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Colorado establishes medical debt collection requirements
On May 4, the Colorado governor signed SB 23-093 to cap the interest rate on medical debt at three percent per year. The Act outlines numerous provisions, including that entities collecting on a medical debt must provide a consumer with a written copy of a payment plan within seven days for medical debt that is payable in four or more installments. The Act also outlines requirements for accelerating or declaring a payment plan longer operative, and lays out prohibited actions (such as collecting on a debt or reporting a debt to a consumer reporting agency within a certain timeframe) relating to medical debt that an entity knows, or reasonably should know, is under review or being appealed. An entity that files a legal action to collect a medical debt must provide to a consumer (upon written request) an itemized statement concerning the debt and must allow a consumer to dispute the debt’s validity after receiving the statement. Entities are prohibited from engaging in collection activities until the itemized statement is delivered. The Act outlines self-pay requirements and estimates, and further provides that it is a deceptive trade practice to violate outlined provisions relating to billing practices, surprise billing, and balance billing laws. The Act takes effect immediately and applies to contracts entered into after the effective date.
CFPB examines high-cost financings that cover medical expenses
On May 4, the CFPB released a report examining high-cost alternative financing products targeted to patients as a way to cover medical expenses. Products offered by a growing number of financial institutions and fintech companies include medical credit cards and installment loans, which typically carry significantly higher interest rates than those associated with traditional consumer credit cards (26.99 percent annual percentage rate as compared to 16 percent), the Bureau found, adding that these products also often have deferred interest plans which can create significant financial burdens for patients. The report found that between 2018 and 2020, consumers used alternative financing products to pay for nearly $23 billion in healthcare expenses and paid $1 billion in deferred interest. The report further found that companies are primarily marketing their products directly to healthcare providers with promised incentives. While the companies service the credit cards and loans, the Bureau explained that the healthcare providers are responsible for offering the products to patients and disclosing terms and risks. Many of these healthcare providers are unable to adequately explain complex terms, such as deferred interest plans, leaving patients facing ballooned deferred interests and lawsuits, the Bureau warned. According to the Bureau’s announcement, “financing medical debt on a credit card may increase patients’ exposure to extraordinary credit actions that healthcare providers would typically not pursue,” as “there can be a greater incentive for creditors to pursue lawsuits because unlike many healthcare providers, creditors can pursue a debt’s principal plus interest and fees.”
CFPB examines removal of medical collections from credit reports
On April 26, the CFPB released a data point report estimating that nearly 23 million American consumers will have at least one medical collection removed from their credit reports when all medical collection tradelines under $500 are deleted. Additionally, the Bureau found that the removal will result in approximately 15.6 million people having all medical collections removed. The reporting change occurred as part of an undertaking by the three nationwide consumer reporting companies announced earlier in April. Examining credit reports that occurred between 2012 and 2020, the Bureau studied the impact of this change and noted that on average consumers experienced a 25-point increase in their credit scores in the first quarter following the removal of their last medical collection. The average increase, the report found, was 21 points for consumers with medical collections under $500 compared to 32 points for those with medical collections over $500. The report further discussed the association between the removal of medical collection tradelines and the amount of available credit for revolving and installment accounts, as well as increases in first-lien mortgage inquiries (attributable, the Bureau believes, to consumers working to remove these tradelines as part of applying for mortgage credit).
CFPB finds 33 percent decline in collections tradelines on credit reports
On February 14, the CFPB released a report examining debt collection credit reporting trends from 2018 to 2022. The Bureau’s report, Market Snapshot: An Update on Third-Party Debt Collections Tradelines Reporting, is based on data from the agency’s Consumer Credit Panel—a nationally representative sample of roughly five million de-identified credit records maintained by one of the three nationwide credit reporting companies. According to the report, from Q1 2018 to Q1 2022, the total number of collections tradelines on credit reports declined by 33 percent, from 261 million tradelines in 2018 to 175 million tradelines in 2022. The Bureau determined that this decline was driven by contingency-fee-based debt collectors (responsible for primarily furnishing medical collections tradelines), who furnished 38 percent fewer tradelines during this time period. The total number of unique contingency-fee-based debt collectors also declined by 18 percent (from 815 to 672).
In a related blog post, the Bureau estimated that while medical collections tradelines declined by 37 percent between 2018 and 2022, these tradelines still constitute a majority (57 percent) of all collections on consumer credit reports. The Bureau explained that the “decline may be partly explained by structural dysfunctions in medical billing and collections, which increase the risk that debt collectors will not meet their legal obligations” and can result in false and inaccurate information. The Bureau said it will continue to closely examine medical billing and collection practices and highlighted a bulletin published in January 2022, which reminded debt collectors and credit reporting agencies of their legal obligations under the FDCPA and the FCRA when collecting, furnishing information about, and reporting medical debts covered by the No Surprises Act. (Covered by InfoBytes here.)
NYDFS describes plan to include medical debt in Consumer Credit Fairness Act
On January 10, NYDFS announced that the New York governor revealed several healthcare-related proposals in the State of the State address, including a plan to include medical debt in the state’s Consumer Credit Fairness Act. NYDFS noted that the governor “will create a comprehensive plan to address excessive medical debt” by amending “the Consumer Credit Fairness Act to cover medical debt, launching an industry and consumer education campaign that addresses medical debt and affordability, and reforming hospital financial assistance applications to require hospitals to use a uniform application form.” According to NYDFS, the best way to combat “medical debt is a commitment to an affordable and equitable healthcare system with transparency that empowers consumers, regardless of their socioeconomic status.”
Arizona establishes new limits on consumer debt collection
Recently, the Arizona governor approved Proposition 209, which decreases the maximum lawful annual interest rate on “medical debt” from 10 percent to three percent. Among other things, the proposition defines “medical debt” as “a loan, indebtedness, or other obligation arising directly from the receipt of health care services or of medical products or devices.” Accordingly, in addition to judgments on medical debt, the three percent annual rate limit applies to loans or other financing for health care services or medical products or devices. The proposition also decreases the share of borrowers’ wages that lenders can garnish. The current limit is 25 percent, but that percentage will decrease to 10 percent for many consumers, and to five percent for consumers dealing with extreme economic hardship. Additionally, the proposition increases various exemption amounts, including: (i) $400,000 (up from $150,000) for the homestead exemption; and (ii) $15,000 (up from $6,000) for household furniture, furnishing, goods, and appliances. The proposition is effective immediately.
On December 7, a state court granted a temporary restraining order, which stopped the enactment of the approved measure. An evidentiary hearing is set to happen in December where the plaintiffs are seeking to have the proposition nullified.
New York enacts protections for consumers with medical debt
On November 23, the New York governor signed S6522A/A7363A to prohibit certain hospitals and healthcare providers from placing liens on the primary residences of individuals with unpaid medical debts or garnishing wages to collect on unpaid bills or satisfy judgments arising from a medical debt lawsuit. “No one should face the threat of losing their home or falling into further debt after seeking medical care,” Governor Kathy Hochul said in an announcement. “I’m proud to sign legislation today that will end this harmful and predatory collection practice to help protect New Yorkers from these unfair penalties. The bill is effective immediately.
CFPB examines finances and debt in Appalachia
On September 1, the CFPB released a report detailing family finances and debt in rural Appalachia, intended to provide a starting point in better understanding the needs and challenges of these consumers. The report—which is the first in a series regarding the finances of consumers living in rural areas—focuses on rural Appalachians, who, according to the Bureau, tend to earn less than consumers in other rural areas and have higher rates of subprime credit. According to the report, of the 26 million people living in the Appalachian region, 33 percent live in rural counties. Over 2 million Appalachians live in Persistent Poverty Counties (PPCs), which are defined as counties that have had poverty rates of 20 percent or higher for the past 30 years. Nearly one-in-four Appalachians are carrying some amount of medical debt, according to the report, compared with 17 percent of people nationally. Those people in the region with medical debt have more than double the rate of delinquency on their credit report compared to people without medical debt. Other findings of the report include, among other things, that: (i) 71 percent of rural Appalachians and 63 percent of those living in PPCs have an active credit card, compared to 80 percent of consumers nationally; (ii) auto loan balances equal 31 percent of household annual income for rural Appalachians, compared to 21 percent nationally; (iii) denial rates for mortgage applications in rural Appalachia were almost twice the rate of mortgage applications nationally; and (iv) though the high school graduation rate for individuals in Appalachia is higher than the national average, the percentage of individuals who attended some college is significantly lower than the national average. According to the Bureau, these circumstances have “led to disproportionately high levels of distress in rural Appalachians’ consumer financial lives.”
Federal government directs agencies to eliminate medical debt as an indicator of creditworthiness
On August 25, the Director of the Office of Management and Budget (OMB) issued a memo directing “agencies with direct loan and loan guarantee programs that focus on consumer loans or small and medium businesses where a consumer’s credit history is a factor, to whenever possible and consistent with the law take actions to reduce the impact of medical debt in the underwriting of Federal credit programs.” Although OMB recognized that some agencies such as the Department Veterans Affairs and the CFPB have already taken some steps to lessen medical debt burdens, it found that these prior efforts have been insufficient. Instead, the memo stresses that “[t]he collective efforts of the Federal Government, working with the private sector” are necessary to “remedy the impact of the issue of medical debt as an indicator for creditworthiness.” The memo outlines guidance for agencies to develop a plan to eliminate medical debt as a factor for underwriting in credit programs. These steps include (i) “[i]dentifying any statutory, regulatory, or administrative changes that would be required to modify criteria and consideration factors, exclude medical debt, or otherwise lessen the impact of medical debt consideration or underwriting in Federal lending programs”; (ii) conducting an “[i]nitial qualitative assessment and cost-benefit analysis of any statutory or regulatory changes” or any anticipated changes; (iii) conducting an “[a]ssessment of whether model updates are required for FCRA cost estimation, especially if the exclusion of medical debt would explicitly or implicitly affect particular underwriting requirements such as debt-to-income ratios, etc.”; and (iv) incorporating stakeholder input and assessing known risks that may impact an agency’s goal of achieving its plan.
Colorado reminds collection agencies about medical law
On August 16, the Colorado attorney general published a memorandum reminding collection agency licensees and interested parties that HB21-1198 becomes effective September 1. HB21-1198, among other things, amends the Colorado Fair Debt Collection Practices Act to add a new unfair practice—attempting to collect a debt that violates certain HB21-1198 requirements. The bill also creates requirements for notice and certain limitations on collections of medical debt. Specifically, the bill enacts healthcare billing requirements for indigent patients who are treated, but not reimbursed, through the state’s indigent care program and sets forth requirements before any collection proceeding may be initiated against an indigent patient.