Ruchi Kapoor, Colorado Politics
As a lawyer representing parents in the child welfare system, I meet people on some of the most vulnerable days of their life. I represent parents who are generally in need of aid, but without the education or support to successfully navigate the myriad of systems that affect their well-being and the well-being of their family. One system that can often lead to child welfare involvement, unbelievably, is the health-care system and the related debt that can create a pile-on for already hard-pressed families. .
The past couple of years have demonstrated the cracks in our health-care system that can spiral into child welfare involvement. Many Coloradans lost their jobs, and therefore their health insurance, and turned to short-term, limited-duration health insurance (STLDI) plans to bridge the gap between jobs. What they don’t know is that these STLDI plans or “junk insurance” plans are exempt from many Affordable Care Act requirements and can exclude coverage for preexisting conditions. Additionally, they are also not required to cover preventive services and have a host of other substantial risks for consumers. By paying for these plans, hardworking Americans will face steep medical bills, discrimination and other problems receiving care. These stressors only increase the pressure families face as they cobble together their finances in the face of increasing costs.
But insurance is only part of the problem. After patients have received treatment, many are left with astronomical medical bills. What’s worse is that many Americans don’t expect to receive the medical bills that they do. A reported 35% of Americans have received a surprise bill in the mail after getting medical treatment. Thankfully, legislation passed in 2020 that will protect hardworking Americans from receiving surprise bills, starting this year. This includes “balance billing,” which occurs when patients get treatment by an out-of-network provider at an in-network facility. Despite these protections, insurers have found loopholes and are saddling patients with surprise bills, like charges related to facility fees.
Surprise billing can lead to medical debt, which is the leading cause of bankruptcy in the nation. But medical debt does not affect all communities equally. A 2013 survey showed that 32.9% of African Americans and 21.7% of Hispanics had problems paying their medical bills compared to 16.1% of white Americans. To make matters more difficult, an average family income gap of $26,000 exists between white and nonwhite households.
In Colorado, communities of color face twice the rate of medical debt-in-collection as their white counterparts. According to data compiled by the Urban Institute, the median amount of medical debt-in-collection is $748 and $635 among minority communities. Coloradans reported addressing their medical debt in a variety of ways. A 2017 survey conducted by Colorado Consumer Health Initiative showed that 46.2% took on credit card debt; 37.2% were unable to pay for necessities like food, heat, or rent;15.7% took out a loan; and 5.4% declared bankruptcy.
These financial stresses can lead to increased surveillance by the child welfare system. For parents struggling to make ends meet, the resultant impacts on their constitutional right to parent can be astronomical.
This is simply unacceptable. We need to be doing everything we can to ensure that hard working Americans are able to navigate the health-care system to the best of their ability. Predatory practices like junk insurance plans, surprise billing and toxic billing practices that leave Americans bankrupted are not the answer. We need our elected officials to act swiftly to ensure that our health-care system is equitable for all.
Ruchi Kapoor is the founding attorney of Kapoor Law + Policy, focusing primarily on appeals and movement lawyering for nonprofits and B-corps. Before re-entering private practice in 2021, she was the appellate director and legislative liaison for the office of respondent parents counsel.