How California can reform medical billing so patients aren’t overwhelmed with debt

In our early 30s, my husband and I were working hard to build our future in Salinas, honing our skills as schoolteachers and saving to buy our first house. We thought we had our priorities in order.

Everything changed when my then-33-year-old husband was diagnosed with Stage 4 cancer.

Three years later, his lymphoma is in remission, but our finances still haven’t recovered. We are among the more than 1 in 3 Californians who live under the weight of medical debt.

We now know that hospitals are required to provide financial assistance to patients that meet certain income requirements, but patients need those options and help navigating the complex forms and criteria before the bills start piling up.

California lawmakers have an opportunity to protect patients from being saddled with preventable but crushing medical debt by passing Assembly Bill 1312. This legislation, authored by Assemblymember Pilar Schiavo, a Santa Clarita Democrat, faces a big hurdle on Friday in the Assembly Appropriations Committee, as deep-pocketed hospital associations mobilize against it. 

My husband and I are the “lucky” ones, with health insurance through our jobs and an extra cancer insurance plan that covered many of the expenses from his life-saving treatment. As teachers, we don’t qualify for state disability insurance but we wisely paid into an optional plan that covered his time off. 

Yet I feel heartbroken, not fortunate, when my husband asks me if he should skip his next MRI because of the cost. With his cancer in remission, insurance no longer covers tests intended to catch any recurrence early. His latest screenings added $3,000 to our pile of debt.

AB 1312 would require hospitals to screen patients to see if they are eligible for existing financial assistance programs and help those who qualify before they start amassing debts that can feel impossible to repay. Hospitals say the available tools to do this are too costly and not accurate enough, but these arguments are belied by the fact that hospitals already use information patients provide to have third-party vendors assess our ability to pay.

This bill simply requires hospitals to use that information for the benefit of patients. 

In the weeks after we began receiving my husband’s medical bills, the hospital’s billing agency called us repeatedly. Not once did they offer us financial assistance or even suggest a payment plan. It’s no wonder that scores of Californians are unable to pay for necessities because of medical debt, as a recent L.A. County analysis found. 

The rate of medical debt is also an equity issue. Among Black and Latino Californians, rates of medical debt are 48% and 52%, respectively, compared to 28% for white Californians. 

Like many first-generation Latino families, my husband and I didn’t come from parents with money. We worked for everything we’ve gotten. Cancer put it all at risk. 

I used to pick up summer school classes to put away extra savings for retirement. I taught extra courses to help support my younger sisters with college expenses. Now I do that extra work, teaching at 120% of full time, just so we can keep the heat on in the winter while we pay down our hospital debt. 

Anyone could find themselves in our shoes, but that doesn’t stop my husband from feeling guilty that his care has cost us so much. I hope that my assemblymember, Robert Rivas, and other state leaders will use their power to support families like mine before they’re overwhelmed with medical debt.