as nonprofit hospitals. If that money had been spent on financial aid, it could have offset the medical debt of 240,612 residents.
The lack of accountability in the application of financial assistance policies complicates the problem. In the past decade, the IRS has not revoked the nonprofit status of any hospitals for noncompliance, leaving a regulatory gap that states must fill to protect residents from unnecessary medical debt.
Addressing medical debt requires comprehensive solutions aimed at breaking the cycle that perpetuates it. Connecticut lawmakers need to take action.
We urge the state and hospitals to work together to ensure that some of the most difficult times in our lives do not also leave us in dire financial straits. How? 1) Simplify the process for patients to learn about and access hospital financial assistance through streamlined applications and robust notification systems. 2) Prevent patients from being sent to collections before they are reviewed for financial aid and, if they do not qualify, offer a reasonable payment plan. 3) Accept alternative documents for patients to verify their income to determine eligibility. 4) Hold hospitals accountable for ensuring fair screening processes and cease aggressive billing practices.
The first week of April, recognized by statute as Health Equity Week, is Connecticut’s annual commitment to eliminating health disparities and creating opportunities for every resident to thrive in good health. This year’s theme “Delivering Equity” aims to dismantle the financial barriers that hinder equitable health outcomes for all residents.
As a community, we must address the systemic injustices that perpetuate medical debt and hinder access to health care. The implementation of HB 5320 would bring us closer to this goal. Looking back on my time as an international student, I would not have had to compromise my health for financial stability if these support systems had been in place.
By rallying behind HB 5320, we can pave the way to a health care system where every individual can seek medical care without fear of financial devastation.
Ichchha Pradhan is the policy and advocacy specialist at Health Equity Solutions.
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