Advocates and political leaders in Illinois have been at the forefront of developing solutions to the medical debt crisis. Last week, the state Senate approved a measure to remove medical debt from credit reports, offering debt-ridden residents some much-needed relief. But despite this progress, advocates say more needs to be done to address medical debt for people living in the state, especially for marginalized people who are more likely to have no insurance, little savings, or special medical needs.  

As of 2021, people in the U.S. owe at least $220 billion in medical debt, and a 2019 study from the American Journal of Public Health found that roughly 530,000 people annually fall into personal bankruptcy because of it. About 6% of U.S. adults owe more than $1,000 in medical debt, and 3 million people owe more than $10,000. People of color are disproportionately impacted by medical debt due to being less likely to have health insurance than white families. 

Illinois has a serious problem with medical debt, especially among marginalized communities. About 40% of the people in the state have some medical debt. A 2020 report by the Urban Institute found that the Illinois counties with the highest proportions of Black people and immigrants are also the counties in which higher percentages of people struggle with medical debt. A 2022 poll in the Chicago area found that 65% of surveyed immigrants were worried about paying a hospital bill.     

Sahida Martinez, a community health workers supervisor for Enlace Chicago, advocates for health equity in Chicago’s Little Village community. She told Prism that seven years ago, her husband, who at that point was the family’s sole earner, had a disabling condition that resulted in $8,000 in debt. A hospital social worker told them that as immigrants without insurance or a Social Security number, they were ineligible for financial assistance. With her husband incapacitated, no income, and three children, Martinez had no way to pay back the debt. 

“I got depression,” she said. “I had panic attacks … Oh my God, it was really very stressful for me.” 

Martinez got most of the debt forgiven after she connected with the Illinois Coalition for Immigrant and Refugee Rights (ICIRR). ICIRR got the hospital to admit that Martinez did qualify for assistance programs and that the social worker had misinformed her. The ordeal took more than a year and helped inspire Martinez to join Enlace. 

“A lot of people die in my community because they don’t want to go to the hospital because they don’t have insurance,” she said. “They think they don’t have the right to financial help.”

Sam, a Chicago resident who asked to withhold his real name for privacy, faced large debts and considerable stress because of medical misinformation. Two years ago, Sam, who has cat allergies, decided to get shots so he could spend more time with his partner and her pets. Sam had good insurance through Blue Cross Blue Shield (BCBS), called to ensure the shots were covered, and was told his copay would be about $65. A month after his visit, he said he received a bill for almost $6,000. 

“I spent dozens of hours across three months on the phone and in chat working with BCBS customer service to try and get this resolved,” he said. “That’s time I won’t get back. And at the end, despite the fact that the support people seemed to want to help, they essentially told me I was shit out of luck.”

These kinds of struggles with miscommunication are a significant contributor to medical debt. They are exacerbated for people who, unlike Sam, are immigrants or non-English speakers, according to Edith Avila Olea, policy manager at ICIRR. 

ICIRR often works with and tries to help clients in the immigrant community with medical debt. Most clients should be eligible for Medicaid, Medicare, or Illinois’ CareLink financial assistance program, but in many cases, hospitals fail to explain to patients in a language they can understand that they are eligible or wrongfully tell them they are ineligible. In other cases, patients are asked for more documentation than state laws require. Even though some insurance information is available online, it doesn’t always eliminate the confusion.

“In our community, the digital divide is real,” Olea said. “Even though it might be on [the hospital] website, it’s not accessible to clients who don’t feel comfortable navigating an online system.”

ICIRR was one of the main advocates for the Protect Illinoisans from Unfair Medical Debt bill, which was signed into law in January and will take effect in June. The law requires hospitals to screen uninsured patients for public health insurance programs and financial assistance, and it provides language interpreters (as requested) to help ensure patients understand their rights.

Cook County has taken a proactive approach to helping those burdened with medical debt. In 2022, it was the first local government to work with Undue Medical Debt, an organization that uses donations to purchase and retire discounted medical debt. The county put aside $12 million of its federal COVID-19 funds to purchase and forgive $1 billion in medical debt for low-income residents. 

“The context for [the debt relief] is my conviction that we ought to have universal health care in this country—but we don’t,” said Cook County Board President Toni Preckwinkle. “And so those of us who believe that should do everything we can in the interim to help us down that path.” Preckwinkle also noted that almost half of the county’s $9.2 billion budget is health care-related.

Cook County’s example has inspired similar programs in New York City and Illinois at the state level. But despite progress, advocates say more work needs to be done. Illinois has struggled to follow through on its commitments to expand care and coverage. Last year, the state had to close enrollment in an innovative program to provide insurance for undocumented immigrants after costs vastly exceeded expectations. Advocates hope the state will move to fully fund this program, aggressively enforce the Protect Illinoisans from Unfair Medical Debt bill, and expand state debt purchase and forgiveness programs.