Mary Shannon

ACA premiums to surge in 2026. Here’s what to do about it With ACA premium tax credits expiring soon, 22 million enrollees could see premiums surge an average of 114%. Here's how to combat rising costs

qz.com/healthcare-c...

Screenshot of Quarts news article headline and subheading: "Healthcare costs are set to surge. Here’s what to do about it With ACA premium tax credits expiring soon, 22 million enrollees could see premiums surge an average of 114%. Here's how to combat rising costs"

Screenshot from Quartz news article: "How ACA participants can avoid the subsidy cliff in 2026 To avoid going over the ACA subsidy cliff, here are some strategies McGrath and other experts recommend. 1. Max out annual 401(k), HSA, IRA or other tax-advantaged accounts Maxing out contributions to a pre-tax account like an employer-provided 401(k) or 403(b) account, an IRA, or a health savings account (HSA) can also help reduce your income if you’re close to the cliff. And if you’re older, you can make catch-up contributions to further reduce your income, McGrath said."

Screenshot from Quartz news article: "2. Be strategic about taxable distributions Avoiding or minimizing taxable distributions from retirement accounts or deferring income (such as bonuses) is another move to consider — especially if those distributions would push your adjusted gross income beyond the cliff, McGrath said. But don’t try to figure this one out alone and consult an accountant or financial advisor, he added. 3. Work fewer hours The subsidy cliff presents another tough choice for some who need manageable health premiums: reducing their work hours. This applies to hourly workers or those who are self-employed with flexible incomes who can adjust their work schedules to lower their income enough to qualify for the subsidy. Working (and earning) less may make more sense for those with pre-existing health conditions that are expensive to manage to keep their premiums from skyrocketing."

Screenshot from Quartz news article: "4. Increase charitable distributions If you’re 70 ½ or older, making qualified charitable distributions directly from an IRA to a qualified charity is one way to reduce your modified adjusted gross income if you’re on the cliff borderline, McGrath explained."

Pretty bleak!

Losing your premium tax credit? Concerned about rising costs? Try these hot tips!

1) Reduce your taxable income.
2) Defer your income.
3) Reduce your actual income.
4) Donate your income.

Barriers block SNAP and Medicaid users from keeping vital benefits, survey finds Researchers surveyed low-wage workers and found many report administrative burdens in signing up and keeping vital Medicaid and SNAP coverage.

A new study finds the people who need SNAP and Medicaid the most often struggle to access them.

Administrative hurdles and uncertainty make enrollment hard.

It's *exhausting* to be a patient in the U.S. healthcare system.

This isn't about medical debt, but it is the same pattern: patients forced to absorb every bit of the system's dysfunction.

Hours on hold, weeks on wait lists, months or even years without necessary care...

Collage of three screenshots from the poster's call log, showing three outgoing calls over the past week, their durations totaling 5.5 hours.

I spent 5.5 hours on hold with my pharmacy this week... only to be told my medication is still out of stock. 🙃

Someone run the ROI for me: is $335,000 over 3.5 years enough to save 300 jobs?

Wait... you're telling me the $104 lawsuits didn't save the day?? And you can't balance a billion-dollar budget by suing patients for pocket change?! 🤯😱

For context: I'm not aware of any law "requiring" them to pursue medical debt in court, and while the targeting may not be intentional, the impact is clearly disproportionate in certain communities.

Screenshot from St. Louis Public Radio's coverage of the research, which includes a response from WashU. The text in the screenshot reads: "WashU officials said those affected by the lawsuits represent a small sliver of the patients the medical group has treated. During the time period of the study, WashU Physicians treated nearly 1.5 million patients and provided $752 million in uncompensated care, “underscoring [Wash U’s] role as a critical safety net provider for the uninsured and underinsured,” said spokeswoman Julie Flory. “In some cases, we are required to pursue collection of amounts owed by patients and only do so with people who have the means to pay, excluding, for example, those who are unemployed, work part-time, or are paying child support,” Flory continued. “We offer assistance to patients with financial needs. Any suggestion that we would target individuals from certain groups for debt collection is false and misguided, and anything that attempts to draw such a conclusion should be closely examined.”"

They did. When @stlpublicradio.bsky.social covered our research, WashU gave this statement. They emphasized their overall charity care & denied "targeting" anyone.

For those keeping score at home:

🔥 Higher gas rates. Can't pay? Face a shutoff.

⚡ Higher electric rates. Can't pay? Face a shutoff.

💧 Higher water rates. Can't pay? Face a shutoff.

🛒 Higher grocery prices. Can't pay? Go hungry.

⚕️ Exorbitant medical costs. Can't pay? See you in court.

Non-profit mission, tax-exempt status, and a $12B endowment. Yet WashU still takes patients to court over $104 medical debts and garnishes wages, even from their own employees. Make it make sense... 😵

This building from a WashU for-profit entity is under a TIF and also received a personal property tax abatement this year. SLPS wasn't even notified of the abatement bill as required. Anyway, tax exempt WashU needs to join its wealthy university colleagues and pay PILOTs.

Outreach Advocate - Medical Debt Project - The Rome Group Job Title: Outreach Advocate – Medical Debt Project Reports To: [...]

Our work to uncover & reduce harmful medical debt collection practices is growing!

Thanks to the Missouri Foundation for Health & @moconsumer.bsky.social, we're taking our efforts statewide. And we're hiring!

📌 Outreach Advocate: tinyurl.com/5epdz76w
📌 Social Media Specialist: tinyurl.com/7sd9euy7

#Medicaldebt is an indicator of an inherent failure of our health system to protect the most vulnerable. Aggressively pursuing it does little to serve the financial bottom line of a hospital, while exposing the most vulnerable & their families to a lifetime of downstream consequences.

@jama.com

Lawsuits for Unpaid Medical Bills and the Role of Physician Groups This cross-sectional study examines the prevalence and impact of physician-driven medical debt lawsuits among Black, low-income, and other marginalized communities.

🚨This @jama.com NO 📄 examines St Louis physician practices who SUE their patients.

There are inequitable impacts of debt collection. Areas with ⬆️ % of Black residents & ⬇️ incomes...

face ⬆️lawsuits, ⬆️judgments, & ⬆️wage garnishment.

#Medicaldebt has disproportionate effects on certain communities.

So grateful for your support in sharing this, Dr. Chino! Excited to share more from STL soon.

Health leaders warn of 'domino effect' from Medicaid changes at St. Louis roundtable Around two dozen people from local health organizations aired concerns Wednesday at a roundtable in downtown St. Louis convened by U.S. Rep. Wesley Bell.

Representatives from St. Louis-area hospitals and clinics think new changes to Medicaid will lead to issues for patients, even those who don’t rely on the government-sponsored health insurance.

11/ I owe enormous gratitude to the Center for Social Development at WashU & @moconsumer.bsky.social for their encouragement, insight, and belief in the project, especially Dr. Michael Sherraden, Chris Leiker, Sandra Padgett, & Ed Weisbart. This work wouldn't have been possible without them.

Lawsuits for Unpaid Medical Bills and the Role of Physician Groups This cross-sectional study examines the prevalence and impact of physician-driven medical debt lawsuits among Black, low-income, and other marginalized communities.

10/ The pattern is clear: tax-exempt, mission-driven institutions suing low-income, mostly Black communities over small sums. We hope this research contributes to a more equitable system.

Read the full study here: ja.ma/3In6gkj

#MedicalDebt #HealthEquity #STL

9/ These lawsuits weren't filed by hospitals, but by university-affiliated physician groups, raising serious questions about institutional values, charity care, and community impact.

8/ Wage garnishment orders were even issued against employees of local hospital systems and against the universities themselves.

A stacked bar chart showing distribution of medical debt lawsuits and legal outcomes by ZIP code racial majority: Majority-Black zip codes, home to 21.9% of the region’s population (286 087 individuals), accounted for 392 identified lawsuits (41.1%), $488 352.10 in judgment totals (47.3%), and 203 wage garnishments (48.0%). Majority-White zip codes, home to 70.8% of the region’s population (924 397 individuals), saw 420 lawsuits (44.0%), $421 515.83 in judgment totals (40.8%), and 160 wage garnishments (37.8%).

7/ The burden wasn't equally shared:
🔹 Majority-Black ZIP codes represent 22% of the region's population, but they accounted for:
🔸 41% of lawsuits
🔸 47% of total judgments
🔸 48% of wage garnishments

A Sankey diagram showing the final outcomes of 973 lawsuits: 531 resulted in judgments, of which 462 were default judgments, 66 were consent judgments, and 3 carried the disposition "tried by court - civil." Other potential case outcomes included: Dismissed (346), Not Disposed (61), Change of Venue (34) and Structured Settlement (1).

6/ Here's what we found:
🔹55% of lawsuits led to judgments
🔹87% of those were default judgments (the patient didn’t appear)
🔹The average judgment: just under $2,000
🔹The smallest: $104

5/ We carried out this work independently and without funding. No grants, no institutional affiliation — just a Google spreadsheet, a lot of late nights, and a few social workers committed to uncovering and understanding the issue in our community.

4/ That discovery became a years-long project. With my co-authors Kathryn Koch and @mollywm.bsky.social we tracked and analyzed 973 lawsuits between January 2020 and May 2023. Our findings were just published in @jamanetworkopen.com.

3/ Curious and concerned, I turned to Missouri's court database, Case.net. I found not just a few lawsuits, but hundreds — mostly filed by physician groups affiliated with SLU, and also WashU. I decided then to start building a dataset.

2/ I'd spent years helping patients navigate complex billing & financial assistance systems, but I had never seen someone taken to court. I couldn't understand how this aligned with the Jesuit values I'd been taught at SLU...

1/ In 2020 while working at a non-profit health clinic in St. Louis, I encountered a patient being sued over unpaid medical bills. When I looked closer at the summons, I saw the plaintiff was my alma mater: Saint Louis University. 🧵

KFF graphic featuring quote from Lunna Lopes, KFF Senior Survey Manager, Public Opinion & Survey Research. It says, “The impact of medical debt on credit scores often has a cascading effect… Adults with health care debt from KFF’s Health Care Debt Survey cited a range of negative outcomes from trouble qualifying for loans to homelessness.”

⚡ KFF’s Lunna Lopes explores how medical debt affects consumers, an issue back in the news after a recent court decision blocked a federal rule that would have stopped medical debt from being included in people’s credit reports. #QuickTake on.kff.org/4lN5zzy