The Health Divide: Reporters can make a real difference by covering how health care debt traps millions
Author(s)
Image
Getty Images
Published on
April 27, 2026
A new report on medical debt puts a sharper, more unsettling point on a crisis that has been unfolding for years: It’s not just hospitals driving patients to financial ruin. A sprawling web — including lawyers, debt collectors, dentists, physicians and even employers — has turned unpaid medical bills into an industry reaping billions of dollars from patients, low-income people especially.
Public attention has focused largely on hospitals, particularly those benefitting from tax breaks as nonprofits while aggressively pursuing vulnerable patients. But as the report describes it, hospitals are only part of an ecosystem that uses hidden prices and incomprehensible billing to saddle patients with inflated costs and fees. Those who can’t pay are often slapped with lawsuits and swift judgments that drain their wages and life savings.
“This is a lot of people not just milking the system but making deliberate economic decisions to exploit a vulnerable population,” said Barak Richman, the report’s lead author and a professor of business law at the George Washington University Law School.
There’s one bright spot in this picture: Sustained public scrutiny, often spurred by investigative journalism, can drive changes in hospital practices and spur legislation that protects patients. The report offers a roadmap for using public records to track the flow of money and the suffering such practices leave in their wake.
And stories on the issue are urgent, as the Trump administration pulls back on federal protections for patients while medical costs skyrocket and millions of people reduce health coverage or drop it altogether. Millions more are bracing to lose Medicaid.
The researchers analyzed all debt collection cases filed in Virginia courts from 2010 through 2024 and found that 27% involved medical debt. Hospitals, doctors and clinics filed 1.15 million lawsuits against patients in those years. These cases resulted in nearly 813,000 judgments against patients, averaging $1,753, plus interest that ran as high as 18% a year.
The cases generated $87.1 million in attorney fees, a handsome payday for the 20 small law firms that filed more than half of the cases studied.
As big as they are, the numbers don’t begin to convey the harm such tactics cause. People told the researchers about struggling to pay for rent and groceries, worrying they could be fired or jailed for nonpayment, and foregoing later medical care. The numbers don’t even fully capture the debt nightmare, because people often use credit cards or payday loans with exorbitant interest rates, so they don’t get sued by their health care provider.
Richman and colleagues at Stanford School of Medicine and the nonprofit PatientsRightsAdvocate.org (PRA) previously investigated medical debt in Colorado and North Carolina. While the Virginia report is consistent with their earlier findings, it documents several striking trends:
- Although federal rules require hospitals to post prices online, compliance is sparse and enforcement is lax. “You have no idea what you’re paying for, no idea,” a patient told the researchers. And making costs even more confounding, prices for the same procedure vary hugely even within the same hospital chain. Across Sentara Health, a large health system and the state’s most litigious one, the estimated price for spinal fusion ranged from $1,600 to $121,500, according to the report.
PRA has aggregated hospital prices from 6,000 hospitals to make searching for prices easier. The group is also rolling out a simple online tool to compare hospital pricing and it’s creating another tool to investigate hospital drug prices.
- Rather than a measure of last resort, garnishment has become routine. The report documented 403,924 garnishment filings over the 15 years of the study. “I was surprised how commonly plaintiffs and courts just kind of went to the next stage and tried to get patients' assets, either in their bank accounts or their wages,” Richman said. “It seemed to be just another step in the assembly line.”
A new law in Virginia, effective in July, prohibits garnishing wages of patients who qualify for financial assistance.
The researchers also found that the most litigious nonprofit hospitals almost never spend as much on charity care as they reap in tax benefits as institutions claiming to serve their communities. This raises the question: Why aren’t more debts forgiven or more patients offered financial assistance instead of being sued?
- Employers are tangled in the debt-collection machinery. Actions to seize paychecks target the low-wage workforce at large corporations so often that some have departments dedicated to handling garnishment. Walmart received the most garnishment orders for medical debt in this study.
By law, employers must comply with these court orders. But, Richman said, given their central role in providing health insurance, employers might take a hard look at the products they offer (if they offer insurance at all). “Maybe we want to rethink who we send our employees to, like we don't want to send them to hospitals that keep suing them and garnishing their wages,” he said.
Holding hospitals accountable isn’t easy. “They have extraordinary influence — economic and social and political influence in the community, to say nothing about how much they influence communities’ health,” Richman said. Yet time after time, reporters have sparked change. For example, in North Carolina, Advocate Health — one of the nation’s largest hospital systems — announced it had overhauled billing and collections, expanded charity care and cancelled thousands of debts after journalists exposed the chain’s aggressive tactics.
The University of Virginia Health System had a similar reckoning, after KFF Health News reported that the system had filed nearly 36,000 lawsuits against patients over six years.
And last October, the same outlet reviewed 1,200 legal cases in Colorado in which judges permitted wage garnishment for debt and found at least 30% stemmed from medical debt. A bill introduced in the state’s legislature in February would ban wage garnishment for medical debt.
Seven other states — Florida, Hawaii, Indiana, Maine, Michigan, Ohio, and Washington — are considering similar bans or curbs on the practice.
Like Virginia, several states — including New York and New Jersey, have passed laws in recent years that offer some protection against ruinous medical-debt collection practices or excessive fees and interest. But many states have yet to act.
“If local reporters cover their hospital with some scrutiny, they’re really helping their community a lot,” Richman said.