If hospitals want to be better members of society they should be more lenient on low-income people with medical debt | COMMENTARY

Consumers groups have criticized hospitals for suing low-income people with medical debt.

Three months have passed since Baltimore-area medical systems issued statements in support of the Black Lives Matters movement in the wake of George Floyd’s murder. MedStar Health called for everyone to share “our individual and collective sadness.” Ascension pledged to “listen, pray, learn, and act.” Johns Hopkins University and Medicine pledged, among other things, to host a town hall on racial injustice.

Yet, as the proverb says, actions speak louder than words. These nicely worded statements in and of themselves do nothing to improve the lives of Black men and women who live near, work at or are treated by these hospitals.


One simple action hospitals could take is to end medical debt lawsuits under $5,000. If a judge rules that the patient owes the debt (which happens more often than not) the patient’s bank account can be wiped out, their wages garnished or a lien can be filed against their home or car. Our report, Preying on Patients, found that over the past nine years, Maryland hospitals sued 145,746 patients over a median debt of $944.

Hospitals are profiting off of patients’ poverty because if they can’t pay the debt outright these medical debt lawsuits add interest rates, attorney fees and other fees to medical debt owed. Medical debt lawsuits disproportionately affect Black households. In 2015, 31% of Black households had past due medical debts, compared to 23% of white households, according to The Urban Institute. That percentage will likely increase in the coming months since Black communities are experiencing higher rates of infection and death from COVID-19, in part due to chronic health issues that may have gone untreated or only sporadically treated as household finances would allow.


It’s time, or really long past time, for hospitals to put their money where their mouths are. Hospitals may claim that their charity care programs address the needs of low-income patients. Maryland law requires nonprofit hospitals to provide free and reduced care, and hospitals receive tax subsidies for these efforts. Yet a look at the data cast doubt on the benefits of the current charity care model. Our report found that charity care fell 36% (or $168 million) between 2014-2018.

Not only did the amount spent on charity care fall, but when families applied for charity care, they were often denied. Bon Secours denied charity care applications an astonishing 81% of the time, while Johns Hopkins turned down 46.9% of financially struggling families that applied for assistance, and University of Maryland rejected 27.5% of applicants. The Maryland General Assembly passed legislation (H.B. 1420, S.B. 875) on Sine Die to expand the number of families that will be eligible for free or reduced care. Unfortunately, the bill won’t go into effect until Oct. 1. One simple thing that hospitals could do is to voluntarily expand their eligibility requirements for free or reduced care now.

Other states have eliminated these debts with relative ease. Last year, the largest nonprofit hospital system in Memphis, Tennessee, erased the debts of 6,500 patients it had sued for medical debt. This May, amid the COVID-19 pandemic, a physician-owned hospital in Tulsa, Oklahoma, forgave $2.1 million in medical debt. Closer to home, Mary Washington Healthcare in Fredericksburg, Virginia, suspended its policy of suing patients for medical debt. It’s important to remember that charity care represents less than 2% of hospitals’ budgets, so there is room to expand charity care and eliminate debt lawsuits.

Legislation (H.B. 1081, S.B. 873) was introduced in the 2020 session by Del. Lorig Charkoudian and Sen. Brian Feldman, both Montgomery County Democrats, to eliminate this practice in Maryland as well as to end the practice of wage and property garnishment to pay medical debts. The bill was passed as an interim study and a report with recommendations will be due in December. The legislation will be re-introduced in 2021 and the General Assembly should move swiftly to pass it.

Doctors take the Hippocratic Oath which says, in part, “I do not treat a fever chart … but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems.” Doctors and hospitals actions should uphold this oath as well as their Black Lives Matter statements by ending hospitals’ medical debt lawsuits.

Marceline White ( is executive director of the Maryland Consumer Rights Coalition.