Trump administration should continue momentum on tackling the medical debt crisis

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No one, regardless of where they live or how much money they have, should be forced to make the impossible choice between getting essential care and going into debt. But for too many people in this country, this is the reality they face every day.

The reality that we must confront is that America is facing a medical debt crisis, one that impacts more than 100 million people — that’s four in 10 adults and their families. And ethnic minorities, particularly those from lower-income backgrounds, often have higher rates of underinsurance and uninsurance, making them more vulnerable to higher medical costs, resulting in more medical debt.

Brandon G. Wilson, DrPH, MHA
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It impacts people like Misty from Grand Junction, Colorado.At age 23, Misty underwent lifesaving heart surgery, leaving her with $200,000 in medical bills and unable to divorce her abusive partner. Because medical debt had destroyed her credit score, Misty could not get housing, a car or a credit card on her own, forcing her to stay in an abusive relationship for 20 years. Misty studied and got her license to be an insurance provider, but she could not get a job, because prospective employers checked her credit as part of the hiring process.

And Misty is not alone. She is one of millions who have similar stories. A 2020 report by the Commonwealth Fund offers a few alarming facts about medical debt: 48% of people with medical debt depleted their savings to cover medical bills; 40% saw their credit ratings decline due to this debt; and 25% were forced to forgo basic necessities like food, heat or rent. Misty’s story and these findings highlight the real struggles faced by people and their families, as well as the urgent need for actions that can alleviate the burden of medical debt and ensure that basic needs are met and protected.

The administration of President Joe Biden took important steps to begin to address this crisis — most importantly, the Consumer Financial Protection Bureau (CFPB) recently announced that it had finalized a rule to prevent medical debt from impacting credit scores. This was a vitally important step and one Community Catalyst and our partners have long called for. But it should be the beginning of the story, not the end.

As a new administration prepares to take office, we need to ensure we move forward, not backward, and build on the CFPB rule. Policy makers in Washington can and should take decisive action to address this crisis, including banning predatory, deferred-interest credit cards and implementing stronger protections against unfair billing practices at nonprofit hospitals.

Despite Donald Trump’s running for office on a platform aimed at delivering economic relief for those in desperate need, addressing the medical debt crisis does not appear to be a priority for the incoming administration. This is particularly concerning given the long-standing positions of individuals nominated for key positions within the incoming administration that could exacerbate the crisis. And the early warning signals are coming from the key public health appointments made by President-elect Trump, which further underscore this troubling trend.

Take, for example, the recent nomination of Dr. Mehmet Oz to lead the U.S. Centers for Medicare & Medicaid Services (CMS). Oz’s record of promoting questionable medical practices over evidence-based care should raise alarms for the millions of people who rely on Medicaid and Medicare — programs that provide vital health and economic stability for older adults, people with disabilities and families with low incomes — and it undermines the principles of health equity and justice. Promoting such practices can lead to patients spending money on ineffective or unnecessary treatments, contributing to medical debt.

Oz’s support for market-based health care solutions raises significant concerns about the impact on individuals’ fundamental rights to health care. While market-driven approaches can encourage innovation, they often pose threats to crucial safety net programs and the rights guaranteed to patients. By prioritizing profit over patient care, a market-driven system tends to favor those who can afford services, effectively sidelining those who rely on accessible and affordable health care. This increased shift toward a profit-oriented model can lead to increased medical debt for many individuals, as it allows for the prioritization of profitability over equitable health care access.

Under Oz’s leadership, we are concerned that predatory practices driving the medical debt crisis will worsen, pushing even more families into cycles of debt and hardship. Harmful and burdensome reporting requirements for Medicaid, long proven ineffective, would further exacerbate these issues by creating unnecessary barriers to care. These requirements not only lead to poorer health outcomes but also increase medical debt, forcing families to make impossible choices between getting care and going into debt.

And for communities already harmed by racism, classism, ableism and other forms of oppression, Oz’s appointment could deepen entrenched inequities. The potential dismantling of the Office of Minority Health and the Center for Medicare and Medicaid Innovation, which has been promoted by many close to the incoming administration, is yet another significant threat. These critical centers within CMS have made real progress in addressing deeply rooted health disparities by advancing minority health interventions. These efforts have not only improved health outcomes for systemically excluded communities but have also reduced costs to the government through preventive care and reduced reliance on costly emergency care.

To really tackle the medical debt crisis, we must strengthen, not dismantle, the Medicare and Medicaid programs administered by CMS, as well as the various offices and centers within CMS that play vital roles in ensuring access to affordable health care. Dismantling these programs would undermine efforts to create innovative solutions that prevent medical debt, erode the safety nets that protect underserved communities and ultimately compromise the rights of individuals to access necessary health services. Instead, we should focus on strengthening CMS and initiatives to promote transparency, reduce health care costs and better protect patients from the burdens of medical debt.

Health care is not a luxury — it’s a right. And we cannot empower extremist politicians and special-interest groups that seek to maintain an inequitable system where access to care disproportionately favors the wealthiest. When health care is comprehensive, accessible and affordable for everyone, our society as a whole thrives, and that benefits every individual and community.

And only through strengthening, not stripping away, the public health system can we begin to address the medical debt crisis. And Misty, and the tens of millions like her, cannot afford for the new administration to take us backward.

We hope the Trump administration will build on the advances of the Biden administration when it comes to addressing this crisis. But Oz’s appointment is a stark reminder of the urgent work ahead to protect Medicaid and Medicare from predatory practices, address the growing burden of medical debt, and ensure that our health system is accountable to the people it serves, not corporate interests or extremist agendas.

Wilson is co-interim president and CEO and senior director, Health Innovation, Public Health and Equity at Community Catalyst.