Seven intimate Egon Schiele artworks, looted by the Nazis from a Jewish art collector, are returned to his heirs
Content retrieved from: https://apnews.com/article/grunbaum-schiele-nazis-looted-art-holocaust-762e220d7c799f35db49c5b9a08c3a1e.
Meet the people
Meet the People Deciding How to Spend $50 Billion in Opioid Settlement Cash
By Aneri Pattani JULY 10, 2023
As more than $50 billion makes its way to state and local governments to compensate for the opioid epidemic, people with high hopes for the money are already fighting over a little-known bureaucratic arm of the process: state councils that wield immense power over how the cash is spent.
In 14 states, these councils have the ultimate say on the money, which comes from companies that made, distributed, or sold opioid painkillers, including Purdue Pharma, Johnson & Johnson, and Walmart. In 24 other states, plus Washington, D.C., the councils establish budget priorities and make recommendations. Those will affect whether opioid settlement funds go, for example, to improve addiction treatment programs and recovery houses or for more narcotics detectives and prisons.
KFF Health News, along with Johns Hopkins University and Shatterproof, a national nonprofit focused on the addiction crisis, gathered and analyzed data on council members in all states to create the first database of its kind.
The data shows that councils are as unique as states are from one another. They vary in size, power, and the amount of funds they oversee. Members run the gamut from doctors, researchers, and county health directors to law enforcement officers, town managers, and business owners, as well as people in recovery and parents who’ve lost children to addiction.
“The overdose crisis is incredibly complex, and it demands more than just money,” said Rollie Martinson, a policy associate with the nonprofit Community Education Group, which is tracking settlement spending across Appalachia. “We also need the right people in charge of that money.”
That’s the $50 billion question: Are the right people steering the decisions? Already, criticism of the councils has been rife, with stakeholders pointing out shortcomings, from overrepresentation to underrepresentation and many issues in between. For example:
- Council membership doesn’t always align with the states’ hardest-hit populations — by race or geography.
- Heavy presence of specific professional groups — treatment providers, health care executives, or law enforcement officials, for example — might mean money gets directed to those particular interests at the expense of others.
- Few seats are reserved for people who’ve dealt with a substance use disorder themselves or supported a family member with one.
Admittedly, no one can design a perfect council. There’s no agreement on what that would even look like. But when a pile of money this big is at stake, everyone wants in on the action.
More than $3 billion of opioid settlement funds has already landed in government coffers, with installments to come through 2038. The money is meant as restitution for the hundreds of thousands of Americans who have died from drug overdoses in recent decades.
But what restitution looks like depends on whom you ask. People running syringe service programs might suggest spending money immediately on the overdose reversal medication naloxone, while hospital officials might advocate for longer-term investments to increase staffing and treatment beds.
“People naturally want money to go toward their own field or interest,” said Kristen Pendergrass, vice president of state policy at Shatterproof.
And that can trigger hand-wringing.
In many parts of the country, for instance, people who support syringe service programs or similar interventions worry that councils with high numbers of police officers and sheriffs will instead direct large portions of the money to buy squad cars and bulletproof vests. And vice versa.
In most states, though, law enforcement and criminal justice officials make up fewer than one-fifth of council members. In Alaska and Pennsylvania, for instance, they’re not represented at all.
Outliers exist, of course. Tennessee’s 15-member council has two sheriffs, one current and one former district attorney general, a criminal court judge, and a special agent from the state Bureau of Investigation. But like many other councils, it hasn’t awarded funds to specific groups yet, so it’s too soon to tell how the council makeup will influence those decisions.
Pendergrass and Johns Hopkins researcher Sara Whaley, who together compiled the list of council members, say criticism of councils drawing too heavily from one field, geographic area, or race is not just a matter of political correctness, but of practicality.
“Having diverse representation in the room is going to make sure there is a balance on how the funds are spent,” Pendergrass said.
To this end, Courtney Gary-Allen, organizing director for the Maine Recovery Advocacy Project, and her colleagues chose early on to ensure their state’s 15-member council included people who support what’s known as harm reduction, a politically controversial strategy that aims to minimize the risks of using drugs. Ultimately, this push led to the appointment of six candidates, including Gary-Allen, to the panel. Most have personal experience with addiction.
“I feel very strongly that if these six folks weren’t on the council, harm reduction wouldn’t get a single dollar,” she said.
Others are starting to focus on potential lost opportunities.
In New Jersey, Elizabeth Burke Beaty, who is in recovery from substance use disorder, has noticed that most members of her state’s council represent urban enclaves near New York City and Philadelphia. She worries they’ll direct money to their home bases and exclude rural counties, which have the highest rates of overdose deaths and unique barriers to recovery, such as a lack of doctors to treat addiction and transportation to faraway clinics.
Natalie Hamilton, a spokesperson for New Jersey Gov. Phil Murphy, a Democrat who appointed the members, said the council represents “a wide geographic region,” including seven of the state’s 21 counties.
But only two of those represented — Burlington and Hunterdon counties — are considered rural by the state’s Office of Rural Health needs assessment. The state’s hardest-hit rural counties lack a seat at the table.
Now that most of the council seats nationwide are filled, worries about racial equity are growing.
Louisiana, where nearly a third of the population is Black, has no Black council members. In Ohio, where Black residents are dying of overdoses at the highest rates, only one of the 29 council members is Black.
“There’s this perception that this money is not for people who look like me,” said Philip Rutherford, who is chief operating officer of Faces & Voices of Recovery and is Black. His group organizes people in recovery to advocate on addiction issues.
Research shows Black Americans have the fastest-rising overdose death rates and face the most barriers to gold-standard treatments.
In several states, residents have lamented the lack of council members with firsthand knowledge of addiction, who can direct settlement dollars based on personal experiences with the treatment and criminal justice systems. Instead, councils are saturated with treatment providers and health care organizations.
And this, too, raises eyebrows.
“Service providers are going to have a monetary interest,” said Tracie M. Gardner, who leads policy advocacy at the New York-based Legal Action Center. Although most are good people running good treatment programs, they have an inherent conflict with the goal of making people well and stable, she said.
“That is work to put treatment programs out of business,” Gardner said. “We must never forget the business model. It was there for HIV, it was there for covid, and it’s there for the overdose epidemic.”
Councils in South Carolina and New York have already seen some controversy in this vein — when organizations associated with members pursued or were awarded funding. It’s not a particularly surprising occurrence, since the members are chosen for their prominent work in the field.
Both states’ councils have robust conflict-of-interest policies, requiring members to disclose professional and financial connections. New York also has a law precluding council members from using their position for financial gain, and South Carolina uses a rubric to objectively score applications.
That these situations cause alarm regardless shows how much hope and desperation is tied up in this money — and the decisions over who controls it.
“This is the biggest infusion of funding into the addiction treatment field in at least 50 years,” said Gardner. “It’s money coming into a starved system.”
Database Methodology
The list of council members’ names used to build the database was compiled by Johns Hopkins University’s Sara Whaley and Henry Larweh and Shatterproof’s Kristen Pendergrass and Eesha Kulkarni. All council members, even those without voting power, were listed.
Although many states have councils to address the opioid crisis generally, the database focused specifically on councils overseeing the opioid settlement funds. A council’s scope of power was classified as “decision-making” if it directly controls allocations. “Advisory” means the council provides recommendations to another body, which makes final funding decisions.
The data is current as of June 9, 2023.
KFF Health News’ Aneri Pattani, Colleen DeGuzman, and Megan Kalata analyzed the data to determine which categories council members represent, based on the following rules:
— Each council member can be counted in only one category. There is no duplication.
— People should be given the most descriptive categorization possible. For example, attorneys general are “elected officials,” but it is more specific to say they are “law enforcement and criminal justice” officials.
— A “government representative” is typically a government employee who is not elected and does not fit into any other descriptive category — for example, a non-elected county manager.
— People who provide direct services to patients or clients, such as physicians, nurses, therapists, and social workers, are classified as “medical and social service providers.” People with more administrative roles are typically classified as “public” or “private health and human services,” based on their organization’s public or private affiliation.
— “Lived or shared experience” refers to someone who has personally experienced a substance use disorder, has a family member with one, or has lost a loved one to the disease. Because people’s addiction experiences are not always public, only individuals explicitly appointed because of their firsthand connection or to fill a seat reserved for someone with that experience were categorized as such.
KFF Health News’ Colleen DeGuzman and Megan Kalata contributed to this report.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core
Hollywood’s A- List Health Insurance
Hollywood’s A-List Health Insurance Is Jeopardized by the Labor Strikes
The issues dominating the dual Hollywood strikes by actors and writers are artificial intelligence, residual payments, and job protections. But one topic that’s often a contentious point in labor negotiations — health insurance — has slipped under the radar.
A-list stars have been out in force snapping selfies on picket lines in the bright California sun, but it’s the people who may have never walked the red carpet who are forgoing a paycheck and potentially their health insurance as the negotiations drag on and work dries up.
The health insurance offered by both unions is predicated on the notion that it is for members who work consistently and lucratively enough to make a minimum amount of money. That makes the insurance difficult first to attain and then to sustain. In exchange, it is very, very good health insurance.
Often referred to in hushed, reverent tones as the “Cadillac of health insurance” by those who have it, the policy offered by the Writers Guild of America, formerly the Screen Writers Guild, feels like a holdover from a bygone age. It has no monthly premiums, costs $600 a year to cover the rest of your immediate family, and has deductibles in the hundreds — not thousands — of dollars.
But the biggest strike in more than six decades in Hollywood threatens that security. The WGA has been on strike since May 2, and the actors’ union, SAG-AFTRA, since mid-July. Together they represent over 170,000 workers, who have refused to perform any part of their job since talks with studios and streamers stalled. Writers and actors could lose their eligibility for insurance simply because they aren’t working while striking.
Filmmaker and Writers Guild member Susanna Fogel said no matter how good her union health insurance is, members are always at risk of losing it. “If we’re this close to not having it, then we’re already on a razor’s edge,” she said, “which is kind of why we’re striking, even though in the short term it sort of just shines a light on the problem.”
A Complicated Formula for Writers
For writers to qualify for health insurance, they must earn a little over $41,700 in covered union work within a year. Residuals don’t count. The income requirement continues to rise, which, coupled with the increasingly uncertain reliability of employment, means even experienced writers can have a hard time qualifying.
Writers can accumulate credits by qualifying for WGA health insurance for 10 years and by earning more than $100,000 in covered work. Top earners can rack up three points per year, which can be cashed in when writers experience a dry spell and can’t make the minimum income requirement, but health coverage ends the quarter after the credits are used up.
For example, a writer who qualifies for health insurance for 10 years but earns less than $100,000 can cash in all their points and continue their insurance for up to a year and a half if they are insuring only themselves.
But insuring dependents uses up more credits, meaning people with families have less of a stopgap to fall back on.
As the strike stretches into another quarter, many union writers are furtively calculating how many credits they have and how long this temporary measure will buy them, if they have credits at all.
Actors’ Good Deal Is Precarious
By contrast, residual payments do count toward the $26,000 per year that members of SAG-AFTRA must earn to qualify for health insurance offered by the actors’ union. So boosting residual payments, especially from streamers like Netflix, which can pay almost nothing, is a high priority for members on the margins.
Plan premiums from SAG-AFTRA are $125 a month for union members. For a family of four or more, the monthly cost rises to $249 a month, or $2,988 a year. That’s less than half of the $6,680 that the average California worker with employer-sponsored health insurance paid for coverage for a family of four in 2022, according to a report by the California Health Care Foundation. (KFF Health News produces California Healthline, an editorially independent service of the California Health Care Foundation.)
Members of both unions say it took them years to make enough money to qualify for the union health insurance, while other union members who have worked in the industry for years never have.
“The moments that I’ve been at risk of or have lost health insurance in the past, pre-strike, were when I was working,” said filmmaker Fogel, who is also a member of the Directors Guild of America. “I was working, but there were particulars to the work that just made it fall short or fall in the wrong month to stay covered. So it was just always a stress.”
Should the unions simply drop the income requirement to a lower amount so more members could qualify? Alex Winter, a longtime member of three industry unions, doesn’t think so.
“It seems draconian to turn back to the unions and say, ‘Well, since we have these oligarchs who are hoovering up all the profits, let’s try to take what few squirrel nuts we have and scatter them out amongst whoever survived staying in the industry,’ as opposed to fighting to get equitable pay, which is what we’re doing,” Winter said.
Both SAG-AFTRA and WGA were approached for interviews about their health insurance offerings. SAG-AFTRA declined to be interviewed and WGA sent LAist a link to its FAQ page.
SAG-AFTRA sent members a letter on Aug. 30 saying health insurance would be extended for certain members who would otherwise have lost eligibility on Oct. 1. Members who made at least $22,000 before the strike began will continue to get union health insurance through the end of the year.
A New California Law Could Help Strikers on the Margins
All California workers who lose their employer-sponsored health insurance may be eligible for the state’s Medicaid program, known as Medi-Cal, or qualify to buy health insurance through Covered California, where their costs could be low if they have minimal income. Still, it would be a disruption to lose their low-cost SAG-AFTRA or WGA plans, and an additional expense at a time when striking workers are making much less money.
Writers and actors who lose their union health insurance because of the strike could benefit from a new California law that took effect July 1 aimed at averting just that situation.
AB 2530 received $2 million in funding under the new state budget. To qualify, a union worker must first lose coverage as a result of the strike. According to Covered California spokesperson Craig Tomiyoshi, eligible workers will have their premiums covered as if their incomes were just above the Medicaid eligibility level.
Not all striking workers will enroll in a free plan. Striking workers will be able to pick plans that are more expensive than the benchmark plan. If they do, they will pay the difference in premiums.
“Covered California has seen fewer than 150 applicants who have identified an affiliation to WGA or SAG-AFTRA apply for coverage,” said spokesperson Kelly Green. She added that they expect to see more if the strikes continue and that people who anticipate losing their union health insurance should get in touch.
On Jan. 1, another new law kicks in. Covered California will end deductibles on the middle-tier benchmark plans, meaning a striking worker could receive free premiums under one law and no deductibles in the new year, if the labor dispute lasts that long.
These new rules don’t cover crew members who are not part of the striking unions but have lost health insurance due to the work stoppage.
A new mutual aid group was created to fill that gap.
The Union Solidarity Coalition, known by the acronym TUSC, has raised more than $315,000 to give assistance to International Alliance of Theatrical Stage Employees and Teamsters members, said founding member Winter.
“I don’t know anyone, honestly, in a lot of the primary crew areas who isn’t in danger of losing their health insurance, and I know a lot of people who have lost their health insurance,” Winter said.
The idea for the nonprofit began with conversations between crews and filmmakers, said Fogel, a fellow founding TUSC member.
“Because their coverage is based on the hours that they get within a certain window of time, some of the [crew members] mentioned they or people they knew were at risk for not making their hours due to productions shutting down, or if they opted not to cross a picket line, that could cost them their health insurance,” she said.
TUSC has partnered with the Motion Picture and Television Fund and its Entertainment Health Insurance Solutions, which acts as an insurance navigator for people in the industry.
Fogel said it’s about making sure that everyone in the industry has access to high-quality health care no matter the current industry conditions.
“Every so often, when there’s one group of people that are going on strike, and it’s our turn to strike right now, we just wanted to kind of let the other unions know that we consider ourselves to be part of a collective, and we hope that they feel that love from us,” Fogel said.
Could studios and streamers continue the industry members’ coverage? They could, but it’s unlikely because decision-makers are on the other side of the bargaining table.
Half of the trustees of the Motion Picture Industry Pension & Health Plans are represented by companies involved in the strike. The WGA’s strike FAQ tells members “there is no Health Fund requirement that the Health Plan extend health insurance coverage during a strike, and Trustees are 50% management and 50% Guild.”
In July, Matt Loeb, president of IATSE, the union that represents behind-the-scenes workers, called for studios and streamers to offer an extension of health care benefits to those who may lose them if they fall short of qualifying during the strikes. IATSE is not on strike.
“Make no mistake — if the studios truly cared about the economic fallout of their preemptive work slowdown … they could continue to pay crewmembers and fully fund their health care at any moment, as they did in 2020 during the onset of the COVID-19 pandemic,” Loeb wrote.
This article is from a partnership that includes LAist, NPR, and KFF Health News.
A Father Dreamed of a Home for His Family. Medical Debt Nearly Pushed Them Onto the Streets.
A Father Dreamed of a Home for His Family. Medical Debt Nearly Pushed Them Onto the Streets.
DENVER — Kayce Atencio used to be haunted by a thought while working at a homeless shelter in downtown Denver. “It could have been me,” said Atencio, 30, who lives in a small apartment with his son and daughter not far from the shelter.
It nearly was. Atencio and his children for years slept on friends’ couches or stayed with family, unable to rent an apartment because of poor credit. A big reason, he said, was medical debt.
Atencio had a heart attack at 19, triggered by an undiagnosed congenital condition. The debts from his care devastated his credit score. “It always felt like I just couldn’t get a leg up,” he said, recalling a life of dead-end jobs and high-interest loans as he tried to stay ahead of debt collectors. By 25, he’d declared bankruptcy.
Across the country, medical debt forces legions of Americans to make painful sacrifices. Many cut back on food, take on extra work, or drain retirement savings. For millions like Atencio, the health care system is threatening their very homes.
That’s proven particularly devastating in communities like Denver, where skyrocketing prices have put housing out of reach for many residents and fueled a crisis that’s left thousands homeless and sleeping on the streets.
At the Community Economic Defense Project, or CEDP, a Denver nonprofit that helps people facing eviction or home foreclosure, about two-thirds of clients have medical debt, an informal survey by KFF Health News and the organization suggests. Close to half of the nearly 70 people surveyed said medical debt played a role in their housing issue, with about 1 in 6 saying it was a major factor.
“All day long I hear about medical debt,” said Kaylee Mazza, a tenant advocate who staffs a CEDP legal clinic at the Denver courthouse that offers aid to tenants going through eviction proceedings. “It’s everywhere.”
Nationwide, about 100 million people have some form of health care debt. Of those, about 1 in 5 said the debts have forced them to change their living situation, including moving in with friends or family, according to a 2022 KFF poll.
A growing body of evidence shows that stable housing is critical to physical and mental well-being. Some major medical systems — including several in Colorado — have even begun investing in affordable housing in their communities, citing the need to address what are sometimes called social determinants of health.
But as hospitals and other medical providers leave millions in debt, they inadvertently undermine community health, said Brian Klausner, a physician at a clinic serving homeless patients in Raleigh, North Carolina.
“Many of the hospitals across the country that are now publicly vowing to address health inequities and break down barriers to health are simultaneously helping to create these very problems,” Klausner said. “Nobody likes the elephant in the room, but the reality is that there are thousands of sick Americans who are likely homeless — and sick — because of medical debt.”
A Downward Spiral
Medical debt can undermine housing security in several ways. For some, it depresses credit scores, making it difficult to get a lease or a mortgage. Last year, about 1 in 8 U.S. consumers with a credit report had a medical debt listed on it, according to the nonprofit Urban Institute.
Patients with chronic medical conditions may fall behind on rent or home payments as they scramble to keep medical debts in check to preserve access to health care. Many hospitals and other providers will turn away patients with outstanding bills, KFF Health News found.
Denise Beasley, who also assists clients at CEDP in Denver, said many older people, who typically depend most on physicians and medications, believe they must pay their medical and pharmacy bills before anything else. “The elderly are terrified,” she said.
For others, such debt can compound financial struggles brought on by an accident or unexpected illness that forces them to stop working, jeopardizing their health coverage or ability to pay for housing.
In Seattle, researchers found widespread medical debt among residents in homeless encampments. And those with such debt tended to experience homelessness two years longer than encampment residents without it.
More broadly, people with medical debt are more likely to say the debt has caused them to be turned down for a rental or a mortgage than people with student loans or credit card debt, according to a 2019 nationwide survey of renters, homebuyers, and property owners by real estate company Zillow.
For Atencio, who left home at 16, his struggles with medical debt began with the heart attack. He was working at a gas station and living in Trinidad, a small city in southern Colorado near the New Mexico border.
Rushed to a local hospital, he underwent surgery. The bills, which topped $50,000, weren’t covered by his health plan because he’d unknowingly gone to an out-of-network provider, he said. “I fought it as hard as I could, but I couldn’t afford a lawyer. I was stuck.”
Atencio, who is transgender, has close-cropped dark hair and a large tattoo on his right forearm memorializing two friends who died in a car accident. Sitting on an aging couch in an apartment with bars on the windows, he’s philosophical about his long journey from that medical crisis through years of debt and housing insecurity. “We’ve pulled ourselves out of this,” he said. “But it took a toll.”
When Atencio’s credit score dipped close to 300, the lowest rating, there were few places to turn for help. Atencio’s relationship with his parents, who divorced when he was 2, had been strained for years. Atencio got married at 18, but he and his husband rarely had enough to make ends meet. “I remember thinking, ‘What kind of a start to my adult life is this?’”
They were ultimately taken in by Atencio’s mother-in-law. “If it wasn’t for her, we would have been homeless,” he said. But getting out from the debt was agonizing.
“You end up in this cycle,” he said. “You get into debt. Then you take out loans to try to pay off some of the debt. But then there’s all this interest.” With poor credit, Atencio relied at times on payday lenders, whose high interest rates can dramatically increase what borrowers owe. Many employers also check credit scores, which made it difficult for Atencio to land anything but low-wage jobs.
The job at the shelter was a step up, and Atencio this year got the apartment, which is reserved for single-parent families at risk of being homeless. (Atencio separated from his husband last year.)
Colorado’s Housing Challenges
Atencio’s housing struggles are hardly unique. Jim and Cindy Powers, who live in Greeley, a small city north of Denver, saw their own housing dreams collapse after Cindy was diagnosed with a life-threatening condition that required multiple surgeries and left the couple with more than $250,000 in medical debt.
When the Powers declared bankruptcy, the settlement protected their home. But their mortgage was sold, and the new lender rejected the payment plan. They lost the house.
Lindsey Vance, 40, who moved to Denver five years ago seeking more affordable housing than the Washington, D.C., area where she was from, still can’t buy a house because of medical debts. She and her husband have a six-figure income, but medical bills for even routine care that she’s struggled to pay since her 20s have depressed her credit score, making it difficult to get a loan. “We’re stuck in a holding pattern,” she said.
In and around Denver, elected officials, business leaders, and others have become increasingly concerned about medical debt as they look for ways to tackle what many see as a housing crisis.
“These things are deeply connected,” Denver City Council member Sarah Parady said. “As housing prices have gone up and up, I’ve seen more and more people, especially people with a medical issues and debts, lose housing security.” Parady, who ran for office last year to address housing affordability, is helping lead an effort to get the city to buy and retire medical debt for city residents.
Fueled by skyrocketing prices and rising interest rates, the cost of buying a home more than doubled in Denver from 2015 to 2022, according to one recent analysis. And with rents also surging, evictions are rocketing upward after slowing during the first two years of the pandemic.
Perhaps nowhere is Denver’s crisis more visible than on the streets. The city’s downtown is dotted with tents and encampments, including one that stretches over several blocks near the shelter and clinic where Atencio used to work. By one count, metro Denver’s homeless population increased nearly 50% from 2020 to 2023.
CEDP, which was founded to help residents with housing challenges sparked by the pandemic, this year joined other Colorado consumer and patient advocates to push the legislature for stronger protections for patients with medical debt.
And in June, Colorado enacted a trailblazing bill that prohibits medical debt from being included on residents’ credit reports or factored into their credit scores, a move that put the state at the forefront of efforts nationally to expand debt protections for patients.
A few other states are considering similar steps. And in Washington, D.C., consumer and patient advocates are pushing for federal action to limit medical bills on credit reports. In most states — including many with the highest rates of medical debt — patients still have no such protections.
For his part, Atencio is hoping the new apartment marks a turning point.
The home is modest — a small unit in an aging concrete tower. There’s a security guard by the front door and long, linoleum corridors painted institutional blue and brown.
Atencio’s family is settling in, along with four pet rats — Stitch, Cheese, Peach, and Bubbles — who live in a large cage in the living room. “This feels like freedom,” said Atencio.
He’s tried to give his children, who are 5 and 11, a sense of security: home-cooked meals and the space to play or hang out in their own bedrooms. Like parents everywhere, he frets over their screen time and rolls his eyes when they critique what’s for dinner. (They didn’t like the potatoes he put in a pot roast.)
They are all full-time students: Atencio, who left his job at the shelter, is working on a master’s in social work. His son just started kindergarten, and his daughter is in middle school. “I have big plans and big goals,” he said.
And with several thousand dollars of medical debt still to pay off, Atencio said he’s careful not to take his kids to an out-of-network hospital or physician. “I won’t make that mistake again,” he said.
About This Project
“Diagnosis: Debt” is a reporting partnership between KFF 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 conducted by the Urban Institute, which analyzed credit bureau and other demographic data on poverty, race, and health status for KFF 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 analyzed records 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 KFF Health News on a survey of its clients to explore links between medical debt and housing instability.
KFF Health News journalists worked with KFF public opinion researchers to design and analyze the “KFF Health Care Debt Survey.” 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 KFF 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.
KFF 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 KFF.