1. Health Wealth Symposium Oakland, CA June 23, 2010 Mark Rukavina, Director The Access Project rukavina@accessproject.org rukavina@accessproject.org (617) 275-2825

2. The Access Project National health research and advocacy organization supporting local health access improvement efforts Mission: work to strengthen community action, promote social change, and improve health, especially for those who are most vulnerable Provide technical assistance to local efforts through research, policy analysis, community engagement, and communication services Nationally recognized for expertise on issue of medical debt

3. The Problem of Escalating Healthcare Costs Between 2000 and 2005, health insurance premiums increased by 73 percent while workers’ wages rose by only 15 percent In 2008, $2.3 trillion was spent on healthcare in the United States

4. Uninsured and Underinsured 46 million Americans have no health insurance 25 million Americans are underinsured

5. Unaffordable Health Care Costs Plague American Families 72 million American adults (41%) under the age of 65 experienced medical bill problems Problems paying or unable to pay medical bill Contacted by a collection agency for unpaid medical bill Changed way of life in order to pay medical bill Medical debt or medical bills being paid off over time Nearly two-thirds of people experiencing these problems had insurance at the time the medical care was provided

6. Health Care Costs Deplete Savings 21 million Americans were unable to pay for basic necessities such as food, heat, or rent due to medical bills 28 million Americans used up all of their savings trying to pay off medical bills 21 million Americans took on credit card debt to pay medical bills

7. Medical Debt Consumes Assets 7.5 million Americans took out a mortgage or loan in order to pay off medical debt Nearly one in five retired Americans used retirement account funds to pay healthcare expenses Twenty-eight (28%) percent of those taking early or hardship withdrawals from retirement accounts did so to pay for medical emergencies

8. Medical Debt Ruins Credit 28 million American adults were contacted by a collection agency for unpaid medical bills More than half (52%) of non-credit related accounts in collection are medical bills Bills in collection are considered major derogatory accounts and lower credit scores Lower credit scores effect consumer’s ability to obtain credit and/or the price of credit

9. Many People Lack Disposable Income to Promptly Pay Off Reduced Medical Bills Payday lending research found that 31% of borrowers reported using the funds for emergency expenses, such as car repairs or medical expenses

10. Housing Problems Result from Medical Debt Nearly half (46%) reported having medical debt More than one-quarter (27%) of respondents with debt said housing problems resulted from the medical debt Relatively small debts had far-reaching effects 12% of respondents with medical debts of less than $500 reported having housing problems Source: Home Sick: How Medical Debt Undermines Housing Security, The Access Project, November 2005 Among clients seeking assistance filing income tax forms at 7 Volunteer Income Tax Assistance sites:

11. Unaffordable Health Care is Costly for Families and the Economy One study of home mortgage foreclosures in four states found that nearly one in four (23%) of all respondents indicated that their foreclosure was caused in part by unmanageable medical bills Approximately 45,000 families, or 7% of the 633,000 families facing foreclosure and counseled through the National Foreclosure Mitigation Counseling Program, cited medical issues as the primary reason for mortgage default, more than those identifying an increase in loan payment as primary reason for default

12. Health Reform IS Anti-Poverty Work Expansion of Medicaid eligibility up to 133% of the federal poverty level would bring coverage to an estimated 16 to 23 million low-income people Millions of Americans who have never received public benefits will qualify for new subsidies under health reform New rules governing insurance companies will reduce likelihood that insured patients will be left unprotected

13. The Opportunity TODAY: Many Medical Bills Could Be Covered By… Private Insurance – Millions of Americans never exercise their right to internal or external review for appealing private insurance claims Public Programs – Millions of American children and adults are eligible but not enrolled in government- sponsored health coverage programs Charity Care – Healthcare providers often have charity care or financial assistance programs but many patients with outstanding medical bills know little or nothing about such assistance

14. The Access Project’s Comprehensive Medical Debt Work-Out Protocol Reduced or eliminated millions of dollars in medical debt for more than 1,500 clients Successfully reduces the burden of medical debt and renegotiates affordable payment plans Repairs credit ruined by medical bills on credit reports Provides up-to-date information in a rapidly changing health policy environment

15. Americans Trust Non-Profits to Help With Financial Problems Many people with medical debt are committed to paying off the bills in full but lack the liquidity to do so The Access Project is interested in partnering with counseling, credit repair and asset building programs, as well as financial services providers to offer new opportunities

16. Medical Debt Work-Out Demonstration Program Partner with existing programs and organizations providing counseling and other direct services to low- and moderate-income clients Provide assistance to program clients with medical debt, evaluate intervention Share data on affordability and medical debt with public policy makers