Story summary
Los Angeles County, home to nearly 10 million people, is facing a severe medical debt crisis with roughly 800,000 residents owing significant amounts for healthcare. To address this issue, the Los Angeles County Department of Public Health has introduced a new system allowing hospitals to screen patients for financial aid more easily. This initiative aims to prevent low-income families from incurring large bills that can become unmanageable debt.
Dr. Naman Shah, an epidemiologist with the department, estimates the new screening system could potentially stop up to several hundred million dollars of medical debt annually. Initially skeptical, the Hospital Association of Southern California eventually saw the benefits of improving financial aid programs for hospitals as well, recognizing that many were wasting resources on collection efforts.
The program reflects a broader shift towards preventive measures in public health, aiming to alleviate financial burdens before they become overwhelming for patients and costly for healthcare providers.
Written for “Medical Debt Crisis Fix Proposed” on 2026-10-08,
grounded in this article and the 0 other(s) covering the same event.
Medical debt is crushing hospital patients in LA.
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debt → crush → LA
Health officials may have a fix
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officials → have → fix
Every Tuesday, Naman Shah sees tuberculosis patients at a small public clinic in Los Angeles' San Fernando Valley.
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Shah → see → Valley
Shah, a physician and epidemiologist at the Los Angeles County Department of Public Health, pores over images of battered lungs, listens to labored breathing and checks medications.
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Shah → pore → medications
It's part of an initiative dating to the early 20th century to control infections so tuberculosis doesn't spread.
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tuberculosis → date → infections
"We like doing things upstream," Shah said, "meaning before they happen, not after the damage is done."
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damage → do → things
Today, Shah and his colleagues are applying the same principle to medical debt.
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Shah → apply → debt
A key part of that effort is a new system to allow every hospital in LA County to easily screen patients for financial aid.
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hospital → allow → aid
The goal: to stop low-income families from getting a bill that buries them in debt.
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that → stop → debt
Shah estimates this system could prevent several hundred million dollars of medical debt every year.
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system → estimate → debt
In the U.S., an estimated 100 million adults have some form of healthcare debt.
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adults → estimate → debt
In LA County, the nation's most populous, public health officials calculate that about 800,000 residents have medical bills they can't pay.
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they → calculate → bills
"The impacts of medical debt were staggering," said Shah, who used to staff a rural health clinic in India and, since 2023, has led a county initiative in LA to tackle the debt problem.
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who → say → problem
"People end up with credit card debt and then a vicious cycle of high interest rates and poverty," he said.
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he → end → rates
"People forgo their prescriptions.
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People → forgo → prescriptions
People forgo appointments.
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People → forgo → appointments
And then you get into worse health."
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you → get → health
Hospitals typically offer financial aid to patients with low incomes.
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But information about assistance is often hard for patients to get.
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patients → get → assistance
Applying can be cumbersome.
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Applying → apply → ?
And many eligible patients never seek aid, research shows.
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research → seek → aid
"Most people walk into the hospital and walk out without any knowledge of financial assistance," said Jared Walker, founder of Dollar For, a nonprofit that helps patients nationwide apply for aid, often called charity care.
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patients → walk → aid
That's fueling debt.
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That → fuel → debt
It's also driving costly collection efforts that even hospital officials acknowledge pointlessly target low-income patients who are unlikely to be able to pay.
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who → drive → patients
"They're turning their wheels trying to collect on debt that isn't collectable," said Adena Tessler, regional vice president for the Hospital Association of Southern California.
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Tessler → turn → California
One potential solution is a system that automatically screens and qualifies low-income patients for financial aid without requiring an application.
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that → screen → application
This is called presumptive eligibility.
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This → call → ?
Some hospitals already use such systems, which rely on software that checks patient eligibility based on publicly available information such as credit history.
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that → use → history
Shah said hospitals that have deployed presumptive eligibility systems have reported as much as a 50% increase in the amount of financial aid they give patients.
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they → say → patients
Under a state law passed last year, all California hospitals will have to start doing presumptive eligibility screening by next July.
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hospitals → pass → July
But the systems can be expensive and difficult for smaller hospitals to implement.
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hospitals → implement → ?
Only about 1 in 5 hospitals in LA County currently use them, Shah said.
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Shah → use → them
Public health officials wondered whether they could help more hospitals set up the systems.
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hospitals → wonder → systems
The county, which, like many local governments, faces major fiscal challenges, couldn't pay for this, Shah said.
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Shah → face → this
But the public health department could bring together healthcare and hospital officials in the county to figure out another solution.
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department → bring → solution
"The beauty of government is not when it always has to do the work," Shah said.
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Shah → have → work
"We have the ability to make sure that people cooperate."
The Hospital Association of Southern California, initially wary of the county initiative, came to see improving hospital financial aid programs as beneficial to hospitals, many of which were wasting money on collections.
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many → have → collections
The billing process is cumbersome and costly," said Paul Young, a senior vice president with the association.
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Young → say → association
The association agreed to procure a digital presumptive eligibility system and make it available to its members.
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it → agree → members
This bulk-purchasing approach, which Young compared to "a Costco model," would lower the cost for individual hospitals, he said.
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he → compare → hospitals
…and 17 more, not listed.
The Aporia
