Oregon has seen a decline in residents pursued by debt collectors for unpaid medical bills following the implementation of a 2019 state law, according to an April 17 study published in the Journal of the American Medical Association Network Open.
The findings matter as medical debt remains a significant issue for many Americans, and policies that address this problem could provide relief to those struggling with healthcare costs. The study compared Oregon’s approach to other states with similar policies limited only to Medicaid patients and found greater reductions in medical debt across Oregon counties.
Researchers from Tulane University, Northeastern University, Colorado School of Public Health, and Virginia Commonwealth University conducted the analysis. They linked Oregon’s policy to at least 872 fewer people per county being pursued by debt collectors than in other states. The state law requires nonprofit hospitals—nearly all hospitals in Oregon—to clear or reduce debts for patients earning up to 200% of the federal poverty line before sending bills to collections. Hospitals must also offer sliding scale financial assistance and at least a 25% discount for those earning up to 400% of the poverty level.
Federal regulations require nonprofit hospitals nationwide to have written financial assistance policies but do not specify minimum aid amounts. In contrast, Oregon’s law ties assistance directly to household income levels. Study authors said this policy could serve as a model for other states seeking ways to reduce medical debt burdens.
“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.
The researchers noted that while impacts were strong initially after passage of the law, progress plateaued by 2022. Santos said maintaining enforcement and ensuring patient awareness are ongoing challenges: “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.”
The broader implications suggest that state-level reforms like Oregon’s may be increasingly important as federal coverage changes threaten access for millions nationwide.
