Through an interpreter, Francis Flores described how she has brought 68-year-old father to the emergency room multiple times for a deep pain in his ear because she doesn’t have insurance coverage for doctor visits and, in doing so, has racked up more than $4,000 in medical debt she can’t afford.
Flores was joined by the nonprofit group Health Equity Solutions, Connecticut Comptroller Sean Scanlon, and senators Matthew Lesser, D-Middletown, and Saud Anwar, D-Windsor, and Representatives. Josh Elliott, D-Hamden, and Keith Denning, D-Wilton, calling for more transparency and reporting by Connecticut’s nonprofit hospitals when it comes to financial assistance for those who may not be able to afford their medical bills.
They are advocating for legislation that would “improve access to hospital financial assistance and stop unnecessary medical debt from happening,” regardless of the patient’s immigration status.
According to proponents, federal law requires that nonprofit hospitals provide financial assistance for those who can’t afford medical treatment, commonly called “charity care,” but the application for assistance is often confusing, varies from hospital to hospital, and patients are not informed of this option at the outset of treatment.
House Bill 5320 would change that by requiring hospitals to offer easy-to-understand financial assistance language at the beginning of treatment, and uniform applications for assistance for patients enrolled in the Supplemental Nutrition and Benefits (SNAP) program or the Women, Infants, and Children (WIC) program, or whose income is below 250 percent of the Federal Poverty Level. It also prohibits hospitals from directing patients to Medicaid or Connecticut’s health exchange before offering financial assistance, unless the hospital believes the patient would qualify for those programs.
Although the original bill empowered the Attorney General to monitor and enforce the provision to prevent “inappropriate billing and collection activities,” that language was removed through the committee process.
“Medical debt is escalating, and it is a concern for many Connecticut residents and nationwide,” Ayesha Clark, executive director of Health Equity Solutions, said at a press conference. “It disproportionately effects Black and Latino individuals at rates exceeding the population average. Medical debt not only perpetrates economic disparity, but it also exacerbates a cycle of health inequity, entangling individuals in a web of financial debt and health related challenges.”
Rep. Elliott said people with medical debt will often put off going to the doctor or hospital until their condition becomes so severe that it incurs greater costs, and that the legislation will merely standardize access to financial assistance across the state.
“What HB 5320 does is it ensures that there is documentation across the board, universal, with all of the different hospitals to ensure that people who have access to this care and this help can actually get it,” Elliott said. “Then there is a reporting requirement ensuring the state is aware of how much aid is out there and how much is given.”
The hospitals, on the other hand, are universally opposed to the measure, according to public hearing testimony, claiming they are already offering financial assistance and the reporting requirement will increase their administrative burden and increase their costs under threat of action from the Attorney General’s office, which has since been removed.
The Connecticut Hospital Association (CHA) said that financial assistance programs offered to patients differ across hospitals, so making a universal application would be difficult, and that they already report charity care information to the Office of Health Policy – points that were all repeated, nearly verbatim, by hospitals that submitted testimony, including Hartford Healthcare, Yale New Haven Hospital and Middlesex Health, among others, who also indicated the bill would impose “unnecessary and burdensome reporting requirements that add to hospitals’ administrative expenses and, ultimately, the cost of care.”
In a response to the press conference, the CHA indicated Connecticut hospitals provided “over $130 million in charity care” in 2022, and they “strive to offer clear and meaningful pricing information, patient resources to assist in the bill payment process, and free and discounted care for uninsured individuals.”
“Connecticut leads the nation in financial assistance programs and protections against medical debt. Local hospitals work hard to make sure patients know about their financial assistance policies, connect uninsured patients to coverage, and advocate for policies to prevent medical debt in the first place,” the CHA wrote. “Connecticut also has some of the strongest patient protections in the nation when it comes to surprise billing and banning practices such as medical liens on property.”
The proposed legislation does come at a cost. According to the fiscal note attached to the bill, UConn Health would incur $1.47 million in lost clinical revenue over two years, estimating that 22 percent of UConn Health patients would qualify for financial assistance for out-of-pocket costs. The financial note only applies to state agencies, so there is no estimated cost impact listed for hospitals.
According to Ichchha Pradhan, policy and advocacy specialist for HES, roughly 280,000 people in Connecticut have medical debt and nonprofit hospitals are “not providing care compared to the tax breaks they receive, so there’s a $339 million deficit in 2020 alone.”
“That is a surplus they are receiving in tax breaks compared to the money they spend on community investments, which includes financial assistance,” Pradhan said.
Sen. Anwar said that some people fall through the cracks, reaching a “cliff” because they earn too much to qualify for Medicaid, but can’t afford plans under Connecticut’s health insurance exchange, or they are under-insured.
Anwar, as chair of the General Assembly’s Public Health Committee, said he is working with Connecticut’s hospitals to address some of their concerns with the legislation, including using technology to make the system more efficient.
“We are in conversations with them,” Anwar said. “They are in agreement in principle, and they feel they’re already doing it, but we’re not seeing the results we want to and that is part of the conversation in the process. There are parts of the bill they have significant concerns about. We are willing to look at this in more depth with them.”
“The hospitals have the capacity to be able to address that because that is the investment they are supposed to make in any case,” Anwar said. “They are making them in various other ways, we feel this is a better way to serve the community they represent.”
The CHA has voiced support for Senate Bill 395 which would prevent the reporting of medical debt to credit rating agencies. Currently, hospitals can report that debt after one year. CHA indicated the change was “reasonable” and in line with practice at many Connecticut hospitals already. In 2023, Gov. Ned Lamont reached an agreement with lawmakers to pay $6.5 million in ARPA funds to wipe out “hundreds of millions,” in medical debt.
“A comprehensive approach to protecting patients from medical debt would go beyond what is currently being debated to address high-deductible health plans that shift cost from health insurance companies to patients and the ever-increasing cost of prescription drugs,” the CHA wrote in their statement. “Connecticut hospitals remain committed to supporting solutions to reducing medical debt and its associated burdens.”
HB 5320 passed out of the Public Health Committee with a 24-13 vote. During the committee meeting, co-chair Rep. Cristin McCarthy-Vahey, D-Fairfield, confirmed there is no enforcement mechanism to the bill since the removal of the Attorney General’s power to investigate.
“They’re actually required to provide some form assistance,” HES Senior Manager of Policy Kally Moquete said. “Many of the hospitals are providing financial assistance, what we’re asking for is a universal application.”
**This article was updated with statements from the Connecticut Hospital Association**
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