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CFPB reports on New Mexican consumers’ complaints
On August 10, the CFPB posted a blog entry sharing insights into medical debt and junk fees in New Mexico in advance of CFPB Director Rohit Chopra’s scheduled meeting with New Mexico elected officials this week. The blog entry noted that the CFPB’s public consumer complaint database contains more than 11,600 complaints from New Mexicans, primarily focused on issues with credit products, consumer reporting, and debt collection. The CFPB indicated that almost 18 percent of New Mexico’s population had medical debt (totaling ~$881 million) and the average amount owed per individual is $2,692. Building on the CFPB’s recent hearing on medical billing and collections (covered by InfoBytes here), the CFPB stated that “along with several other states, New Mexico has alerted the CFPB to its concern about fees that consumers are routinely compelled to pay to access consumer financial services or forced to pay for services they do not want.”
CFPB holds hearing on medical billing and collections
On July 11, CFPB Director Rohit Chopra delivered prepared remarks at a public hearing on medical billing and collections. Chopra commented on the prevalence of medical debt in the country, which affects over 100 million Americans, while $433.2 billion of the national GDP is sourced from consumers’ out-of-pocket expenses. Specifically, the CFPB hearing addressed the effects of medical payment products, including special-purpose credit cards and installment loans used to cover the cost of medical treatment, which Chopra claimed can leave patients “worse off.” The Bureau highlighted the predatory nature of such medical credit cards, which typically have a higher interest rate than other cards and are often presented to consumers by their providers. According to Chopra, the Bureau recently launched a public inquiry (covered by InfoBytes here) to answer questions related to these products.
During the expert panel discussion, multiple panelists raised issues regarding the federal requirements for hospital financial assistance programs that exist in exchange for tax benefits. Panelists criticized the complicated processes patients must follow for such programs and compared it to the simple and fast online application process for medical credit cards. Panelists also highlighted the need to include stronger, clearer federal requirements for hospital financial assistance programs, such as setting standards on income and setting minimums or floors, so consumers can access such services more easily. Panelists commonly noted that state requirements for hospital financial assistance programs are more robust than the federal requirements. In response to Chopra’s question on what the panelists wish to see from the Bureau regarding regulation, one panelist asked for a ban on deferred interest, noting the “special regulatory authority” the Bureau has. Another panelist requested that the agency ban medical credit cards from being offered in a medical setting, citing her communication with clients who claim they feel “pressured” to sign the paperwork in that setting. Additionally, another panelist requested that the Bureau prohibit the reporting of medical debt on credit reports—mentioning Colorado’s headway in being the first state to ban such reporting and noting the Bureau’s potential to ban it at a federal level. The panelists each applauded the agency’s efforts to bolster regulations on medical payment products.
Split 9th Circuit: Nevada’s medical debt collection law is not preempted
The U.S. Court of Appeals for the Ninth Circuit recently issued a split decision upholding a Nevada medical debt collection law after concluding the statute was neither preempted by the FDCPA or the FCRA, nor a violation of the First Amendment. SB 248 took effect July 1, 2021, in the wake of the Covid-19 pandemic, and requires debt collection agencies to provide written notification to consumers 60 days “before taking any action to collect a medical debt.” Debt collection agencies are also barred from taking any action to collect a medical debt during the 60-day period, including reporting a debt to a consumer reporting agency.
Plaintiffs, a group of debt collectors, sued the Commissioner of the Financial Institutions Division of Nevada’s Department of Business and Industry after the bill was enacted, seeking a temporary restraining order and a preliminary injunction. In addition to claiming alleged preemption by the FDCPA and the FCRA, plaintiffs maintained that SB 248 is unconstitutionally vague and violates the First Amendment. The district court denied the motion, ruling that none of the arguments were likely to succeed on the merits.
In agreeing with the district court’s decision, the majority concluded that SB 248 is not unconstitutionally vague with respect to the term “before taking any action to collect a medical debt” and that any questions about what constitute actions to collect a medical debt were addressed by the statute’s implementing regulations. With respect to whether SB 248 violates the First Amendment, the majority held that debt collection communications are commercial speech and thus not subject to strict scrutiny. As to questions of preemption, the majority determined that SB 248 is not preempted by either the FDCPA or the FCRA. The majority explained that furnishers’ reporting obligations under the FCRA do not include a deadline for when furnishers must report a debt to a CRA and that the 60-day notice is not an attempt to collect a debt and therefore does not trigger the “mini-Miranda warning” required in a debt collector’s initial communication stating that “the debt collector is attempting to collect a debt.”
The third judge disagreed, arguing, among other things, that the majority’s “position requires setting aside common sense” in believing that the FDCPA does not preempt SB 248 because the 60-day notice is not an action in connection with the collection of a debt. “The only reason that a debt collector sends a Section 7 Notice is so that he can later start collecting a debt,” the dissenting judge wrote. “It is impossible to imagine a situation where a debt collector would send such a notice except in pursuit of his goal of ultimately obtaining payment for (i.e., collecting) the debt.” The dissenting judge further argued that by delaying the reporting of unpaid debts, SB 248 conflicts with the FCRA’s intention of ensuring credit information is accurately reported.
CFPB puts spotlight on “banking deserts” in the south
On June 21, the CFPB published a data spotlight, titled Banking and Credit Access in the Southern Region of the U.S., addressing banking and credit access, particularly mortgage lending, in in the south (Alabama, Arkansas, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee). Considering the prevalence of “banking deserts” in the south, the report seeks to identify gaps and opportunities to increase financial access in the region. The report also includes a comparative analysis of rural and nonrural areas. For example, in rural communities and communities of color, the Bureau reports that “even though 23 percent of the population lives in a rural county, only 14 percent of home purchase loans in 2021 went to those areas. Between 2018 and 2021, only 9 percent of home purchase loans went to Black rural borrowers in the region, even though they represent 24 percent of the region’s rural population.” Moreover, the report notes that home loan applications from rural southerners are more likely to be denied than in the rest of the country. The Bureau also states that mortgage interest rates further set the rural south apart, as they tend to be higher, on average, than interest rates nationally. The Bureau’s initial analysis shows that credit scores alone do not explain these lower levels of lending.
With respect to banking access, the data spotlight highlights the association between the presence of a bank branch and access to necessary financial services—a common concern reported from stakeholders from the south. The Bureau reports that with only 3.6 branches per 10,000 people in the south (as compared to 5.0 branches per 10,000 people nationally), financial services access is limited, particularly when combined with inaccessible online banking due to limited broadband. The report also highlights how small businesses employ nearly half of the region’s workforce; thus, small business lending is a crucial resource to the south. In support of small business lending, the report references resources for business owners to leverage. (As previously covered by InfoBytes, when the Small Business Lending Rule goes into effect, the Bureau believes that it will provide “visibility” into small business lending.) The report further includes a reminder that “lenders have the ability to create Special Purpose Credit Programs, which enable the development of directed lending programs to reach historically underserved populations.” The Bureau goes on to state that even when branch locations are present, top barriers include minimum balance requirements, distrust of banks, high fees, and barriers to meeting identification requirements.
A second report, the Consumer Finances in Rural Areas of the Southern Region, was also published the same day. The report analyzes southern consumer financial profiles, compared to other geographies, including credit scores, financial distress, medical debt, and other debt categories. Among other things, the report highlights the unique position of mortgage borrowers from the rural south. Findings include that the share of chattel loans (for which the land underneath the home is not used as collateral) is seven times higher in the rural south than in other parts of the country. These borrowers are reportedly more venerable to both repossession and rent hikes or eviction. Also, student loan borrowers in the rural south tend to have lower monthly payments and delinquent balance amounts than the respective national averages, but given the area’s lower median incomes, borrowers in this region face a much higher student loan debt burden. Other findings include that rural southerners are less likely to have a credit card or an outstanding mortgage, which is partially reflective of the lower likelihood of successfully taking out credit, even within credit score tiers. According to the report, rural southerners are also more likely to pay higher interest rates on average and are more likely to have medical collections, with medical collections as the most common type of delinquency. These findings, the Bureau says, are an attempt to provide a “starting point” to better understand the financial situations, needs, and challenges of consumers in the south.
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.