In Los Angeles, one of the nation's most populous counties, a groundbreaking initiative has been launched to address the staggering issue of medical debt, which totals a staggering $2.9 billion. Over the course of a year, the county has meticulously crafted a comprehensive strategy aimed at tackling this challenge head-on.

Led by the Department of Public Health, the initiative encompasses several key components, including tracking patient debt and hospital collection practices, enhancing bill forgiveness options for low-income individuals, and acquiring and forgiving significant amounts of medical debt.

What distinguishes Los Angeles County's approach is its framing of medical debt not merely as a political concern, but as a pressing public health crisis on par with conditions like asthma and diabetes. This perspective underscores the urgency of the issue and signals a proactive effort to mitigate its impact on individuals and communities.



"At a medical debt symposium on April 10th, Barbara Ferrer, director of the public health department, emphasized that economic constraints should not hinder anyone in Los Angeles County from accessing the vital healthcare services and support necessary for optimal well-being."

Community Catalyst's Mona Shah hailed the county's endeavors as bold, commending its dual approach of addressing both the underlying causes of medical debt and offering immediate relief. This comprehensive strategy, developed in collaboration with health plans, hospitals, community organizations, and government partners, is particularly significant given Los Angeles County's vast population of approximately 10 million.

However, on the eve of the symposium, the local hospital association issued a plea for the county to reconsider its plan.

George Greene, CEO of the Hospital Association of Southern California, expressed concern in a letter to the LA County Board of Supervisors regarding the proposed Department of Public Health (DPH) debt relief program and data collection initiative. He argued that these measures would only impose unnecessary burdens on hospitals without effectively addressing the underlying issue.

According to Greene, many of the county's recommendations would necessitate hospitals to alter their procedures and assume additional reporting responsibilities. For example, hospitals would be required to notify the county when patient debt is referred to collections and to enhance accessibility to financial assistance programs. Despite state law mandating hospitals to offer assistance, patient advocates highlight that many hospitals do not facilitate easy access for patients.



Adena Tessler, the LA County regional vice president for the hospital association, conveyed to KFF Health News that the healthcare industry already offers substantial financial aid. She expressed the opinion that the county is overly focusing on hospitals' contribution to the debt crisis, asserting that other segments of the healthcare system, notably insurers, should also shoulder responsibility.

Tessler emphasized that the county's plan should encompass all stakeholders, including health plans, provider groups, and ambulance providers.

"Medical debt is undoubtedly a significant issue, and we are committed to contributing to its resolution," Tessler stated. "However, it's essential to recognize that hospitals are not the sole source of medical debt."

According to an analysis by KFF Health News, medical debt affects 4 in 10 adults in the U.S. Additionally, LA County's own analysis for the current year revealed that approximately 785,000 residents were burdened with a collective $2.9 billion in medical debt in 2022. 


The county analysis shows that medical debt disproportionately affects people of color, low-income people, and families with children. Having medical debt more than doubled the likelihood that patients would delay or forgo health care or prescriptions or be at risk of losing housing or going hungry.

Nationally, a handful of states have passed rules to limit medical debt collection or bolster hospital financial assistance policies. Some jurisdictions have relieved residents of debt. Connecticut, Colorado, and New York enacted laws in the last two years to ban medical debt on credit reports, which can depress credit scores and make it harder for patients to get a job, rent an apartment, or secure a car loan. California lawmakers have proposed similar legislation, and the federal Consumer Financial Protection Bureau is also developing a set of rules.

“It’s a huge public health problem,” said Naman Shah, medical and dental affairs director at the public health department. “We in public health try to shift the determinants of health. Those are things that impact health deeply and impact people widely. Medical debt fulfills both of those. It’s important that we see this as a health issue, and not just a regulatory issue.



Last spring, the department introduced initial recommendations, which were subsequently refined with the support of the Board of Supervisors. The Board characterized medical debt as "pervasive," causing "financial, mental, and physical harm," particularly to individuals from historically marginalized communities.

Shah noted that although the department remains open to hospital input and has clarified certain misunderstandings raised by the association, officials are proceeding with the plan. Tessler echoed this sentiment, affirming that the emphasis is on collaboration rather than halting the county plan.

In the upcoming months, the county intends to assess hospitals based on their accessibility to financial assistance and equip them with templates and guidelines to simplify and alleviate the burden of financial aid for patients. Similar materials have been developed by states like Washington, Oregon, and Maryland for their hospitals.

Additionally, the county aims to implement other strategies to prevent debt, including collaborating with plans and providers to enhance consumer education to avoid surprise billing and out-of-network charges.





Shah expressed surprise at the timing of the hospital association's letter, particularly since county officials and hospital representatives had met multiple times before the April symposium. While acknowledging the importance of addressing all sources of medical debt, Shah suggested that hospitals are a logical starting point. According to a 2023 Urban Institute analysis, nearly 75% of adults with medical debt owe some or all of it to hospitals.

"We want to maximize our efforts," Shah stated. "The largest bills patients receive are typically from hospitals, not dental or office bills.

KFF Health News is a national newsroom dedicated to producing comprehensive journalism on health-related topics. It serves as a cornerstone program within KFF, an independent organization renowned for its health policy research, polling, and journalistic endeavors.