“An Arm and a Leg” host Dan Weissmann talks with credit counselor Lara Ceccarelli about how the CFPB has helped clients at the nonprofit where she works, and how she’s navigating the sudden change.

Consumer rights advocate Chi Chi Wu, an attorney at the National Consumer Law Center, describes the court battle she and her colleagues are mounting to slow down the agency’s dismantling, and where things could go from here. 

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Note: “An Arm and a Leg” uses speech-recognition software to generate transcripts, which may contain errors. Please use the transcript as a tool but check the corresponding audio before quoting the podcast.

Transcript: A medical-debt watchdog gets sidelined by the new administration

Dan: Hey there– 

Lara Ceccarelli works for American Financial Solutions. That’s a non-profit credit counseling agency. 

Lara spends her days talking with people who have bills they can’t pay, debt collectors chasing them, including for medical bills.

On a recent Sunday night, Lara was winding down her day the way she usually does.

Lara: I tend to read the news before bed. I usually find that it gives me less anxiety, uh, when I have a clear picture of, you know, what’s happening in the world and I don’t feel like I’m in the dark. And yeah, that Sunday was an exception. 

Dan: That Sunday was February 9, and that evening big news had broken about the Consumer Financial Protection Bureau– C F P B, for short. 

A federal agency that’s basically a watchdog for consumer rights of all kinds. 

So, for years, whenever Lara’s talked to a client, and it sounds like a debt collector is violating their rights — which happens a lot– she has referred the client to the CFPB. And it has worked. 

Lara: They’ve created these streamlined processes where consumers can submit complaints and see enforcement action taken right away. 

Dan: But that Sunday night, February 9, news broke that an official President Donald Trump had put in charge of the CFPB was basically shutting the agency down. Effective immediately.

Agency staff had gotten a memo telling them to — stop working. 

Lara: I felt my stomach sink through the floor. And my poor husband is active duty in the military, so he was preparing for a very long day the next day on his Navy ship, and he took one look at me and knew something was badly wrong, 

Dan: What did your husband say?

Lara: He tried to tell me that it was all going to be okay. I think he was, uh, doing his best to be as supportive as he could. 

Dan: How late were you up that night?

Lara: Oh, I didn’t sleep. I think I got maybe one or two hours of sleep. I Lay down and I, uh, looked at my awful popcorn ceiling and tried to sleep and just could not shut my brain off. 

Dan: She was thinking about how important the CFPB has been– how many clients she’s referred to them.

I talked with Lara just over a week after that Sunday night. We’ll hear how she managed that first week, how she started shifting what she tells clients– what other resources she’s still referring them to. 

And we’ll hear about a court case that has slowed down the Trump administration’s efforts to completely dismantle the CFPB. And where things COULD go from here.

But first, we should talk about why the CFPB has been such a big deal, especially for people with medical debts. 

This is An Arm and a Leg, a show about why health care costs so freaking much, and what we can maybe do about it. I’m Dan Weissmann. I’m a reporter, and I like a challenge. So the job we’ve chosen on this show is to take one of the most enraging, terrifying, depressing parts of American life–and bring you a show that’s entertaining, empowering and useful.

We’re gonna hear about what the CFPB has done about medical debts from somebody who’s been working on this issue since the beginning. 

Chi Chi Wu: My name is Chi Chi Wu. I’m a senior attorney at the National Consumer Law Center.

Dan: Actually, she’s been at this since before the beginning. Chi Chi Wu joined the National Consumer Law Center in 2001. 

The Consumer Financial Protection Bureau started out a half dozen years later, in 2007– as an idea. A proposal from a law professor named Elizabeth Warren. She thought financial institutions needed a watchdog– or as she called it, “a cop on the beat.”

In 2008, financial institutions crashed the economy. Barack Obama became president. In 2010 Congress passed a law to put some new restrictions on financial institutions– the “Dodd Frank Wall Street Reform and Consumer Protection Act”– which mandated the CFPB’s creation. 

Chi Chi Wu says it didn’t take long for medical debts to land in the agency’s cross-hairs..

Chi Chi Wu: In 2014, the Consumer Financial Protection Bureau did a study that found, if you look at the debt collection items on credit reports… 

Dan: In other words,if you ask: When people get put in collections, what are the bills actually for?

Chi Chi Wu: …over half of them are for medical debt. Half. It was a huge number.

Dan: In other words, a ton of people had lousy credit scores, not because they’d taken a cruise they couldn’t pay for. But because they’d gotten sick. 

Chi Chi Wu: It was a huge problem. People would try to be buying a house or a car trying to get a credit card and they’d have to pay more or even get turned down .

Dan: And now it was on the record, thanks to the CFPB. 

The next year a bunch of state attorneys general reached a “voluntary agreement” with the big three credit bureaus — Equifax, Experian, TransUnion. The big three agreed that, they’d wait 180 days — six months — before putting a medical debt on somebody’s credit report. 

Chi Chi Wu: So the idea was the consumer would have six months to straighten out the debt with insurance, figure out what they actually owed, maybe dispute it if they didn’t think they owed it. 

Dan: Meanwhile, the CFPB was working on another problem.

Chi Chi Wu: Sometimes people would have items on their credit reports, especially for small dollar amounts that they never knew about until they went to buy a car or refinance their house. 

Dan: This was called “parking,” and Chi Chi Wu says it was especially common with medical debts.

Chi Chi Wu: A debt collector would get a medical debt referred from a healthcare provider and they wouldn’t do anything with it.

They wouldn’t send a single letter. They wouldn’t make a single phone call. All they would do is report that debt to the credit bureaus and wait… would just wait until the consumer had to use their credit score for something, you know, refinance their mortgage, buy a car…

Dan: Rent an apartment. Apply for a job… 

Chi Chi Wu: Yes, yes, all of those. And then, their credit would get pulled, this medical debt would show up. And they’d be left scrambling because they would have to clear that debt from their credit report before they could get that mortgage or car loan or job or apartment, and even if they were like, ‘I paid that, or insurance should have paid that,’ they didn’t have time to deal with it. Because if you’re in the middle of this big important transaction, you don’t have time to wait 30 days for a credit reporting dispute to be resolved. And often it takes longer.

Dan: So, people paid up. They didn’t have a choice. 

Chi Chi Wu:  And the reason debt collectors do that is because it’s cheap. It’s cheap to do credit reporting. It’s expensive to send a letter because it costs you, what is the price of a stamp right now?

Dan: 73 cents! Plus whatever it costs you to print it out and stuff. A guy who used to be a debt collector once told me sending a bill costs two bucks. 

Chi Chi Wu says the CFPB started working on a rule banning “parking” during the second Obama administration. And finalized the rule in 2020, under Donald Trump. It takes a while.

When Joe Biden became President, he appointed a CFPB director who put extra focus on medical debts. The credit bureaus got the idea that they might be subject to some new rules on that topic, and volunteered to make some changes of their own. 

In May 2022 they announced: Instead of waiting just six months to put medical bills on credit reports, they were gonna wait a full year. 

Chi Chi Wu: Because six months sometimes is not enough to deal with an insurance dispute, right? I mean, sometimes it takes a lot longer. So they extended that to a year and then they agreed not to report medical debts under 500.

Dan: And that’s when I first talked with Lara Cecarelli for this show. 

I was trying to figure out: Was it really a big deal? The debts would still be on the books — collectors could still bug people about them. And tons of debts would stay on credit reports. 

Lara told me: YEP. That’s gonna be a big deal. 

When we talked this month, she told me she could see the impact of the CFPB in her work day to day.

Lara: We’ve seen a huge decrease in the number of complaints from consumers, or difficulty that consumers are having with medical debt. It’s still something that we see. But you know, I used to have at least one conversation about medical debt a day, usually more, and that’s not the case. You know, I’m having a couple of conversations per week, maybe, about medical debt. So we’ve seen the impact.

Dan: And she could see more on the horizon: 

In January, before the inauguration, the CFPB actually issued new rules about medical debt. Like we said, credit bureaus had already promised to remove everything below five hundred dollars. 

Now, under the new rules, all medical debts would come off. And lenders couldn’t look at medical debts when they made lending decisions. 

The CFPB had planned to start enforcing those rules in March.

Now– on that Sunday evening in February– Lara was seeing news: The whole agency was shutting down. Over the next few days, news outlets reported more than a hundred and fifty immediate layoffs — and the cancellation of more than $100 million in contracts. And rumors of much deeper cuts to come.   

Lara started doing this job during the first Tump administration. She says, this sweeping change is not just a swing of the pendulum back to how things were then.    

Lara: No, this is new territory. They were still robust, they were still responsive to client complaints. The enforcement and the protection was still there,

Dan: For right now, it’s gone. Coming up: What the first CFPB-free week was like for Lara and her colleagues. What she’s telling clients now. And what Chi Chi Wu and her colleagues are doing. 

An Arm and a Leg is a co-production of Public Road Productions and Ñî¹óåú´«Ã½Ò•îl Health News — that’s a nonprofit newsroom covering health issues in America. KFF’s reporters do amazing work. We’re honored to work with them. 

Lara Ceccarelli says she’s had to revise what she’s used to telling clients. Because referring people to the CFPB was a pretty regular part of herday to day works.

Lara: It makes a difference feeling like you’ve got a powerhouse at your back. You say, you know, the CFPB is incredibly solid, they will help support you. You know, all you have to do is reach out. They’re communicative, and they are robust, and I can’t say that anymore. 

Dan: There’s still a website. There’s still a phone number. 

Lara: But you’re not getting a person right now. You’re getting voicemails. So at this point, we’re still advising clients that the CFPB is, you know, an important agency But we’re also informing them that right now the CFPB is basically going dark,

Dan: So, she’s telling people: Hey, it’s worth calling the CFPB, just in case somebody picks up. But meanwhile here are some other places to call. 

Lara: I had a client who had been threatened by a debt collector, and the debt that they’re collecting on is actually outside of the statute of limitations. It’s not collectible anymore. But they’re being harassed basically, you know, calling them at all hours of the day and night and advising them that, you know, they’re still subject to legal action, none of which is true.

Dan: Which means, Lara tells me, that collector is breaking a law called the Fair Debt Collection Practices Act. 

Lara: And normally I would have sent that client in the direction of the CFPB. 

Dan: Normally, you file a complaint with the CFPB, the company responds to you within 15 days, according to the agency’s website.

Lara says companies pay attention– because the CFPB has a big stick. In 2023, the agency shut down one medical-debt collection company for violating this very law.

That version of normal is gone for now. But Lara happens to know, the Federal Trade Commission — which is still up and running– also has authority to enforce that law. They’re not specialists, but they’ve got someone to answer the phones. So she encouraged her client to try them. 

Other folks, she’s referring to their state attorney general’s office. In a lot of states, consumer-protection is a big part of the state AG’s job. Some state’s have independent consumer protection bureaus. 

Lara and her colleagues respect the work they do. 

But it’s not the same as having a powerful, national agency that enforces federal law.

Lara: You know, it wasn’t something where somebody in Ohio has a different set of rules from somebody in California as far as where you go and who you contacted. Centralized enforcement and made it really easy for everybody to know where to go to get help with their particular issue. All these other different places, can sort of take up a piece of the enforcement action , but none of them have that same robust power that the CFPB had, or the direct focus specifically on financial institutions and and their interactions with consumers directly.

Dan: Lara and her colleagues are still there. She says their funding comes from private organizations, not the feds. 

Lara: We’re not worried about the lights going out here yet

We all tried to lift each other up and, you know, talk about the other resources that we have available, all of which are valuable. and we have to, you know, maintain some degree of equilibrium, when you’re speaking to clients that, you know, one of you could have a breakdown at a time, right?

And that’s never our turn. So, um, you know, you have to maintain some degree of optimism and positivity, because if you’re not optimistic and positive, for their outcomes. How can they possibly think there’s hope for the future? 

Dan: Lara says she’s doing her best at work– and working on keeping her balance.  

Lara:  I’ve got a beautiful little paint mare that I ride um, and I get to go out and play with her whenever the, uh, news gets too bleak. Normally, she gets, uh, one or two days without, you know, having to put up with me, but right now the need is dire.

Dan: Meanwhile, Chi Chi Wu is fighting. On two fronts. 

I mentioned earlier: Biden’s CFPB took a big parting shot in early January. The agency finalized a rule banning medical debts from credit reports.

That rule got hit immediately with lawsuits from ACA International — that’s the industry association for debt collectors — and the credit bureaus.

Chi Chi Wu and her colleagues at the National Consumer Law Center figured: The Trump Administration might not defend those lawsuits. 

So they started preparing motions to intervene: basically asking the court’s permission to take over the defense. On the Sunday evening when Lara Ceccarelli read about the CFPB shutdown on the news, Chi Chi Wu was not watching the news.

Chi Chi Wu: I had been working like a mad woman that weekend 

Dan: Drafting documents for that motion to intervene.

Chi Chi Wu: So I was kind of busy all weekend, writing, not watching the Super Bowl

Dan: She got word from colleagues that Trump’s people had shut down the CFPB, and she was like, “OK. That going into this document I’m writing..”

Chi Chi Wu: …Because that was more support saying, well, the, this new CFPB is not going to defend this rule and so you should let us defend the rule.

Dan: Let us — the NCLC — defend the rule in court. 

So OK, that was material for her fight on one front. But of course it opens up another front, another legal battle. 

In this one, NCLC is actually a plaintiff — along with a union representing CFPB employees, and a couple other non profits. On February 13– four days after the CFPB went dark — they asked a federal judge, basically to stop the CFPB shutdown. 

The next day, the judge issued a temporary order, telling the CFPB to hold off on three things:

One. No more mass firings.

Two: Don’t destroy data — or take data down from public websites.

And three: Don’t return money to congress.

That order lasts just over two weeks, then there’s a hearing scheduled. That’s happening a few days after we publish this episode, and we’ll be watching.  . 

The other lawsuit, about the CFPB’s rule on medical debt– it’s on a slower timetable. 

Meanwhile, Chi Chi Wu says there are other fronts to fight on, and not just for her.

Chi Chi Wu: This is where states can step in and protect the consumers in their state. Nine states have already banned medical debt from credit reports. New York, Colorado, California, Rhode Island, even Virginia — a purple state. And so, if your listeners are wondering what can they do —  I mean, you know, obviously contact their members of Congress to support the CFPB — but also, you know, if they are in a state that doesn’t have one of these laws, they can try to get their state legislatures to pass a law to protect them from medical debts on credit reports.

Dan: We are gonna do our best to stay on top of this story.A few days after we publish this episode, there’ll be that  hearing in federal court on the lawsuit opposing the CFPB’s shutdown.  

I’ll post updates on the social networking site BlueSky — it’s kind of a Twitter substitute, and you can find me there at danweissmann (spelled with two esses and two enns)

Next week’s First Aid Kit newsletter will include a roundup of what we know, and what resources are available. If you’re not signed up for First Aid Kit yet, just head to arm and a leg show, dot com, slash, first aid kit.

And we’ll be back in a few weeks, with an episode about one listener’s fight — successful fight — against a six thousand dollar charge. 

Megan: I didn’t need to be an expert on this. I just needed to have access to the tools and the podcast would remind me of them. So I was like, okay, I’m so confident that I do not owe this  and so that would get me, like, really amped up and angry about it.

Till then, take care of yourself.

This episode of An Arm and a Leg was produced by me, Dan Weissmann, with

help from Emily Pisacreta and Claire Davenport — and edited by Afi Yellow-Duke. 

Ellen Weiss is our series editor.

Adam Raymonda is our audio wizard. 

Our music is by Dave Weiner and Blue Dot Sessions. 

Bea Bosco is our consulting director of operations.

Lynne Johnson is our operations manager.

An Arm and a Leg is produced in partnership with Ñî¹óåú´«Ã½Ò•îl Health News. That’s a national newsroom producing in-depth journalism about health issues in America — and a core program at KFF:  an independent source of health policy research, polling, and journalism.

Zach Dyer is senior audio producer at Ñî¹óåú´«Ã½Ò•îl Health News. He’s editorial liaison to this show.

And thanks to the Institute for Nonprofit News for serving as our fiscal sponsor.

They allow us to accept tax-exempt donations. You can learn more about INN at

INN.org.

Finally, thank you to everybody who supports this show financially.

You can join in any time at:

Thanks! And thanks for listening.

“An Arm and a Leg” is a co-production of Ñî¹óåú´«Ã½Ò•îl Health News and Public Road Productions.

To keep in touch with “An Arm and a Leg,” . You can also follow the show on Ìý²¹²Ô»åÌý³Ù³ó±ð . And if you’ve got stories to tell about the health care system, the producers .

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]]> 1996943 /news/article/biden-administration-cfpb-medical-debt-credit-scores-final-rule/ Tue, 07 Jan 2025 10:00:00 +0000 The federal Consumer Financial Protection Bureau on Tuesday issued new regulations barring medical debts from American credit reports, enacting a major new consumer protection just days before President Joe Biden is set to leave office.

The rules ban credit agencies from including medical debts on consumers’ credit reports and prohibit lenders from considering medical information in assessing borrowers.

These rules, which the federal watchdog agency proposed in June, could be reversed after President-elect Donald Trump takes office Jan. 20. But by finalizing the regulations now, the CFPB effectively dared the incoming Trump administration and its Republican allies in Congress to undue rules that are broadly popular and could help millions of people who are burdened by medical debt.

“People who get sick shouldn’t have their financial future upended,” CFPB Director Rohit Chopra said in announcing the new rules. “The CFPB’s final rule will close a special carveout that has allowed debt collectors to abuse the credit reporting system to coerce people into paying medical bills they may not even owe.”

The regulations fulfill a pledge by the Biden administration to address the scourge of health care debt, a problem that touches an estimated 100 million Americans, forcing many to make sacrifices such as limiting food, clothing, and other essentials.

Credit reporting, a threat that has been wielded by medical providers and debt collectors to get patients to pay their bills, is the most common collection tactic used by hospitals, a Ñî¹óåú´«Ã½Ò•îl Health News analysis found.

The impact can be devastating, especially for those with large health care debts.

There is growing evidence, for example, that credit scores depressed by medical debt can threaten people’s access to housing and drive homelessness. People with low credit scores can also have trouble getting a loan or can be forced to borrow at higher interest rates.

That has prompted states including Colorado, New York, and California to enact legislation prohibiting medical debt from being included on residents’ credit reports or factored into their credit scores. Still, many patients and consumer advocates have pushed for a national ban.

The CFPB has estimated that the new credit reporting rule will boost the credit scores of people with medical debt on their credit reports by an average of 20 points.

But the agency’s efforts to restrict medical debt collections have drawn fierce pushback from the collections industry. And the new rules will almost certainly be challenged in court.

Congressional Republicans have frequently criticized the watchdog agency. Last year, then-chair of the House Financial Services Committee Patrick McHenry (R-N.C.) labeled the CFPB’s medical debt proposal “regulatory overreach.”

More recently, billionaire Elon Musk, whom Trump has tapped to co-lead his initiative to shrink government, of the watchdog agency. “Delete CFPB,” Musk posted on the social platform X.

]]> 1966066 /news/article/medical-debt-trump-consumer-financial-protection-bureau-reverses-credit-protections/ Tue, 28 Oct 2025 21:50:00 +0000 The Trump administration took another step Tuesday to weaken protections for Americans with medical debt, issuing new guidance that threatens ongoing state efforts to keep that debt off consumers’ credit reports.

More than a dozen states, including Washington, Oregon, California, Colorado, Minnesota, Maryland, New York, and most of New England, have enacted laws in recent years to keep medical debt from affecting consumers’ credit.

And more states — including several in conservative regions of the Midwest and Mountain West — have been considering similar protections, spurred by bipartisan concerns that medical debt on a credit report can make it harder for people to get a home, a car, or a job.

Nationwide, about 100 million people have some form of health care debt, with millions burdened by $10,000 or more in unpaid bills.

But , the Consumer Financial Protection Bureau asserts that federal law bars states from restricting medical debts from credit reports, arguing that only the federal government has this authority.

“Congress meant to occupy the field of consumer reporting and displace state laws,” the bureau concluded in an “interpretive rule” signed by Russell Vought, the White House budget director and acting head of the CFPB.

The guidance, which offers a new interpretation of the Fair Credit Reporting Act, reverses policies advanced under former President Joe Biden that sought to empower states to expand protections for people with medical debt.

The Trump administration’s latest move will not immediately roll back existing state protections.

But advocates for patients and consumers warn that the new guidance may stall progress elsewhere, just as millions of Americans are poised to lose federal aid that helps them buy health insurance through the Affordable Care Act. The aid is tied up in the current budget showdown between congressional Republicans and Democrats.

“You’d be hard-pressed to find a crueler regulatory interpretation,” said Elisabeth Benjamin, a vice president for the Community Service Society of New York. The nonprofit has pushed for medical debt protections in that state.

Lucy Culp, who oversees state lobbying efforts by Blood Cancer United, formerly known as the Leukemia & Lymphoma Society, warned that the Trump administration’s guidance could reverberate across the country. “This rule will have a chilling effect on states’ willingness to pass these critical patient protections,” she said.

The CFPB did not respond to a request for comment.

The new CFPB guidance might spur more litigation challenging state restrictions on medical debt credit reporting.

Trade groups representing credit reporting agencies and debt collectors went to court early this year challenging regulations issued by the Biden administration that would have removed medical debt from credit reports nationwide. They argued that the administration exceeded its authority in issuing the credit reporting restrictions.

The federal restrictions would have helped an estimated 15 million people. But the Trump administration chose not to defend the new regulations, and a federal judge in Texas appointed by Trump ruled that the regulations should be scrapped. They never went into effect.

The Consumer Data Industry Association, which represents credit agencies and has argued that regulating medical debt should be left to the federal government, welcomed the new guidance from the Trump administration.

“There should be one national standard to govern how information is provided to consumer reporting agencies and what information can appear on a consumer’s credit report,” association president Dan Smith said in a statement.

Broader health insurance protections could prevent more Americans from sinking into debt and depressing their credit scores.

But millions of Americans to lose health coverage in the coming years as a result of the tax and spending bill signed by the president in July.

“Millions of Americans are avoiding medical care, putting off needed surgeries, skipping essential treatments,” said Allison Sesso, president and chief executive of Undue Medical Debt, a nonprofit that buys up and retires patients’ debts and advocates for broader patient protections.

“This isn’t just a health care issue,” Sesso added. “It’s an economic crisis that’s keeping families from building wealth and fully participating in the economy. When credit scores are dinged by medical bills, everyone loses.”

“The election simply shifts our focus,” said Eva Stahl, who oversees public policy at Undue Medical Debt, a nonprofit that has worked closely with the Biden administration and state leaders on medical debt. “States are going to be the epicenter of policy change to mitigate the harms of medical debt.”

New state initiatives may not be enough to protect Americans from medical debt if the incoming Trump administration and congressional Republicans move forward with plans to scale back federal aid that has helped millions gain health insurance or reduce the cost of their plans in recent years.

Comprehensive health coverage that limits patients’ out-of-pocket costs remains the best defense against medical debt.

But in the face of federal retrenchment, advocates are eyeing new initiatives in state legislatures to keep medical bills off people’s credit reports, a consumer protection that can boost credit scores and make it easier to buy a car, rent an apartment, or even get a job.

Several states are looking to strengthen oversight of medical credit cards and other financial products that can leave patients paying high interest rates on top of their medical debt.

Some states are also exploring new ways to compel hospitals to bolster financial aid programs to help their patients avoid sinking into debt.

“There’s an enormous amount that states can do,” said Elisabeth Benjamin, who leads health care initiatives at the nonprofit Community Service Society of New York. “Look at what’s happened here.”

New York state has enacted several laws in recent years to rein in hospital debt collections and to expand financial aid for patients, often with support from both Democrats and Republicans in the legislature. “It doesn’t matter the party. No one likes medical debt,” Benjamin said.

Other states that have enacted protections in recent years include Arizona, California, Colorado, Connecticut, Florida, Illinois, Minnesota, Nevada, New Jersey, New Mexico, Oregon, Rhode Island, and Washington. Many measures picked up bipartisan support.

President Joe Biden’s administration has proved to be an ally in state efforts to control health care debt. Such debt burdens 100 million people in the United States, a Ñî¹óåú´«Ã½Ò•îl Health News investigation found.

Led by Biden appointee Rohit Chopra, the Consumer Financial Protection Bureau has made medical debt a priority, going after aggressive collectors and exposing problematic practices across the medical debt industry. Earlier this year, the agency proposed landmark regulations to remove medical bills from consumer credit scores.

The White House also championed legislation to boost access to government-subsidized health insurance and to cap out-of-pocket drug costs for seniors, both key bulwarks against medical debt.

Trump hasn’t indicated whether his administration will move ahead with the CFPB credit reporting rule, which was slated to be finalized early next year. Congressional Republicans, who will control the House and Senate next year, have as regulatory overreach that will compromise the value of credit reports.

And Elon Musk, the billionaire whom Trump has tapped to lead his initiative to shrink government, last week . “Delete CFPB,” Musk posted on X.

If the CFPB withdraws the proposed regulation, states could enact their own rules, following the lead of Colorado, New York, and other states that have passed credit reporting bans since 2023. Advocates in Massachusetts are pushing the legislature there to take up a ban when it reconvenes in January.

“There are a lot of different levers that states have to take on medical debt,” said April Kuehnhoff, a senior attorney at the National Consumer Law Center, which has helped lead national efforts to expand debt protections for patients.

Kuehnhoff said she expects more states to crack down on medical credit card providers and other companies that lend money to patients to pay off medical bills, sometimes at double-digit interest rates.

Under the Biden administration, the CFPB has been investigating patient financing companies amid warnings that many people may not understand that signing up for a medical credit card such as CareCredit or enrolling in a payment plan through a financial services company can pile on more debt.

If the CFPB efforts stall under Trump, states could follow the lead of California, New York, and Illinois, which have all tightened rules governing patient lending in recent years.

Consumer advocates say states are also likely to continue expanding efforts to get hospitals to provide more financial assistance to reduce or eliminate bills for low- and middle-income patients, a key protection that can keep people from slipping into debt.

Hospitals historically have not made this aid readily available, prompting states such as California, Colorado, and Washington to set stronger standards to ensure more patients get help with bills they can’t afford. This year, North Carolina also won approval from the Biden administration to withhold federal funding from hospitals in the state unless they agreed to expand financial assistance.

In Georgia, where state government is entirely in Republican control, officials have been discussing new measures to get hospitals to provide more assistance to patients.

“When we talk about hospitals putting profits over patients, we get lots of nodding in the legislature from Democrats and Republicans,” said Liz Coyle, executive director of Georgia Watch, a consumer advocacy nonprofit.

Many advocates caution, however, that state efforts to bolster patient protections will be critically undermined if the Trump administration cuts federal funding for health insurance programs such as Medicaid and the insurance marketplaces established through the Affordable Care Act.

Trump and congressional Republicans have signaled their intent to roll back federal subsidies passed under Biden that make health plans purchased on ACA marketplaces more affordable. That could hike annual premiums by hundreds or even thousands of dollars for many enrollees, by the Center on Budget and Policy Priorities, a think tank.

And during Trump’s first term, he backed efforts in Republican-led states to restrict enrollment in their Medicaid safety net programs through rules that would require people to work in order to receive benefits. GOP state leaders in Idaho, Louisiana, and other states have expressed a desire to renew such efforts.

“That’s all a recipe for more medical debt,” said Stahl, of Undue Medical Debt.

Jessica Altman, who heads the Covered California insurance marketplace, warned that federal cuts will imperil initiatives in her state that have limited copays and deductibles and curtailed debt for many state residents.

“States like California that have invested in critical affordable programs for our residents will face tough decisions,” she said.

Y ven a la vicepresidenta y candidata demócrata como la mejor esperanza para preservar el acceso de los estadounidenses a seguros de salud. La cobertura integral que limita los costos directos de los pacientes es la mejor defensa contra el endeudamiento, dicen los expertos.

La administración Biden ha ampliado las protecciones financieras para los pacientes, incluyendo una propuesta histórica de la Oficina de Protección Financiera del Consumidor (CFPB) para eliminar la deuda médica de los informes de crédito de los consumidores.

En 2022, el presidente Joe Biden también firmó la Ley de Reducción de la Inflación, que limita cuánto deben pagar los afiliados de Medicare por medicamentos recetados, incluyendo un tope de $35 al mes para la insulina. Y en legislaturas de todo el país, demócratas y republicanos han trabajado juntos de manera discreta para promulgar leyes que frenen a los cobradores de deudas.

Sin embargo, defensores dicen que el gobierno federal podría hacer más para abordar un problema que afecta a 100 millones de estadounidenses, obligando a muchos a trabajar más, perder sus hogares y reducir el gasto en alimentos y otros artículos esenciales.

“Biden y Harris han hecho más para abordar la crisis de deuda médica en este país que cualquier otra administración”, dijo Mona Shah, directora senior de política y estrategia en Community Catalyst, una organización sin fines de lucro que ha liderado los esfuerzos nacionales para fortalecer las protecciones contra la deuda médica. “Pero hay más por hacer y debe ser una prioridad para el próximo Congreso y administración”.

Al mismo tiempo, los defensores de los pacientes temen que si el ex presidente Donald Trump gana un segundo mandato, debilitará las protecciones de los seguros permitiendo que los estados recorten sus programas de Medicaid o reduciendo la ayuda federal para que los estadounidenses compren cobertura médica. Eso pondría a millones de personas en mayor riesgo de endeudarse si enferman.

En su primer mandato, Trump y los republicanos del Congreso intentaron en 2017 derogar la Ley de Cuidado de Salud a Bajo Precio (ACA), un movimiento que, según analistas independientes, habría despojado de cobertura médica a millones de estadounidenses y habría aumentado los costos para las personas con afecciones preexistentes, como diabetes y cáncer.

Trump y sus aliados del Partido Republicano continúan atacando a ACA, y el ex presidente ha dicho que quiere revertir la Ley de Reducción de la Inflación, que también incluye ayuda para que los estadounidenses de bajos y medianos ingresos compren seguros de salud.

“Las personas enfrentarán una ola de deuda médica por pagar primas y precios de medicamentos recetados”, dijo Anthony Wright, director ejecutivo de Families USA, un grupo de consumidores que ha apoyado las protecciones federales de salud. “Los pacientes y el público deberían estar preocupados”.

La campaña de Trump no respondió a consultas sobre su agenda de salud. Y el ex presidente no suele hablar de atención médica o deuda médica en la campaña, aunque dijo en el debate del mes pasado que tenía “conceptos de un plan” para mejorar la ACA. Trump no ha ofrecido detalles.

Harris ha prometido repetidamente proteger ACA y renovar los subsidios ampliados para las primas mensuales del seguro creados por la Ley de Reducción de la Inflación. Esa ayuda está programada para expirar el próximo año.

La vicepresidenta también ha expresado su apoyo a un mayor gasto gubernamental para comprar y cancelar deudas médicas antiguas de los pacientes. En los últimos años, varios estados y ciudades han comprado deuda médica en nombre de sus residentes.

Estos esfuerzos han aliviado la deuda de cientos de miles de personas, aunque muchos defensores dicen que cancelar deudas antiguas es, en el mejor de los casos, una solución a corto plazo, ya que los pacientes seguirán acumulando facturas que no pueden pagar sin una acción más sustantiva.

“Es un bote con un agujero”, dijo Katie Berge, una cabildera de la Sociedad de Leucemia y Linfoma. Este grupo de pacientes fue una de más de 50 organizaciones que el año pasado enviaron cartas a la administración Biden instando a las agencias federales a tomar medidas más agresivas para proteger a los estadounidenses de la deuda médica.

“La deuda médica ya no es un problema de nicho”, dijo Kirsten Sloan, quien trabaja en política federal para la Red de Acción contra el Cáncer de la Sociedad Americana de Cáncer. “Es clave para el bienestar económico de millones de estadounidenses”.

La Oficina de Protección Financiera del Consumidor está desarrollando regulaciones que prohibirían que las facturas médicas aparezcan en los informes de crédito de los consumidores, lo que mejoraría los puntajes crediticios y facilitaría que millones de estadounidenses alquilen una vivienda, consigan un trabajo o consigan un préstamo para un automóvil.

Harris, quien ha calificado la deuda médica como “crítica para la salud financiera y el bienestar de millones de estadounidenses”, apoyó con entusiasmo la propuesta de regulación. “No se debería privar a nadie del acceso a oportunidades económicas simplemente porque experimentó una emergencia médica”, dijo en junio.

El compañero de fórmula de Harris, el gobernador de Minnesota, Tim Walz, quien ha dicho que su propia familia luchó con la deuda médica cuando era joven, firmó en junio una ley estatal que .

Los funcionarios de la CFPB dijeron que las regulaciones se finalizarán a principios del próximo año. Trump no ha indicado si seguiría adelante con las protecciones contra la deuda médica. En su primer mandato, la CFPB hizo poco para abordarla, y los republicanos en el Congreso han criticado durante mucho tiempo a la agencia reguladora.

Si Harris gana, muchos grupos de consumidores quieren que la CFPB refuerce aún más las medidas, incluyendo una mayor supervisión de las tarjetas de crédito médicas y otros productos financieros que los hospitales y otros proveedores médicos han comenzado a ofrecer a los pacientes. Por estos préstamos, las personas están obligadas a pagar intereses adicionales sobre su deuda médica.

“Estamos viendo una variedad de nuevos productos financieros médicos”, dijo April Kuehnhoff, abogada senior del Centro Nacional de Derecho del Consumidor. “Estos pueden generar nuevas preocupaciones sobre las protecciones al consumidor, y es fundamental que la CFPB y otros reguladores supervisen a estas empresas”.

Algunos defensores quieren que otras agencias federales también se involucren.

Esto incluye al enorme Departamento de Salud y Servicios Humanos (HHS), que controla cientos de miles de millones de dólares a través de los programas de Medicare y Medicaid. Ese dinero otorga al gobierno federal una enorme influencia sobre los hospitales y otros proveedores médicos.

Hasta ahora, la administración Biden no ha utilizado esa influencia para abordar la deuda médica.

Pero en un posible anticipo de futuras acciones, los líderes estatales en Carolina del Norte recientemente obtuvieron la aprobación federal para una iniciativa de deuda médica que obligará a los hospitales a tomar medidas para aliviar las deudas de los pacientes a cambio de ayuda gubernamental. Harris elogió la iniciativa.

And they see the vice president and Democratic nominee as the best hope for preserving Americans’ access to health insurance. Comprehensive coverage that limits patients’ out-of-pocket costs offers the best defense against going into debt, experts say.

The Biden administration has expanded financial protections for patients, including a landmark proposal by the Consumer Financial Protection Bureau to remove medical debt from consumer credit reports.

In 2022, President Joe Biden also signed the Inflation Reduction Act, which limits how much Medicare enrollees must pay out-of-pocket for prescription drugs, including a $35-a-month cap on insulin. And in statehouses across the country, Democrats and Republicans have been quietly working together to enact laws to rein in debt collectors.

But advocates say the federal government could do more to address a problem that burdens 100 million Americans, forcing many to take on extra work, give up their homes, and cut spending on food and other essentials.

“Biden and Harris have done more to tackle the medical debt crisis in this country than any other administration,” said Mona Shah, senior director of policy and strategy at Community Catalyst, a nonprofit that has led national efforts to strengthen protections against medical debt. “But there is more that needs to be done and should be a top priority for the next Congress and administration.”

At the same time, patient advocates fear that if former President Donald Trump wins a second term, he will weaken insurance protections by allowing states to cut their Medicaid programs or by scaling back federal aid to help Americans buy health insurance. That would put millions of people at greater risk of sinking into debt if they get sick.

In his first term, Trump and congressional Republicans in 2017 tried to repeal the Affordable Care Act, a move that independent analysts concluded would have stripped health coverage from millions of Americans and driven up costs for people with preexisting medical conditions, such as diabetes and cancer.

Trump and his GOP allies continue to attack the ACA, and the former president has said he wants to roll back the Inflation Reduction Act, which also includes aid to help low- and middle-income Americans buy health insurance.

“People will face a wave of medical debt from paying premiums and prescription drug prices,” said Anthony Wright, executive director of Families USA, a consumer group that has backed federal health protections. “Patients and the public should be concerned.”

The Trump campaign did not respond to inquiries about its health care agenda. And the former president doesn’t typically discuss health care or medical debt on the campaign trail, though he said at last month’s debate he had “concepts of a plan” to improve the ACA. Trump hasn’t offered specifics.

Harris has repeatedly pledged to protect the ACA and renew expanded subsidies for monthly insurance premiums created by the Inflation Reduction Act. That aid is slated to expire next year.

The vice president has also voiced support for more government spending to buy and retire old medical debts for patients. In recent years, a number of states and cities have purchased medical debt on behalf of their residents.

These efforts have relieved debt for hundreds of thousands of people, though many patient and consumer advocates say retiring old debt is at best a short-term solution, as patients will continue to run up bills they cannot pay without more substantive action.

“It’s a boat with a hole in it,” said Katie Berge, a lobbyist for the Leukemia & Lymphoma Society. The patient group was among more than 50 organizations that last year sent letters to the Biden administration urging federal agencies to take more aggressive steps to protect Americans from medical debt.

“Medical debt is no longer a niche issue,” said Kirsten Sloan, who works on federal policy for the American Cancer Society’s Cancer Action Network. “It is key to the economic well-being of millions of Americans.”

The Consumer Financial Protection Bureau is developing regulations that would bar medical bills from consumer credit reports, which would boost credit scores and make it easier for millions of Americans to rent an apartment, get a job, or secure a car loan.

Harris, who has called medical debt “critical to the financial health and well-being of millions of Americans,” enthusiastically backed the proposed rule. “No one should be denied access to economic opportunity simply because they experienced a medical emergency,” she said in June.

Harris’ running mate, Minnesota Gov. Tim Walz, who has said his own family struggled with medical debt when he was young, signed a state law in June .

CFPB officials said the regulations would be finalized early next year. Trump hasn’t indicated if he’d follow through on the medical debt protections. In his first term, the CFPB did little to address medical debt, and congressional Republicans have long criticized the regulatory agency.

If Harris prevails, many consumer groups want the CFPB to crack down even further, including tightening oversight of medical credit cards and other financial products that hospitals and other medical providers have started pushing on patients. These loans lock people into interest payments on top of their medical debt.

“We are seeing a variety of new medical financial products,” said April Kuehnhoff, a senior attorney at the National Consumer Law Center. “These can raise new concerns about consumer protections, and it is critical for the CFPB and other regulators to monitor these companies.”

Some advocates want other federal agencies to get involved, as well.

This includes the mammoth Health and Human Services department, which controls hundreds of billions of dollars through the Medicare and Medicaid programs. That money gives the federal government enormous leverage over hospitals and other medical providers.

Thus far, the Biden administration hasn’t used that leverage to tackle medical debt.

But in a potential preview of future actions, state leaders in North Carolina recently won federal approval for a medical debt initiative that will make hospitals take steps to alleviate patient debts in exchange for government aid. Harris praised the initiative.

Since then, the CFPB has done its share of policing mortgage brokers, student loan companies, and banks. But as the U.S. health care system turns tens of millions of Americans into debtors, this financial watchdog is increasingly working to protect beleaguered patients, adding hospitals, nursing homes, and patient financing companies to the list of institutions that regulators are probing.

In the past two years, the CFPB has penalized medical debt collectors, issued stern warnings to health care providers and lenders that target patients, and published reams of reports on how the health care system is undermining the financial security of Americans.

In its most ambitious move to date, the agency is developing rules to bar medical debt from consumer credit reports, a sweeping change that could make it easier for Americans burdened by medical debt to rent a home, buy a car, even get a job. Those rules are expected to be unveiled later this year.

“Everywhere we travel, we hear about individuals who are just trying to get by when it comes to medical bills,” said Rohit Chopra, the director of the CFPB whom President Joe Biden tapped to head the watchdog agency in 2021.

“American families should not have their financial lives ruined by medical bills,” Chopra continued.

The CFPB’s turn toward medical debt has stirred opposition from collection industry officials, who say the agency’s efforts are misguided. “There’s some concern with a financial regulator coming in and saying, ‘Oh, we’re going to sweep this problem under the rug so that people can’t see that there’s this medical debt out there,’” said Jack Brown III, a longtime collector and member of the industry trade group ACA International.

Brown and others question whether the agency has gone too far on medical billing. ACA International has suggested collectors could go to court to fight any rules barring medical debt from credit reports.

At the same time, the U.S. Supreme Court is considering a to the agency’s funding that some conservative critics and financial industry officials hope will lead to the dissolution of the agency.

But CFPB’s defenders say its move to address medical debt simply reflects the scale of a crisis that now touches some 100 million Americans and that a divided Congress seems unlikely to address soon.

“The fact that the CFPB is involved in what seems like a health care issue is because our system is so dysfunctional that when people get sick and they can’t afford all their medical bills, even with insurance, it ends up affecting every aspect of their financial lives,” said Chi Chi Wu, a senior attorney at the National Consumer Law Center.

CFPB researchers documented that unpaid medical bills were historically the most common form of debt on consumers’ credit reports, representing more than half of all debts on these reports. But the agency found that medical debt is typically a poor predictor of whether someone is likely to pay off other bills and loans.

Medical debts on credit reports are also frequently riddled with errors, according to of consumer complaints, which the agency found most often cite issues with bills that are the wrong amount, have already been paid, or should be billed to someone else.

“There really is such high levels of inaccuracy,” Chopra said in an interview with Ñî¹óåú´«Ã½Ò•îl Health News. “We do not want to see the credit reporting system being weaponized to get people to pay bills they may not even owe.”

The aggressive posture reflects Chopra, who cut his teeth helping to stand up the CFPB almost 15 years ago and made a name for himself going after the student loan industry.

Targeting for-profit colleges and lenders, Chopra said he was troubled by an increasingly corporate higher-education system that was turning millions of students into debtors. Now, he said, he sees the health care system doing the same thing, shuttling patients into loans and credit cards and reporting them to credit bureaus. “If we were to rewind decades ago,” Chopra said, “we saw a lot less reliance on tools that banks used to get people to pay.”

The push to remove medical bills from consumer credit reports culminates two years of intensive work by the CFPB on the medical debt issue.

The agency against forcing residents’ friends and family to assume responsibility for residents’ debts. An investigation by Ñî¹óåú´«Ã½Ò•îl Health News and NPR documented widespread use of lawsuits by nursing homes in communities to pursue friends and relatives of nursing home residents.

The CFPB also has with how hospitals provide financial assistance to low-income patients. Regulators last year of loans and credit cards that health care providers push on patients, often saddling them with more debt.

And regulators have gone after medical debt collectors. In December, the CFPB a Pennsylvania company for pursuing patients without ensuring the debts were accurate.

A few months before that, the agency working with medical debt for violating collection laws. Regulators said the company had “risked harming consumers by pressuring or inducing them to pay debts they did not owe.”

With their business in the crosshairs, debt collectors are warning that cracking down on credit reporting and other collection tools may prompt more hospitals and doctors to demand patients pay upfront for care.

There are some indications this is happening already, as hospitals and clinics push patients to enroll in loans or credit cards to pay their medical bills.

Scott Purcell, CEO of ACA International, said it would be wiser for the federal government to focus on making medical care more affordable. “Here we’re coming up with a solution that only takes money away from providers,” Purcell said. “If Congress was involved, there could be more robust solutions.”

Chopra doesn’t dispute the need for bigger efforts to tackle health care costs.

“Of course, there are broader things that we would probably want to fix about our health care system,” he said, “but this is having a direct financial impact on so many Americans.”

The CFPB can’t do much about the price of a prescription or a hospital bill, Chopra continued. What the federal agency can do, he said, is protect patients if they can’t pay their bills.

A pesar de algunos avances este año, especialmente en estados con mayoría demócrata, los recientes reveses en las legislaturas más conservadoras dejan claro lo difícil que es proteger a los pacientes.

Este año fracasaron proyectos de ley para proteger a los consumidores de deudas médicas en Indiana, Montana, Nevada, Dakota del Sur y Wyoming, debido a la oposición de la industria. Y defensores advierten que los estados deben actuar, ya que se espera que millones de personas pierdan su seguro médico debido a la ley fiscal y de gasto del presidente Donald Trump.

“Este ya era un tema clave incluso antes del cambio de administración en Washington”, dijo Kate Ende, directora de políticas de la organización Consumers for Affordable Health Care, con sede en Maine. “La retirada a nivel federal hizo aún más urgente movilizarse”.

Este año, Maine se unió a una creciente lista de estados que han prohibido que la deuda médica aparezca en los reportes de crédito de sus residentes, una protección que puede facilitar el acceso a una vivienda, un auto o incluso un empleo. La y con apoyo bipartidista.

Se estima que 100 millones de personas en Estados Unidos tienen algún tipo de deuda relacionada con la atención médica.

El gobierno federal estaba a punto de prohibir que la deuda médica apareciera en los reportes de crédito, gracias a una normativa emitida en los últimos días del mandato del ex presidente Joe Biden. Esa medida habría beneficiado a unas 15 millones de personas en todo el país.

Pero la administración Trump no defendió la normativa ante las demandas legales de agencias de cobro y burós de crédito, que argumentaban que la Oficina para la Protección Financiera del Consumidor (CFPB, en inglés) se había excedido en su autoridad.

Un juez federal de Texas, designado por Trump, falló que la normativa debía anularse.

Ahora, solo los pacientes que viven en estados que han aprobado sus propias normas sobre reportes de crédito podrán beneficiarse de esta protección. Más de una docena de estados tienen estas restricciones, entre ellos California, Colorado, Connecticut, Minnesota, Nueva York y Vermont, que al igual que Maine, adoptaron una prohibición este año.

En los últimos años, más estados han aprobado otras protecciones contra la deuda médica, como límites a la tasa de interés que se puede cobrar y restricciones al uso del embargo de salarios o la incautación de bienes para cobrar facturas médicas impagas.

En muchos casos, estas medidas han recibido apoyo bipartidista, lo que refleja la popularidad de las protecciones al consumidor. En Virginia, el gobernador republicano este año que limita el embargo de salarios y establece un tope a los intereses.

Y varios legisladores republicanos en California se unieron a los demócratas para que facilita el acceso a ayuda financiera de los hospitales para quienes enfrentan facturas elevadas.

“Este es el tipo de asunto de sentido común que afecta al bolsillo de las personas y que atrae tanto a republicanos como a demócratas”, señaló Eva Stahl, vicepresidenta de Undue Medical Debt, una organización sin fines de lucro que compra y perdona deudas médicas, y que ha trabajado para que se amplíen protecciones para pacientes.

Pero en varias legislaturas estatales, el impulso por nuevas protecciones se topó con barreras.

Proyectos de ley para prohibir que las deudas médicas aparecieran en los reportes de crédito fracasaron en y , a pesar del apoyo de algunos legisladores republicanos. Y las medidas para limitar los cobros agresivos contra residentes con deuda médica fueron rechazadas en , y .

En algunos estados, las propuestas enfrentaron una fuerte oposición de agencias de cobro, burós de crédito y bancos, que argumentaron ante los legisladores que sin información sobre deudas médicas podrían terminar otorgando a los consumidores préstamos de alto riesgo.

La representante estatal Lana Greenfield (republicana de Dakota del Sur), repitió las objeciones de la industria al pedir a sus colegas que votaran en contra de la prohibición. “Los bancos pequeños de comunidades pequeñas no podrían obtener información sobre una factura médica muy, muy grande. Y entonces, podrían otorgar un préstamo de buena fe a alguien sin saber realmente cuál era su crédito”, dijo Greenfield en el pleno de la Cámara.

Durante el gobierno de Biden, los encontraron que, a diferencia de otros tipos de deuda, la médica no era un buen indicador de la solvencia crediticia.

Pero el representante estatal Brian Mulder (republicano de Dakota del Sur), presidente del comité de salud que redactó la legislación, destacó el poder del sector bancario en el estado, donde regulaciones favorables lo han convertido en un imán para las instituciones financieras.

En Montana, una propuesta para proteger parte de los bienes de los deudores frente al embargo avanzó fácilmente en el comité. Sus defensores esperaban que fuera especialmente útil para pacientes nativos americanos, quienes enfrentan de forma desproporcionada la carga de la deuda médica.

Pero cuando el proyecto de ley llegó al pleno de la Cámara, los opositores “aparecieron en masa” y hablaron personalmente con los legisladores republicanos una hora antes de la votación, contó Ed Stafman, legislador demócrata y autor de la propuesta.

“Juntaron el número de votos suficientes para derrotar el proyecto por poco”, dijo.

Tanto defensores de los pacientes como legisladores que respaldaron estas medidas dijeron que son optimistas respecto a superar la oposición de la industria en el futuro.

Y hay señales de que algunas propuestas para ampliar las protecciones a los pacientes podrían avanzar en otros estados conservadores, como Ohio y Texas.

, una propuesta que obligaría a los hospitales sin fines de lucro a ampliar la ayuda financiera para quienes enfrentan facturas altas ha recibido el respaldo de organizaciones conservadoras influyentes.

“Estas cosas a veces toman tiempo”, dijo Lucy Culp, quien lidera el cabildeo estatal de Blood Cancer United (anteriormente conocida como Leukemia & Lymphoma Society). Esta organización ha impulsado leyes estatales de protección contra la deuda médica en años recientes, incluso en Montana y Dakota del Sur.

Lo más preocupante, dijo Culp, es la ola de pacientes sin seguro que se espera debido a los recortes en la cobertura médica derivados de la nueva ley fiscal aprobada por los republicanos. Esto agravará aún más el problema de la deuda médica en el país.

“Los estados no están preparados para eso”, advirtió Culp.

If enacted, the rules would dramatically expand protections for tens of millions of Americans burdened by medical bills they can’t afford.

The regulations would also fulfill a pledge by the Biden administration to address the scourge of health care debt, a uniquely American problem that touches an estimated 100 million people, forcing many to make sacrifices such as limiting food, clothing, and other essentials.

“No one should be denied access to economic opportunity simply because they experienced a medical emergency,” Vice President Kamala Harris said Tuesday.

The administration further called on states to expand efforts to restrict debt collection by hospitals and to make hospitals provide more charity care to low-income patients, a step that could prevent more Americans from ending up with medical debt.

And Harris urged state and local governments to continue to buy up medical debt and retire it, a strategy that has become increasingly popular nationwide.

Credit reporting, a threat traditionally used by medical providers and debt collectors to induce patients to pay their bills, is the most common collection tactic used by hospitals, a Ñî¹óåú´«Ã½Ò•îl Health News analysis has shown.

Although a single unpaid bill on a credit report may not hugely affect some people, the impact can be devastating for those with large health care debts.

There is growing evidence, for example, that credit scores depressed by medical debt can threaten people’s access to housing and fuel homelessness. People with low credit scores can also have problems getting a loan or can be forced to borrow at higher interest rates.

“We’ve heard stories of individuals who couldn’t get jobs because their medical debt was impacting their credit score and they had low credit,” said Mona Shah, a senior director at Community Catalyst, a nonprofit that’s pushed for expanded medical debt protections for patients.

Shah said the proposed regulations would have a major impact on patients’ financial security and health. “This is a really big deal,” she said.

Administration officials said they plan to review public comments about their proposal through the rest of this year and hope to issue a final rule early next year.

CFPB researchers that medical debt — unlike other kinds of debt — does not accurately predict a consumer’s creditworthiness, calling into question how useful it is on a credit report.

The three largest credit agencies — Equifax, Experian, and TransUnion — said they would stop including some medical debt on credit reports as of last year. The excluded debts included paid-off bills and those less than $500.

Those moves have substantially reduced the number of people with medical debt on their credit reports, government data shows. But the agencies’ voluntary actions left out many patients with bigger medical bills on their credit reports.

A found that 15 million people still have such bills on their credit reports, despite the voluntary changes. Many of these people live in low-income communities in the South, according to the report.

The proposed rules would not only bar future medical bills from appearing on credit reports; they would also remove current medical debts, according to administration officials.

Officials said the banned debt would include not only medical bills but also dental bills, a major source of Americans’ health care debt.

Even though the debts would not appear on credit scores, patients will still owe them. That means that hospitals, physicians, and other providers could still use other collection tactics to try to get patients to pay, including using the courts.

Patients who used credit cards to pay medical bills — including medical credit cards such as CareCredit — will also continue to see those debts on their credit scores as they would not be covered by the proposed regulation.

Hospital leaders and representatives of the debt collection industry have warned that restricting credit reporting may have unintended consequences, such as prompting more hospitals and physicians to require upfront payment before delivering care.

But consumer and patient advocates continue to call for more action. The National Consumer Law Center, Community Catalyst, and about 50 other groups last year sent letters to the CFPB and IRS urging stronger federal action to rein in hospital debt collection.

State leaders also have taken steps to expand consumer protections. In recent months, a growing number of states, led by Colorado and New York, have enacted legislation prohibiting medical debt from being included on residents’ credit reports or factored into their credit scores. Other states, including California, are considering similar measures.

Many groups are also urging the federal government to bar tax-exempt hospitals from selling patient debt to debt-buying companies or denying medical care to people with past-due bills, practices that remain widespread across the U.S., Ñî¹óåú´«Ã½Ò•îl Health News found.

About This Project

“Diagnosis: Debt” is a reporting partnership between Ñî¹óåú´«Ã½Ò•îl Health News and NPR exploring the scale, impact, and causes of medical debt in America.

The series draws on original polling by KFF, court records, federal data on hospital finances, contracts obtained through public records requests, data on international health systems, and a yearlong investigation into the financial assistance and collection policies of more than 500 hospitals across the country. 

Additional research was , which analyzed credit bureau and other demographic data on poverty, race, and health status for Ñî¹óåú´«Ã½Ò•îl Health News to explore where medical debt is concentrated in the U.S. and what factors are associated with high debt levels.

The JPMorgan Chase Institute  from a sampling of Chase credit card holders to look at how customers’ balances may be affected by major medical expenses. And the CED Project, a Denver nonprofit, worked with Ñî¹óåú´«Ã½Ò•îl Health News on a survey of its clients to explore links between medical debt and housing instability. 

Ñî¹óåú´«Ã½Ò•îl Health News journalists worked with KFF public opinion researchers to design and analyze the “.” The survey was conducted Feb. 25 through March 20, 2022, online and via telephone, in English and Spanish, among a nationally representative sample of 2,375 U.S. adults, including 1,292 adults with current health care debt and 382 adults who had health care debt in the past five years. The margin of sampling error is plus or minus 3 percentage points for the full sample and 3 percentage points for those with current debt. For results based on subgroups, the margin of sampling error may be higher.

Reporters from Ñî¹óåú´«Ã½Ò•îl Health News and NPR also conducted hundreds of interviews with patients across the country; spoke with physicians, health industry leaders, consumer advocates, debt lawyers, and researchers; and reviewed scores of studies and surveys about medical debt.

Si se promulgan, estas reglas ampliarían drásticamente las protecciones para decenas de millones de estadounidenses agobiados por facturas médicas que no pueden pagar.

Las regulaciones también cumplirían con una promesa de la administración Biden de abordar el flagelo de la deuda de atención médica, un problema que se presenta solo en Estados Unidos y que afecta a unas 100 millones de personas, obligando a muchos a hacer sacrificios como reducir la compra de alimentos, ropa y otros artículos esenciales.

“A nadie debería negársele el acceso a oportunidades económicas simplemente porque experimentó una emergencia médica”, dijo el martes 11 de junio la vicepresidenta Kamala Harris.

La administración también pidió a los estados que los hospitales aumenten los esfuerzos para restringir la cobros de deudas y que estos centros de salud proporcionen más atención caritativa a los pacientes de bajos ingresos, un paso que podría evitar que más personas terminen con deudas médicas.

Harris también instó a los gobiernos estatales y locales a continuar comprando y eliminando la deuda médica, una estrategia que se ha vuelto cada vez más popular en todo el país.

Reportar a las agencias de crédito, una amenaza tradicionalmente utilizada por los proveedores médicos y los cobradores de deudas para inducir a los pacientes a pagar sus facturas, es la táctica más común utilizada por los hospitales para cobrar sus deudas, según un análisis de Ñî¹óåú´«Ã½Ò•îl Health News.

Aunque una sola factura impaga en un informe de crédito puede no afectar enormemente a algunas personas, el impacto puede ser devastador para aquellos con grandes deudas de atención médica.

Por ejemplo, hay evidencia creciente de que los puntajes de crédito afectados por la deuda médica pueden amenazar el acceso de las personas a la vivienda y aumentar el riesgo de dejarlas sin techo.

Las personas con bajos puntajes de crédito también pueden tener problemas para obtener un préstamo o pueden verse obligadas a pedir prestado a tasas de interés más altas.

“Hemos escuchado historias de personas que no pudieron conseguir trabajos porque su deuda médica estaba afectando su puntaje de crédito y tenían un puntaje bajo”, dijo Mona Shah, directora senior de Community Catalyst, una organización sin fines de lucro que ha presionado por una mayor protección contra la deuda médica.

Shah dijo que las regulaciones propuestas tendrían un gran impacto en la seguridad financiera y la salud de los pacientes. “Esto es algo realmente importante”, dijo.

Funcionarios de la administración dijeron que planean revisar los comentarios públicos sobre su propuesta durante el resto de este año y emitir una regla final a principios de 2025.

Los investigadores de la CFPB que la deuda médica, a diferencia de otros tipos de deuda, no predice con precisión la solvencia crediticia de un consumidor, cuestionando la utilidad de incluirla en un informe de crédito.

Las tres agencias de crédito más grandes —Equifax, Experian y TransUnion— dijeron que ya no incluían algunas deudas médicas en los informes de crédito desde el año pasado. Las deudas excluidas incluían facturas pagadas y aquellas de menos de $500.

Esas acciones han reducido sustancialmente el número de personas con deudas médicas en sus informes de crédito, según muestran datos del gobierno. Pero las acciones voluntarias de las agencias dejaron fuera a muchos pacientes con facturas médicas más grandes en sus informes de crédito.

Un halló que 15 millones de personas todavía tienen estas facturas en sus informes de crédito, a pesar de los cambios voluntarios. Según este informe, muchas de estas personas viven en comunidades de bajos ingresos en el sur.

Las reglas propuestas no solo prohibirían que las futuras facturas médicas aparezcan en los informes de crédito, sino que también eliminarían las deudas médicas que ya están en los informes, según funcionarios de la administración.

Los oficiales dijeron que las deudas que ya no estarán en los informes no solo incluirían facturas médicas sino también cuentas dentales, una fuente importante de deuda de atención médica en el país.

Aunque las deudas no aparecerían en los puntajes de crédito, los pacientes aún las deberán. Eso significa que hospitales, médicos y otros proveedores aún podrían usar otras tácticas de cobros para intentar que los pacientes paguen, incluyendo llevar los casos a los tribunales.

Los pacientes que usaron tarjetas de crédito para pagar facturas médicas, incluidas las tarjetas de crédito médicas como CareCredit, también continuarán viendo esas deudas en sus puntajes de crédito ya que no estarían cubiertas por la regulación propuesta.

Líderes de hospitales y representantes de la industria del cobro de deudas han advertido que restringir el reporte de crédito puede tener consecuencias no deseadas, como inducir a más hospitales y médicos a exigir pagos por adelantado antes de brindar atención.

Pero defensores de consumidores y pacientes continúan pidiendo más acción. El Centro Nacional de Derecho del Consumidor, Community Catalyst y unos 50 otros grupos enviaron cartas el año pasado a la CFPB y al IRS instando a una acción federal más fuerte para controlar los cobros de las deudas hospitalarias.

Los líderes estatales también han tomado medidas para ampliar las protecciones al consumidor. En los últimos meses, un número creciente de estados, liderados por Colorado y Nueva York, han promulgado legislaciones que prohíben que la deuda médica se incluya en los informes de crédito de los residentes o se tenga en cuenta en sus puntajes de crédito. Otros estados, incluido California, están considerando medidas similares.

Muchos grupos también están instando al gobierno federal a prohibir que los hospitales exentos de impuestos vendan la deuda de los pacientes a empresas que compran deudas, o nieguen atención médica a personas con facturas atrasadas, prácticas que siguen siendo comunes en todo Estados Unidos, según comprobó Ñî¹óåú´«Ã½Ò•îl Health News.

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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