After Wiping Out $6.7 Billion in Medical Debt, This Nonprofit Is Just Getting Started

Soon after giving birth to a daughter two months premature, Terri Logan received a bill from the hospital. She recoiled from the string of numbers separated by commas.

Logan, who was a high school math teacher in Georgia, shoved it aside and ignored subsequent bills. She was a single mom who knew she had no way to pay. “I avoided it like the plague,” she said, but avoidance didn’t keep the bills out of mind

“The weight of all of that medical debt - oh man, it was tough,” Logan said. “Every day, I’m thinking about what I owe, how I’m going to get out of this … especially with the money coming in just not being enough.

Then a few months ago — nearly 13 years after her daughter’s birth and many anxiety attacks later — Logan received some bright yellow envelopes in the mail. They were from a nonprofit group telling her it had bought and then forgiven all those past medical bills.

This time, it was a very different kind of surprise: “Wait, what? Who does that?”

RIP Medical Debt does. The nonprofit has boomed during the covid-19 pandemic, freeing patients of medical debt, thousands of people at a time. Its novel approach involves buying bundles of delinquent hospital bills — debts incurred by low-income patients like Logan — and then simply erasing the obligation to repay them.

It’s a model developed by two former debt collectors, Craig Antico and Jerry Ashton, who built their careers chasing down patients who couldn’t afford their bills.

“They would have conversations with people on the phone, and they would understand and have better insights into the struggles people were challenged with,” said Allison Sesso, RIP’s CEO. Eventually, they realized they were in a unique position to help people and switched gears from debt collection to philanthropy.

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14 latest hospital closures

From reimbursement landscape challenges to dwindling patient volumes, many factors lead hospitals to shut down. In the past year, financial damage linked to the COVID-19 pandemic has put many hospitals in a fragile financial position and forced a few to close. 

Below are 14 hospitals that have closed in the past year. 

1. MercyOne Oakland (Neb.) Medical Center closed July 1 after years of declining inpatient and emergency department volumes. While inpatient and emergency services ended, clinics at MercyOne Oakland and its affiliate, Lyons (Neb.) Family Medicine, remain open. 

2. Community HealthCare System-St. Marys (Kan.) closed in June, according to the Cecil G. Sheps Center for Health Services Research. The Sheps Center defines a hospital closure as the cessation in the provision of inpatient services. The hospital's clinic remains open, and physical, occupational and speech therapy, X-ray, laboratory and other services are available.

3. Cancer Treatment Centers of America closed its hospital in Tulsa, Okla., in May. The hospital attributed the closure to patient access pressures and insurance limitations in the local market. About 400 employees were affected by the closure. 

4. Olympia Medical Center, a 204-bed hospital in Los Angeles, closed March 31. Irvine, Calif-based Alecto Healthcare Services, a private company, sold the hospital in January to UCLA Health. UCLA Health told Becker's Hospital Review in March that it is preparing to renovate the facility and exploring services to offer. 

5. Jellico (Tenn.) Medical Center closed March 1, days after the city council voted to send a contract termination notice to the hospital's operator, Rennova Health. Rennova management said the city council's contract termination decision left the company with no option but to close the hospital.

6. Heights Hospital in Houston closed Jan. 18 after its management failed to pay rent. The hospital was once an acute care facility but was offering outpatient and specialty care when it closed. Heights Hospital filed for Chapter 11 bankruptcy protection in June. 

7. Kansas City, Mo.-based Saint Luke's Health System closed two community hospitals in Overland Park, Kan., on Dec. 30. "Two of our locations have seen lower patient volumes since opening, and as we look at ways to provide care while operating as efficiently as possible during this challenging time, we have made the decision to close these two locations," Bobby Olm-Shipman, Saint Luke's South and East Region CEO, said while announcing the closure of the locations in October.

8. Perry Community Hospital in Linden, Tenn., laid off its workers and closed Nov. 27, according to a notice filed with the state Dec. 8. 

9. Northridge Medical Center, a 90-bed hospital in Commerce, Ga., closed Oct. 31. The hospital closed less than seven years after opening its doors on Jan. 1, 2014. It cited a decline in patient volume as the reason for the closure. Hospital leaders said all other options were explored before deciding to shut down Northridge Medical Center. 

10. Southwest Georgia Regional Medical Center in Cuthbert closed Oct. 22. The 25-bed critical access hospital announced plans in July 2020 to close. The hospital closed due to financial strain worsened by the COVID-19 pandemic. 

11. Shands Lake Shore Regional Medical Center in Lake City, Fla, closed Aug. 31. The hospital, owned by the Lake Shore Hospital Authority, announced in July 2020 that it was closing. The hospital said it had to borrow money to maintain operations, and declining patient volume and financial challenges resulted in losses that were unsustainable. 

12. Cumberland River Hospital in Celina, Tenn., closed Aug. 7, 2020, and placed its license on inactive status. In a letter to the state health department, the hospital's owner and CEO Johnny Presley cited several reasons for the closure, including severe staffing shortages and the inability to secure financial funding or grants from the state. Mr. Presley later said the main cause of the closure was the local EMS not bringing patients to the hospital. 

13. Bluefield (W.Va.) Regional Medical Center closed July 30, 2020. Officials said the decision to shut down the hospital was based on several factors, including declining patient volume and reimbursement rates and significant financial damage tied to the COVID-19 pandemic. 

14. First Texas Hospital Cy-Fair, a 50-bed hospital in Houston, closed July 26, 2020, less than four years after opening. Irving, Texas-based Adeptus Health opened First Texas Hospital Cy-Fair in 2016. When the hospital shut down, 62 workers were laid off, according to the Houston Chronicle, which cited a federally required notice.

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Oklahoma and the ACA’s Medicaid expansion

Medicaid expansion takes effect July 1, 2021, with enrollment starting June 1

Key takeaways

• An Oklahoma Medicaid expansion initiative was approved by voters in June 2020; expansion takes effect July 1, 2021 (enrollment begins June 1, 2021).
• Nearly 855k — mostly children — are enrolled in Medicaid in Oklahoma (about 8% higher than enrollment in 2013, with significant enrollment growth in 2020 2020 amid the COVID-19 pandemic)
• Gov. Stitt opposed straight Medicaid expansion, but had proposed SoonerCare 2.0: Expansion in July 2020, with various restrictions that would have taken effect a year later.
• But amid concerns over a sharply higher number of people who would be eligible due to job losses stemming from COVID-19, Stitt vetoed a bill designed to provide funding for SoonerCare 2.0 and the state withdrew the plan to expand coverage in July 2020.
• Oklahoma was seeking federal approval for a Medicaid work requirement that would have applied to 6,000 enrollees (but the Biden administration is not approving Medicaid work requirements).
• Oklahoma has the second-highest uninsured rate in the U.S., and 59% of the uninsured are in the Medicaid coverage gap
• Oklahoma’s GOP majority continues to reject federal funding to expand Medicaid, so voters took matters into their own hands and passed a ballot initiative to expand Medicaid.
• Medicaid expansion, as called for in the ACA, takes effect in July, with coverage newly available to non-elderly adults earning up to 138% of the poverty level.  
• Governor Stitt had proposed an alternative approach to Medicaid expansion — dubbed SoonerCare 2.0 — that would have eventually included premiums, a work requirement, and a per-capita spending cap.  But the future of SoonerCare 2.0 was upended after Governor Stitt unexpectedly vetoed a bill that would have provided funding for the program. Stitt had proposed the SoonerCare 2.0 program before the COVID-19 pandemic began, but noted that the widespread unemployment due to the pandemic has resulted in far more people who would be eligible for coverage under expanded Medicaid, at a financial cost that would be significantly higher than the state had initially projected. Once Stitt vetoed the funding bill, the state withdrew its expansion state plan amendment. A month later, voters in Oklahoma approved ballot Question 802, paving the way for full (no strings attached) Medicaid expansion to take effect in the state as of July 2021.

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Oklahoma cancer hospital closes, affecting 400 employees

After operating for more than 30 years, Cancer Treatment Centers of America closed its hospital in Tulsa, Okla., according to News on 6. 

CTCA Tulsa saw its last patient May 27. About 400 employees were affected by the closure.

The hospital, which announced its intent to close the hospital in March, attributed the decision to patient access pressures and insurance limitations in the Tulsa market. 

"We hope that other healthcare facilities in Oklahoma are able to overcome the insurance limitations that we were unable to so the residents of this great state continue to get quality access to the care they deserve," CTCA Tulsa President Dana Haynie told News On 6. 

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US hospitals overused tests before pandemic, report shows.

2021 Winning Hospitals: Avoiding Overuse

The Lown Institute Hospitals Index is the first ranking to apply overuse criteria to over 3,100 U.S. hospitals to assess their success at avoiding tests and procedures that offer little to no clinical benefit to patients. Related research has been published in JAMA Network Open (April 2021).

We examined twelve low-value services, such as hysterectomy for benign disease, coronary stents for stable heart disease, and head imaging for fainting, chosen based on their validation in previous overuse studies.

Key Takeaways

• Every 80 seconds, a hospital in the U.S. delivers a low-value test or procedure to an older adult, putting hundreds of thousands at risk of harm.
• Out of the 50 top performing hospitals, nine are in New England and ten in the Pacific Northwest, making those regions stand out at the top of the list.
• The South is home to 41 of the 50 lowest-performing hospitals, with five of the bottom ten located in Florida.
• 64% of hysterectomies, 44% of carotid endarterectomies, and 24% of coronary stent procedures met criteria for overuse nationwide.
• The Cleveland Clinic (58th) is the only hospital from the current U.S. News honor roll to break into the Lown top 100 for avoiding overuse. 

See list of top and bottom performing hospitals here source

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Obama's Medicaid expansion keeps gaining ground under Trump

President Donald Trump is still trying to overturn “Obamacare,” but his predecessor's health care law keeps gaining ground in places where it was once unwelcome.

Missouri voters this week approved Medicaid expansion by a 53% to 47% margin, making the conservative state the seventh to do so under Trump. The Republican president readily carried Missouri in 2016, but the Medicaid vote comes as more people have been losing workplace health insurance in a treacherous coronavirus economy.

That leaves only a dozen states opposed to using the federal-state health program for low-income people as a vehicle for covering more adults, mainly people in jobs that don't provide health care. Medicaid expansion is a central feature of former President Barack Obama's Affordable Care Act, covering about 12 million people, while nearly 10 million others get subsidized private insurance.

If present trends continue, it's only a matter of time until all states expand Medicaid, acknowledged Brian Blase, a former health care adviser in the Trump White House, who remains opposed to the expansion.

“Medicaid expansion is terrible policy, but it is attractive to states because it's almost all federal spending and the insurance companies and hospitals get lots of dollars when a state expands Medicaid,” he said.

The federal government pays 90% of the cost of covering people through the expansion, a much higher matching share than for low-income disabled and elderly people traditionally covered by Medicaid. Blase argues that's an incentive to waste federal dollars. Before the ACA most low-income adults couldn't get Medicaid unless they were caring for children.

“There's lots of political pressure to expand,” said Blase. “Eventually all states are going to expand unless the enhanced (federal) match rate changes.”

Voters in another conservative state — Oklahoma — approved a Medicaid expansion earlier this year, although the margin was much closer than in Missouri. Of the seven states that have expanded Medicaid in the Trump years, six have done so by referendum, said Rachel Garfield, a senior policy expert with the nonpartisan Kaiser Family Foundation.

“This is an indication that there is large popular support for providing health care coverage for low-income people, and it is quite possible that this support has increased given what's going on with the pandemic,” Garfield said.

The six states where voters have approved Medicaid expansion in the Trump years are Idaho, Maine, Missouri, Nebraska, Oklahoma and Utah. In Virginia, the legislature passed a Medicaid expansion after Democrats made political gains.

“That has been an interesting feature of the Trump administration, that momentum among the states to expand Medicaid has not slowed down,” said Jesse Cross-Call, a policy expert with the Center on Budget and Policy Priorities, which advocates for low-income people.

Trump is trying to persuade the Supreme Court to toss out “Obamacare,” but as long as it remains the law his administration has to carry out expansions that states approve. Democratic presidential candidate Joe Biden would ask Congress to provide coverage where states have refused.

In Missouri, support for Medicaid expansion in cities and suburbs overcame opposition in rural communities. Supporters used the coronavirus pandemic to highlight the need for health care, especially in the wake of joblessness and loss of employer-provided insurance. The Missouri Chamber of Commerce and Industry, one of the state’s most influential business groups, also pushed for expansion as a way of helping the economy recover after COVID-19.

Cindy Mann, who ran Medicaid under Obama, argues that there's also a strong fairness argument for expansion. About 4.5 million poor adults live in states that have resisted expanding Medicaid. But because of the way the Obama health law is written, they don't qualify for subsidized private insurance through marketplaces like HealthCare.gov and they're stuck in a coverage gap.

“Those people have no access to coverage,” said Mann, now with the Manatt Health consultancy. “Those are a lot of the so-called essential workers, if we think about it through the COVID lens. It's a really inequitable story and one that increasingly can't be tolerated by the public.”

No other state referendum votes on Medicaid expansion are scheduled this political season. But Mann expects the debate will percolate through legislative elections in the 12 states, mainly in the South, that have refused. The biggest prizes are Texas, Florida and Georgia.

“Now they are surrounded by states that have expanded,” she said.

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Egypt arrests doctors, silences critics over virus outbreak

A doctor arrested after writing an article about Egypt's fragile health system. A pharmacist picked up from work after posting online about a shortage of protective gear. An editor taken from his home after questioning official coronavirus figures. A pregnant doctor arrested after a colleague used her phone to report a suspected coronavirus case.

As Egyptian authorities fight the swelling coronavirus outbreak, security agencies have tried to stifle criticism about the handling of the health crisis by the government of President Abdel Fattah el-Sissi.

At least 10 doctors and six journalists have been arrested since the virus first hit Egypt in February, according to rights groups. Other health workers say they have been warned by administrators to keep quiet or face punishment. One foreign correspondent has fled the country, fearing arrest, and another two have been summoned for reprimand over "professional violations."

Coronavirus infections are surging in the country of 100 million, threatening to overwhelm hospitals. As of Monday, the Health Ministry had recorded 76,253 infections, including 3,343 deaths — the highest death toll in the Arab world.

"Every day I go to work, I sacrifice myself and my whole family," said a front-line doctor in greater Cairo, who spoke on condition of anonymity for fear of reprisals, like all doctors interviewed for this story. "Then they arrest my colleagues to send us a message. I see no light on the horizon."

In 2013, el-Sissi, as defense minister, led the military's removal of Egypt's first democratically elected president, Mohamed Morsi, after his brief rule sparked nationwide protests. In years since, el-Sissi has stamped out dissent, jailing Islamist political opponents, secular activists, journalists, even belly dancers.

Now the clampdown has extended to doctors who speak publicly about missing protective gear or question the official infection count.

A government press officer did not respond to requests for comment on the arrests of doctors and journalists but did send The Associated Press a document entitled "Realities defeating evil falsehoods," which details what it says are el-Sissi's successes in improving the economy and fighting terrorism.

El-Sissi has said the virus's trajectory was "reassuring" and described critics as "enemies of the state."

In recent weeks, authorities have marshaled medical supplies to prepare for more patients. The military has set up field hospitals and isolation centers with 4,000 beds and delivered masks to citizens, free of charge, at metro stops, squares and other public places.

The government has scaled up testing within all general hospitals and ordered private companies to churn out face masks and gear for front-line health workers. El-Sissi has ordered bonuses for medical workers equivalent to $44-$76 a month.

But health personnel are sounding the alarm on social media. Doctors say shortages have forced them to purchase surgical masks with their meager salaries. Families plead for intensive care beds. Dentists and pharmacists complain of being forced to handle suspected virus patients with little training.

The pandemic has pushed the Egyptian Medical Syndicate, a non-political group of professionals, into a striking new role as the country's sole advocate for doctors' rights.

Last month, the union released a letter to the public prosecutor demanding the release of five doctors detained for expressing their views about the government virus response. More syndicate members have been arrested than reported, said one board member, but families have kept quiet.

Doctors' low morale sank further last week, following the arrest of board member and treasurer Mohamed el-Fawal, who demanded on Facebook that the prime minister apologize for comments that appeared to blame health workers for a spike in coronavirus deaths.

In a televised briefing, Prime Minister Mustafa Madbouly criticized doctors' "negligence and mismanagement" for endangering citizens' health.

Incensed doctors hit back, saying they're untrained, underpaid and under-resourced, struggling to save patients at crowded clinics. So far at least 117 doctors, 39 nurses and 32 pharmacists have died from COVID-19, according to syndicate members' counts, and thousands have fallen ill.

After Madbouly's comments, the union scheduled a press conference in late June to raise awareness about doctors' sacrifices and discuss staff and supply shortages. But before anyone could speak out, security forces surrounded the syndicate and sent members home, according to former leader Mona Mina. A communications officer who promoted the event was detained and interrogated by security agents for hours, said a board member, before being released.

In its latest statement, the syndicate said the accelerating detentions have caused "widespread anxiety" among health workers.

"These doctors have no history of activism, they were arrested because they offered criticism of their very specific professional circumstances," said Amr Magdi of Human Rights Watch, which has confirmed the arrests of eight doctors and two pharmacists. Two have been released, he said, while the rest remain in pretrial detention.

Last week, Dr. Ahmed Safwat, an intensive care doctor in the Cairo suburb of Nasr City and syndicate board member, disappeared, according to social media posts from fellow doctors. Because he had experienced virus symptoms, many assumed he was self-isolating at home until his family filed a complaint to the syndicate, saying they hadn't heard from him in days. A lawyer representing several detained doctors confirmed that he had been taken by state security and accused of terrorism activities. His last Facebook post also criticized the prime minister's comments, adding, "The government says that everything is fine and under control, but you enter hospitals and find the opposite."

In another case, security agents burst into the home of Hany Bakr, an ophthalmologist north of Cairo, according to his lawyer and Amnesty International, over his Facebook post that criticized the government for sending coronavirus aid to Italy and China while its own doctors were desperately short of protective equipment. He remains in detention on terrorism charges, his lawyer added.

In March, public prosecutors accused 26-year-old Alaa Shaaban Hamida of "joining a terrorist group" and "misusing social media" after she allowed a colleague to call the Health Ministry's coronavirus hotline from her phone instead of first reporting the case to her managers, according to Amnesty International. Three months pregnant, she remains in pretrial detention.

Doctors in three different provinces say their administrators have threatened to report them to the National Security Agency if they expressed frustration over working conditions, walked off the job or called in sick.

In one of several voice recordings obtained by The Associated Press, a health deputy in the Nile Delta province of Beheira can be heard telling workers, "Even if a doctor is dying, he must keep working … or be subjected to the most severe punishment."

In another message sent to staff, a hospital director in the same province describes those who fail to show up to work as "traitors," adding, "this will be treated as a national security matter ... and you know how that goes in Egypt."

A doctor in Cairo shared WhatsApp messages with the AP from his manager, alerting staff that their attendance sheets were monitored by state security. He said two of his colleagues received a pay cut when administrators discovered their complaints on social media. In two other hospitals in the capital, workers retracted letters of collective resignation over working conditions for fear of reprisals.

The suppression of criticism in Egypt is hardly unusual, analysts say, but the government has become even more jittery as the pandemic tests its capabilities and slows the economy.

Although el-Sissi resisted a total lockdown because of the economic impact, schools, mosques, restaurants, malls and clubs were closed early in the outbreak and a nightly curfew imposed.

With borders shut and cruise ships docked, Egypt's critical tourism revenue has disappeared, among other sources of income. The country secured a badly needed $5.2 billion loan from the International Monetary Fund in June, on top of a previous $2.8 billion arrangement.

Last week, fearing further economic fallout, the government reopened much of society and welcomed hundreds of international tourists back to resorts, even as daily reported deaths exceeded 80. Restaurants and cafes are reopening with some continued restrictions, and masks have been mandated in public.

"Because of Egypt's constant attention to its image as a place open for tourism, open for business, open for investment, authorities appear particularly sensitive to divergent perspectives during the pandemic," said Amy Hawthorne, an Egypt expert at the Project on Middle East Democracy. "They want to project an image that everything is fine, they're in control."

Those who spread "false news" online about the coronavirus could face up to five years imprisonment and steep fines, Egypt's top prosecutor warned this spring.

The U.N. High Commissioner for Human Rights voiced concern in late March that 15 individuals had been arrested for broadcasting alleged false news about the pandemic. Four Egyptian journalists who reported on the outbreak remain in prison, according to the Committee to Protect Journalists, which has labeled Egypt one of the world's worst jailers of journalists, along with Turkey and China.

Security forces have also taken aggressive action against foreign reporters. In March, Egypt expelled a reporter for The Guardian who cited a scientific report disputing the official virus count. Egypt's state information body has summoned The Washington Post and New York Times correspondents over their critical coverage during the pandemic.

Despite growing human rights abuses, the international community counts on Egypt as a bulwark against regional instability, said a Middle East-focused rights advocate at the U.N., speaking on condition of anonymity to discuss policy matters.

"There is no appetite," the advocate said, "to address what is going on in Egypt, let alone sanction them in any way for what the government is doing to their own people."

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