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A nearly seven-year-old state law requiring nonprofit hospitals to account for patient income and to provide financial support before collecting debts led to a significant reduction in the number of Oregonians wracking up unpaid medical bills, according to a recent study.
The study, published earlier this year in the Journal of the American Medical Association Network Open, found that the portion of residents in each Oregon county with medical debt fell more than in states that have similar policies, but which only apply those policies to patients on Medicaid. Public health experts at Tulane University in New Orleans, Northeastern University in Boston, the Colorado School of Public Health in Aurora and Virginia Commonwealth University in Richmond conducted the research.
All but two hospitals in Oregon are nonprofits.
Oregon’s 2019 law requires nonprofit hospitals to clear or reduce medical debts for patients earning income within 200% of the federal poverty line — or any patient earning less than about $32,000 per year as an individual or $66,000 per year for a family of four — instead of sending it to debt collectors. The law requires the hospitals to offer sliding scale financial assistance, and at least 25% off, to patients struggling to pay off bills and who earn up to 400% of the federal poverty level — about $64,000 per year as an individual or $132,000 per year for a family of four.
The study authors linked the policy to at least 872 fewer people per Oregon county with medical debt being pursued by debt collectors relative to the other states.
Federal law requires nonprofit hospitals to have a written financial assistance policy, but it doesn’t specify an amount of financial aid that must be provided. Under Oregon law, nonprofit hospitals must maintain financial assistance policies related to a patient’s household income.
The researchers recently highlighted their findings in the wake of the GOP’s 2025 tax and spending law from last year, which is expected to leave more than 15 million Americans without health insurance, according to the Congressional Budget Office. They said Oregon’s policy could be a “roadmap” for other states seeking to craft financial assistance reforms for medical debt.
“With these upcoming cuts to Medicaid, we found that hospitals that have the ability to provide more financial assistance could substantially reduce medical debt in their communities,” said lead author Tatiane Santos, assistant professor of health policy at Tulane University’s School of Public Health, in a late March news release.
The law made big impacts in its first few years, the researchers found, but by 2022 that was beginning to plateau. Santos said this indicates that a challenge of the law will be sustaining its enforcement, and ensuring that patients know they qualify.
“If things stay as they are (with Medicaid cuts) medical debt will get worse, but states and hospitals can implement policies that help alleviate that burden on citizens,” Santos said.
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