NC leaders announce plan to reduce medical debt

I'm now going to invite Secretary Kinsley to share more

2024-07-01

about the specifics of what North Carolina is doing to

take this critical step

Secretary Kinsley

Well thank you Governor and thank you for your leadership

on this important issue and continuing to invest in the

health and well being of North Carolinians

As the governor said we've had the privilege of traveling

the state to hear from individuals at events where navigators

are trying to get folks enrolled in Medicaid

And what often happens is people tell these stories that

are heart wrenching about living without health insurance for a

decade tears fill their eyes and while they're relieved and

have peace of mind for they and their families to

now have health insurance

They're still struggling with the burden of debt that they

had from a cancer diagnosis or a procedure that they

had just a few years prior

It's clear that by providing relief for medical debt we

give North Carolinians not just peace of mind but truly

a fresh start

It's important to recognize that the individual carries the burden

of medical debt even though as it ages hospitals rarely

collect more than 5% individuals continue to struggle to buy

food or to pay rent for the roof over their

heads

And also they're scared to go into a doctor's office

an individual could have as little as $100 of medical

debt and yet they wouldn't walk in to have that

preventative check up or to get that necessary care which

means that they're putting off the health and well being

that they need

And they almost always end up in an emergency department

at a higher cost and sicker medical debt like food

and transportation and other key social determinants of health are

things that we have got to curb in this state

And this is an important way that we're doing it

North Carolina is approaching this in an innovative way at

no additional cost to the state taxpayer by leveraging federal

funding

What we've done is we're applying to the federal government

for enhanced payments through our health care access and stabilization

program

This way we'll be sustaining this in the future hospitals

to qualify for these increased and enhanced payments will have

to do two things

They'll have to put in place relief for debt

That dates back to January 1st of 2014

That was the first day by which we could have

expanded Medicaid in North Carolina specifically focused with income eligibility

limits on low and middle income North Carolinians

And remember hospitals are rarely going to collect much of

that anyways and then going forward put in place charity

care floors and put the onus on hospitals to ensure

that people who are eligible for charity care programs actually

get enrolled

This will not only provide relief for medical debt but

will help make sure that medical debt doesn't build up

in the future

This is a win win win for North Carolina

It's a win for our hospitals to be able to

get enhanced payments for more investments in their health care

and their work

It's a win for individuals who will finally have the

relief from this burden and it is a win for

the health and the economy of North Carolina to be

able to clear this bad and rarely ever paid debt

off the bucks

It's now my pleasure to invite from the American Cancer

Society John Broome thank you so much Secretary Kinsley

Um I'm John Broom

I'm the government relations director for American Cancer Society Cancer

Action Network

Um Please use our acronym A CS C A so

I don't want to repeat that too many times

Um But uh moving on to a very serious subject

of medical debt

Um in March of 2024 A CS K um conducted

a survey we asked individuals uh with cancer and who

had been cancer survivors

Uh you know about their experience with medical debt

Um What we found was over half of the individuals

surveyed um have incurred debt in order to pay for

cancer treatment um or expect to incur debt to pay

for their cancer treatment

Over half of those individuals that's a significant number

And you know this is this kind of creates a

cycle

You know you've got um over half of uh survivors

surveyed had their debts go to collection

So this is this is something that keeps going on

and on once you once you kind of you know

pit to iceberg

So um and you know nearly all of the individuals

surveyed here 98% of these individuals were covered by health

insurance in one way or another

Um And so this just speaks to you know the

the need for an outside box solution

Um We need to really you know think of how

to you know leverage these federal dollars that are coming

in

Um And A CS can you know applaud the administration

applauds the HHS for all the work they've done and

we are fully supportive of this initiative and look forward

to being involved as much as we can

And I would uh love to introduce my friend uh

Dave Almeda

Thank you John

Uh good morning

My name is Dave Almeida

I'm the Governor Affairs Director for the Leukemia Lymphoma Society

And I'm gonna start by saying thank you to Governor

Cooper for addressing the crisis of medical debt in North

Carolina

Today Governor Cooper has made it clear that the status

quo isn't good enough

As the governor said medical debt is no fault debt

because no one chooses to become ill

So no one should have to choose between putting food

on the table paying the rent putting the kids through

college or engaging in life saving treatment

And yet medical debt is one of the leading causes

of personal bankruptcy

It's one of the leading reasons for delaying medical care

in polling that we've conducted more than four in 10

patients made the decision to delay medical care because they

did not want to go further into debt

Equally as alarming is the fact that one in five

patients avoided going back to the same provider where they

owed money out of fear of not being treated

Governor Cooper's initiative to relieve medical debt and prevent the

sale of medical debt to debt collection agencies means giving

patients the ability to focus on what's most important which

is a health instead of worrying about when the debt

collector is going to call again and demand payment

Preventing a patient's death from being reported to credit reporting

agencies means being able to buy a car or a

house or even a dishwasher anything that requires financing contingent

upon a good credit score

But there's a very important component of what Governor Cooper

is doing here today and that is preventing people from

getting into medical debt in the first place

Cancer treatment and medical debt are in many ways very

similar

The earlier the intervention the better the outcome health care

providers hospitals are on the fir the first line of

defense against medical debt because they are on the front

lines of our health care system

They're the first point of contact for many patients with

the system by creating a process whereby people are automatically

enrolled in charity care provides payments for health care services

which renders medical debt deadness tracks

So on behalf of blood cancer patients in North Carolina

I close again by saying thank you to Governor Cooper

for not allowing the status quo to continue

Thank you Dave and John and thank you Secretary Kinsley

for your powerless work on this along with the staff

We'll be glad to take questions

Oh sorry I'll let I'll let Jordan run the show

How can you do that So this is an incentivized

program for hospitals

They're going to get one level of payment through the

this ha program through Medicaid or they can put in

all of these issues on medical debt and get a

much higher amount of money

So this incentivizes the hospitals to put in these programs

that they won't do this that they won't report it

on their credit

This this this will help these patients that they see

and will help going into the future

And this this is a program that really I think

they're going to come out financially a lot better accepting

this higher level of has money instead of continuing to

go after people and not getting a whole lot of

money the old blood blood out of the turn turn

up thing I think is is very appropriate here

Secretary Kinsley would you want to add to that Sure

So the State Directed Payments program which is a federal

program operated by the Centers for Medicaid and Medicare has

in it contemplated in federal rule the requirements and availability

for states to use those payment programs to incentivize certain

policies to be in place

Many other states have requirements like connection to health information

exchange or investments in achieving certain population health metrics and

holding back percentage of the payment until those things are

hit

North Carolina is innovating to put in place

And first in the country a set of medical debt

mitigation policies akin to some of those other policy requirements

that other states have done

The Medicaid program is large and complex

We have a number of provider payment requirements and policies

we put in place all the time

This is us leveraging this particular tool to achieve the

outcomes of that federal program your medical debt or that

this will encourage hospitals to not control their cost

We know that individuals that uh actually well actually on

hospitals controlling costs I mean this is an even more

incentive for hospitals to control costs because as they negotiate

with insurers as far as what will be reimbursed

The piece of the puzzle that's often not negotiated is

the patient responsibility with hospitals knowing that for low and

middle income income middle income North Carolinians they're not going

to be able to collect a certain amount

It puts more of an onus on hospitals to negotiate

with that in mind

And they've got to cap in that helps control prices

with regard to individuals not being able to pay or

choosing not to no individual goes into a hospital and

says sure I'd like all the treatments at no charge

You know that's just not people are going into the

hospital to referred into care because they're making life and

death decisions and we want to make sure that we

can keep those life and death decisions at the forefront

of their minds and not let them worry about the

cost on now from governor

And and just to be clear this is specifically for

Medi and Medicaid patients only or open to go

This will be for all individuals across any type of

insurance

And the reason why that's important is because a little

bit perhaps the Laura's question is we didn't want to

incentivize folks to be on one type of insurance or

another

And so we wanted to make sure that was smooth

across the different programs

And again consistent with the federal program that puts policies

in place that are blind to what type of insurance

Next question this is multipart but not too far from

uh how many people are currently enrolled in expansion that

479 as recently it is 49 498,000 were almost there

And you know remember this 600,000 project projection was to

be over two years

And so we're talking about having almost half a million

in less than eight months

When was when was the

we submitted the request last week And we have been

working closely with uh the centers for Medicaid and Medicare

to provide technical assistance on shaping this request And we'll

work with them to expeditiously go through the approval process

For the last question is about the hospital

Again it's telling that there's no hospitals here

What has been their reaction And are they Well I'm

confident that right now the hospitals are looking very closely

at the details of the program including the implementation time

periods to understand

Um you know what it would take to do this

we've been working collaboratively with the hospitals

We've had a lot of feedback from them

In fact the policy that we're putting forward is very

much a representation of of their perspectives and the things

that they think that they can do

Uh we look forward to working with them to get

this in place as soon as possible

It's the right thing for North Carolina

And again it's a huge win for them as the

governor outlined

those conversations with the looked like

And what you said it feels like they're responsive

Is that what you're saying I talked to the hospital

ceos and a number of hospitals every single day

I am so grateful for them and the work that

they do to support the health and well being of

their communities

It's clear this is giving them another tool where they

can provide access to a sustainable source of funding from

the federal government

And in turn be able to use that tool to

provide the relief to the people that they serve uh

and to get credit for doing it

Uh It's a great win for them

I know that there's a lot of difference across our

99 hospitals that participate in this program

They're all going to think really hard about how they'll

approach it and we hope that they'll all say yes

we've had a lot of positive feedback right out of

the gate on this and we continue to provide technical

assistance and insight into how this program will work

You know we went for over a decade without Medicaid

expansion

And I think about story after story after story of

individuals that had to wait for insurance

Uh You know this is the right time for us

to move forward

It's always the right time for us to move forward

We've worked to where we can to try to be

able to provide relief for things that have been turned

over to collections to tackle liens

Um But we won't be able to go back in

time on all things