In Conn.,(and elsewhere) the baffling world of medical debt

Via Kaiser Family Health News

By Katy Golvala, CT Mirror, Jenna Carlesso, CT Mirror, and Noam N. Levey

When Christine Wood received a $12,000 bill from Bristol (Conn.) Hospital, she thought it must be a mistake. It was more than she and her husband made in a month combined.

“I’m freaking out,” said Wood, who lives in a 1,700-square-foot home in Terryville, a village just outside Bristol. “I don’t understand it.”

Wood, 52, had weight-loss surgery at Bristol Hospital in 2022, hoping it would help with her sleep apnea and the pain in her knees and back. Before scheduling the procedure, she checked with her insurer, she said, and was told the surgery would cost $5,000 out-of-pocket. She paid in advance.

More than six months later, Bristol sent Wood another bill that pushed the cost of her surgery to more than $17,000. Wood said she tried to dispute the charge. The hospital sued her.

“That’s ridiculous. I was told so many times by Aetna: ‘$5,000 out-of-pocket,’” Wood said. “I never would have had the surgery had I known it was going to cost almost 20 grand.”

Wood is among more than three dozen Connecticut patients the Connecticut Mirror and KFF Health News interviewed over the past year who were sued by their hospital or physician over unpaid bills.

The patients include teachers, small-business owners, a postal worker, a retired nursing-home aide, a nurse, and a hotel bellhop. Most had jobs and health insurance. Nearly all said they wanted to pay what they owed.

Patients taken to court described baffling bills, confusing health plan rules, and frustrating and fruitless telephone calls to hospital billing offices and health insurers’ customer-service lines. Even when they tried to resolve their outstanding bills, many said they couldn’t get answers.

Bristol Hospital is part of Bristol Health, one of Connecticut’s most financially strained health systems.

Their experiences encapsulate breakdowns in the health-care system that trap patients in debt. Health insurance didn’t cover care for reasons they couldn’t understand. Several patients did not qualify for financial assistance from providers, despite modest incomes. If they committed to pay, patients were hit with liens on their homes or interest payments and court fees that piled new debt onto their medical bills.

The industry’s key players blame one another for a broken system. Providers say insurers’ high-deductible plans saddle patients with massive bills even when they have coverage. Insurers say hospitals raise prices at rates that outpace inflation.

Meanwhile, patients are stuck with the fallout. In 2022, about 4 in 10 adults in the U.S. reported carrying medical or dental debt.

“It’s bad enough that I have bad health and have to pay mountains of medical bills,” said Samantha Mantiera, whom Danbury Hospital sued in 2024 over $10,000 she said she was erroneously charged. “Then to constantly be dealing with incorrect bills and then a lawsuit on top of it took me over the top.”

Mantiera said she spent months trying to explain to the hospital and then a collection agency that her insurance statements indicated she owed just $260. She was sued anyway.

After Mantiera contested the lawsuit, Danbury Hospital withdrew it, court records show.

Mantiera said she and her husband now travel up to an hour from their Brookfield, Conn., home to avoid hospitals owned by Danbury’s parent company, now called Northwell Health.

Kathy Holt, who leads the state Office of the Healthcare Advocate, said that in the past several decades healthcare has only gotten harder for patients to navigate. The agency fields thousands of calls every year from residents looking for help with medical billing questions.

“I’ve talked to too many people who have just given up,” Holt said. “The system has been made so hard for them, and I feel like it’s deliberate.”

‘They Would Not Talk to Me’

Debt-collection lawsuits against patients have declined in Connecticut since 2019, a CT Mirror-KFF Health News analysis of state court records found. And court records show most Connecticut hospital systems have stopped suing patients, including the state’s two largest systems, Yale New Haven Health and Hartford HealthCare.

Most hospitals stopped suing patients during the COVID-19 pandemic as they reevaluated their collection practices, said Sarah Ginnetti, chief revenue-cycle officer at UConn Health. The system ceased lawsuits in 2022, records show.

“In some of those circumstances, it just felt misaligned with our mission as an organization,” Ginnetti said. “For the small handful of cases that we might gain some type of legal victory, we really didn’t feel as though that would be our best path forward.”

Yale New Haven Health and Hartford HealthCare would not discuss why they stopped suing patients, instead issuing statements about their financial-assistance programs.

Scores of medical providers — including physician groups, dentists, and hospitals — have kept on suing, data shows. The CT Mirror-KFF Health News analysis found more than 1,500 healthcare-related debt cases filed in Connecticut courts in 2024.

This included lawsuits by Bristol Health, an independent local health system that includes Bristol Hospital, and Nuvance Health, a chain of seven hospitals recently acquired by Northwell Health, a multibillion-dollar system based in New York.

Nuvance hospitals filed over 4,000 collection lawsuits from 2019 to 2024, records show. Over the five years, the health system accounted for more than a quarter of the roughly 16,300 medical debt collection lawsuits against patients identified in state court records.

Hospital officials and other medical providers say they try to work with patients who have trouble paying their bills. Nikki Schulz, chief revenue officer for Northwell’s Connecticut hospitals, said in a statement that years ago the system “eased” its collection practices, leading to a “precipitous decline” in medical debt referred to collections.

“We fundamentally retooled our approach to align with industry best practices,” Schulz said. Records show the health system sued about 200 patients in 2024, down from 2,200 in 2019.

Health-care executives also say they have a responsibility to try to collect.

“I don’t have a choice,” said Bristol Hospital CEO Kurt Barwis. “What we’re trying to do is sustain a mission of taking care of this community.”

A Decline in Hospital Lawsuits

Hospital debt-collection lawsuits have declined in Connecticut since 2019, though non-hospital providers continue to sue patients.

Bristol Health is one of Connecticut’s most financially strained systems, and executives are currently in talks with the administration of Democratic Gov. Ned Lamont about an acquisition by state-owned UConn Health. The proposed deal is, in part, an effort to keep the hospital afloat.

Barwis said the hospital has taken steps to help patients with unexpected bills, including enlisting financial counselors to reach out to patients before elective procedures to discuss cost and financial assistance.

But Wood, who was sued by Bristol, said no one from the hospital talked to her before her surgery. When she called the hospital after receiving the $12,000 bill, she said she was told there was nothing they could do because her insurance had denied the claim.

“They would not talk to me about it,” Wood said. “They wanted their money.”

Bristol spokesperson Albert Peguero also blamed Wood’s insurer and said the hospital worked with Wood as she went through numerous insurance appeals with Aetna.

Wood didn’t fare any better with Aetna. It turned out that her health plan covered only $15,000 worth of bariatric surgery, meaning she was responsible for any bills that exceeded that.

Aetna spokesperson Shelly Bandit said Wood had been notified of this provision, though Wood disputes this.

The back-and-forth with the hospital and the insurer enraged Wood. But after she was sued, she concluded she had no more options. She settled with Bristol, agreeing to pay the full balance on a payment plan of $150 a month, court records show. Under the agreement, it would take Wood almost seven years to pay off the debt.

Last year, Wood faced additional financial challenges after her mother died and her husband lost his job and was unemployed for six months.

Wood said she’s regained about a third of the 100 pounds she lost after her surgery because of the stress. Some months she pays Bristol less than $150. In January, the hospital placed a lien on her home.

“We don’t have savings. We don’t have the extra money. We’re living check by check,” Wood said. “We’re working-class people trying to make a living, trying to do the right thing. And we always get screwed.”

‘I Don’t Have Hours on End’

It’s difficult to know how many medical-debt lawsuits arise from disputed bills. But most U.S. adults with healthcare debt say they’ve received a bill in the past five years that they thought contained an error, according to a national survey.

The prevalence of disputed medical bills is one reason many advocates for patients say hospitals and other healthcare providers shouldn’t sue people they treat.

“Understanding insurance to begin with and then navigating denials or bills that are not plainly understood leaves patients stuck in an opaque system where they have the least leverage and power,” said Eva Stahl, a vice president of Undue Medical Debt, a nonprofit that has worked with states to buy and retire debt — including for more than 150,000 Connecticut residents.

“Patients understandably are left with questions and confusion,” Stahl said.

Last year, a judge dismissed one of Danbury Hospital’s lawsuits against a patient over a $64,000 unpaid bill, citing the hospital’s “failure to prosecute with reasonable diligence,” according to court records.

Timothy Bigham, who owns a construction company and was sued in 2023 by Danbury Hospital, said he never understood why he was billed more than $64,000 after he was hospitalized following a 2019 heart attack.

Bigham, who lives in Danbury, Conn., said he was insured at the time. But soon after he got home, Bigham began getting regular calls from the hospital. He was told his insurer wasn’t paying the bill because he refused to “release medical records,” he recalled.

“I had insurance when I had the heart attack, but it’s my job to get the insurance company to pay?” Bigham said. “I’m self-employed. I work in construction. I don’t have hours on end to sit on the phone trying to talk to somebody at an insurance company.”

Bigham said he ultimately “stopped dealing with it” because he didn’t know what else to do.

Then, in 2023, Danbury Hospital sued him. A judge dismissed the case in 2025, citing the hospital’s “failure to prosecute with reasonable diligence,” according to court records. But by then, the alleged debt had devastated Bigham’s credit score, tanking it by over 100 points, he said.

Northwell’s Schulz declined to comment on any specific patient cases, citing privacy laws.

Connecticut passed a law in 2024 barring medical debt from consumer-credit reports.

A handful of states have tried to protect patients from lawsuits through measures including limiting when hospitals can pursue legal action. Illinois, for example, prohibits lawsuits against uninsured patients who prove they can’t afford their unpaid bills. Nevada, New York, North Carolina, Maryland, and Virginia prohibit liens and foreclosures for medical debt.

‘It Was a Nightmare’

Dominique Jean Pierre was equally surprised by the $20,000 bill he got after he was hospitalized at Norwalk Hospital with a urinary-tract infection in July 2020.

Jean Pierre, 66, had worked for nearly two decades as a bellhop at a Hilton hotel in Stamford, Conn., owned and operated by Atrium Hospitality, a Georgia-based company. When he got sick, the hotel was temporarily closed because of covid lockdowns.

What Jean Pierre didn’t realize, he said, was that the hotel had also cut off employee health benefits. He said he was told by the hospital that he’d be responsible for the bill.

“It was a nightmare,” he said.

Jean Pierre said he begged his manager for help but was told there was nothing the company could do. Atrium Hospitality did not respond to requests for comment.

Two years after Jean Pierre’s hospitalization, Norwalk Hospital sued him for more than $20,000, court records show.

Jean Pierre said he tried twice to apply for financial assistance, but the hospital told him he and his wife made too much to qualify, even though his medical bills totaled almost a quarter of their annual income of about $87,000.

With nowhere to turn, Jean Pierre settled with Norwalk Hospital, now part of the Northwell system, in 2025, agreeing to pay the full bill in $100 monthly installments, records show. At that rate, he will be paying off the debt until 2042.

After the settlement, he said, the judge encouraged him to reach out to elected officials to try to get the debt canceled. Jean Pierre was exhausted.

“He says to me, ‘You have to go to your senators. Go to the governor.’ I said, ‘That’s too much. [I’m just going to] let it go.’”

Jean Pierre has left the Hilton and now works as a personal-care attendant, as does his wife. But he said it still nags him that businesses and health-care providers received millions of dollars in government aid during the pandemic, while he was left with $20,000 in medical debt.

“They gave money for the hotel. They gave money for the hospital. They gave money for a lot of stuff,” he said. “But we don’t see none.”

‘I’m Not Trying To Run Away’

Other patients said they felt trapped, even if they tried to do the right thing.

Deneen Brown, who runs a small day care operation out of her home in Norwalk, was sued by Norwalk Hospital in 2024 for $7,200 over bills she allegedly incurred “on or about 2019 and 2020,” according to the lawsuit.

Brown said she was stunned by the lawsuit, as she believed she’d had health insurance at the time. But as a small-business owner who took pride in maintaining good credit and staying on top of her finances, she said she committed to taking care of it.

“I’m not trying to run away from something that may be my responsibility,” Brown said. “If you say I owe it, I’m going to figure it out, and I’m going to pay it.”

In January 2025, she agreed to a nearly 13-year payment plan of $50 a month, court records show. Often she pays more, she said.

The following month, the hospital placed a lien on her home. Brown said she never realized the hospital would continue to penalize her, even after she agreed to a payment plan.

“Had I known that, I would have never settled,” she said.

This article was produced in partnership with The Connecticut Mirror, a statewide nonprofit newsroom that covers public policy and politics.

Conn. physicans step up their medical-debt suits against patients

This article is a Kaiser Family Health News and Connecticut Mirror collaboration

BRISTOL, Conn.

Many hospital systems in Connecticut have stopped suing their patients over unpaid bills, stung by criticism about the harm caused by aggressive collection tactics.

Have you been forced into debt because of a medical or dental bill? Have you had to make any changes in your life because of such debt? Have you been sued or pursued by debt collectors for a medical bill? We want to hear about it.

But physicians, dentists, ambulance companies, and other health care providers are still taking their patients to court, a Connecticut Mirror-KFF Health News investigation of state legal records shows.

Lawsuits by doctors and other nonhospital providers now dominate health care collections in Connecticut, the records show, accounting for more than 80% of cases filed against patients and their families in 2024.

That’s a major reversal from just five years earlier, when hospital system lawsuits made up three-quarters of health-related collection cases in the state’s courts.

The shift is moving medical debt collections into a less regulated realm. Most hospitals, because they are tax-exempt nonprofits, must make financial aid available to low-income patients and follow federal regulations that limit aggressive collection activities. Other medical providers, such as private medical groups, are generally exempt from these rules.

The lawsuits are typically over bills of less than $3,000, but the impact on patients can be devastating. Lawsuits are among the most ruinous byproducts of a health care debt problem that burdens an estimated 100 million people in the U.S.

Lawsuits can lead to garnished wages, liens on homes, and hundreds of dollars of added debt from interest and court fees. They also pile additional financial strains on struggling families, prevent patients from getting needed care, and sap trust in medical providers.

“It’s really messed up,” said Allie Cass-Wilson, a nurse in Bristol, Connecticut, who was sued over a $1,972 debt by an OB-GYN practice where she’d been a patient years earlier. “How can they do that to people?” She did not contest the lawsuit, court records show.

Cass-Wilson, who is 36 and lives in a small apartment just off an expressway on-ramp, said she learned of the outstanding debt only when she was sued. When she tried making an appointment, she said, she was told her doctor wouldn’t see her. “They said I was blacklisted,” Cass-Wilson said. “I was so confused. I couldn’t believe that my medical provider let my care be interrupted like this.”

Cass-Wilson ultimately sought medical care elsewhere.

Radiologists, Dentists, Ambulances

Overall, CT Mirror and KFF Health News identified more than 16,000 health care-related debt cases in Connecticut courts from 2019 to 2024. The database was assembled from online court records with the help of January Advisors, a data science consulting firm that helped extract and sort the data.

Over the six-year period, most of Connecticut’s more than 25,000 licensed physicians and dentists did not pursue patients in court for outstanding balances.

But records show that more than 400 medical providers, including several hospital systems, sued their patients. Among those filing lawsuits were radiologists, anesthesiologists, eye doctors, podiatrists, allergists, and pediatricians.

Dentists, periodontists, and other dental providers filed more than 1,000 lawsuits against patients. And ambulance companies sued more than 140 people.

Med-Aid, a company based outside New Haven, Conn., that provides orthopedic braces and other medical supplies to patients, sued more than 400 people, the court records show. The company’s president, Frank Dilieto, did not respond to repeated interview requests.

Cass-Wilson was sued by Briar Rose Network in Bristol. It’s a member of a large network of OB-GYN practices across Connecticut called Physicians for Women’s Health. The network’s members sued close to 100 patients in 2024, records show.

Paula Greenberg, CEO of Women’s Health Connecticut, a private equity-backed company affiliated with Physicians for Women’s Health that manages business operations for the network, said the lawsuits represent a small fraction of the more than 300,000 patients the network sees every year.

“This is an organization committed to patients,” Greenberg said. She noted that the group offers options to help patients pay, including installment plans and financial aid.

Geoffrey Manton, president of Naugatuck Valley Radiological Associates, said his practice also will work with people who say they can’t pay. But, he said, patients sometimes stop responding to their bills.

“Hiding from your problems isn’t going to solve them,” Manton said. “If we didn’t take any action, there could be that person that is in that late-model Mercedes that just chooses not to pay any bills.” The group sued more than 125 patients from 2019 to 2024, according to the court records.

Many medical providers say that aggressive collections stem from the growing prevalence of high-deductible health plans that leave patients with thousands of dollars of bills before their coverage kicks in.

Greenberg and Manton said each of their physician groups must collect. “This is a business,” Greenberg said. “We have to look at our operating costs.”

Critics of medical collection lawsuits note that the patients are typically sued over relatively small debts that are likely to have little impact on multimillion-dollar medical practices.

The average patient debt that members of Physicians for Women’s Health sued over in 2024 was less than $1,100, court records show. The physician group’s annual revenues are typically in the tens of millions of dollars, according to Greenberg.

Even relatively small debts — which often include interest — can place substantial burdens on families struggling to keep up with their bills, especially while dealing with a serious illness, patient advocates say.

“We don’t have a realistic choice in using health care,” said Lisa Freeman, who heads the Connecticut Center for Patient Safety and has advocated for patients struggling with medical bills. “To then get sued for it, when people have less and less funds available for anything extra, that’s very disheartening.”

A Stroke, Then a Lawsuit

Matthew Millman, 54, lost his job as an IT support worker after having a stroke. Then Meriden Imaging Center sued him over an $1,891 bill.

Millman and his wife said they tried to explain their financial situation to the center, which is affiliated with Midstate Radiology Associates, a large physician group that operates imaging centers and doctors’ offices across Connecticut.

“It was very frustrating,” said Millman, who lives in an aging apartment owned by his wife’s family in New Britain. Millman, his wife, and their teenage daughter are barely getting by on his two part-time jobs — one bagging groceries, the other helping homebound seniors. Together, the jobs pay about $1,500 a month, he said.

The imaging center, after winning the collection case against Millman, tried to garnish his wages, though that was unsuccessful because Millman had lost his IT job.

“It’s all about money,” Millman said, shaking his head. “If you are trained in helping somebody with their health, it shouldn’t be about the money first. It should be about their health.”

Court records show that Midstate Radiology, Meriden Imaging Center and affiliates filed more than 1,000 collection lawsuits against patients from 2019 to 2024, making them the most litigious nonhospital providers in the state. As is common in medical debt lawsuits, the plaintiffs prevailed in most cases, records show.

Midstate president Gary Dee, a radiologist, didn’t respond to emails and messages left at his West Hartford office.

Across town from Millman’s apartment in New Britain, Joseph Lentz lives in a cramped apartment with his wife and daughter. He used to oversee operations at a Boy Scout camp but is now unemployed. Lentz lost his job during the pandemic. The family home went into foreclosure, he said.

In 2023, Orthopedic Associates of Hartford sued Lentz over a $3,644 bill the practice said he owed after having shoulder surgery in 2018.

‘

“I’d pay it if I could, I guess,” said Lentz, 59. “But I don’t even know where next month’s rent is coming from. I’m trying to climb out as best I can. I guess this is just one more thing to shovel in.”

The orthopedic group filed more than 580 lawsuits against patients from 2019 to 2024, prevailing in most, records show.

The medical group declined interview requests. But chief executive David Mudano said in a statement: "As an independent physician practice, we strive to balance compassion for patients with the financial responsibility required to sustain our practice.”

Old Debts and Disputed Claims

Lentz, who did not contest the lawsuit, said he has no reason to doubt he owes the debt. But in many cases reviewed by CT Mirror and KFF Health News and in interviews, patients being sued questioned the accuracy of their medical bills, citing care they thought health insurance should have covered or, in some cases, bills for services they never received.

This reflects broader problems with aggressive collection tactics like lawsuits when disputes over the accuracy of medical bills and delayed or denied insurance claims are so widespread in American health care.

A 2022 report by the federal Consumer Financial Protection Bureau found that nearly half of the medical debt complaints fielded by the agency involved bills that consumers said were erroneous in some way or that consumers said they’d already paid.

“We know people are billed incorrectly,” said Lester Bird, who studies debt collection lawsuits at the nonprofit Pew Charitable Trusts. Bird noted that courts are ill equipped to sort through disputed medical charges or insurance claims, especially when there is little documentation in most debt collection lawsuits.

“It’s complicated before it gets to the courts,” Bird said, “and it’s very complicated when it gets into the courts.”

This can create headaches for physicians and other providers. But billing problems ultimately affect patients and their families most, said Connecticut state Sen. Saud Anwar, a Democrat who is also a physician. “Patients are left to deal with it.”

Andrew Skolnick, an attorney in Milford, outside New Haven, was sued in 2023 by an imaging center where his wife had received services in 2020.

Skolnick said that when the couple, who were covered through his job-based insurance, originally received the bill from Diagnostic Imaging of Milford, he tried to tell the imaging center it had submitted the claim to the wrong insurance plan, but he said they wouldn’t speak with him.

The center later filed the lawsuit, alleging he owed more than $2,000, plus almost $300 in interest.

Despite interview requests, officials at Diagnostic Imaging of Milford did not comment for this article.

Unlike most patients who are sued, Skolnick had the resources and expertise to contest the suit. He said he offered to pay what would have been his responsibility under the plan if the imaging center had filed his claim correctly. He ultimately settled for $1,700, court records show.

“It wasn’t a tremendous amount, but I knew that they had made a mistake,” Skolnick said. “The system is not working.”

More Protections?

Anwar, the state lawmaker and physician, expressed concern that lawsuits undermine patients’ faith in their doctors.

“It’s a sacred relationship,” he said. “If your physician, who is taking care of you, is suing you for money, that’s a problem.

Many hospitals, facing bad publicity from suing patients, have stopped taking patients to court over unpaid bills. Hospital collection lawsuits identified by CT Mirror and KFF Health News in Connecticut court records plunged from more than 4,900 in 2019 to fewer than 300 in 2024.

Also, in recent years, several states, including Connecticut, have expanded protections for patients with bills they can’t pay.

Connecticut now bars medical debt from consumer credit reports, and legislators are pushing to get hospitals to provide more financial aid to patients. Other states have restricted the use of wage garnishment and property liens to collect medical debt.

But state efforts to rein in aggressive medical debt collections have mostly focused on hospitals. That may need to change, said Connecticut state Sen. Matt Lesser, a Democrat who co-chairs the legislature’s Human Services Committee.

He is a key backer of a bill introduced this year that would bar hospitals from billing patients who receive public benefits like food assistance or who make less than twice the federal poverty level, about $32,000 for an individual.

The restriction would not apply to bills from physicians and other nonhospital providers, however. “We may have to go bigger if that’s where the heart of the matter is,” Lesser said.

Connecticut Gov. Ned Lamont, a Democrat who spearheaded an initiative to cancel medical debt for more than 150,000 state residents, also expressed concern about physicians suing the people in their care.

“Everyone should do the right thing by patients,” he said.

Analyzing Conn. Health Care Debt Collection Lawsuits

How often do health care providers sue patients over unpaid bills?

In most states, that’s nearly impossible to answer because courts don’t typically identify which debt collection lawsuits involve a medical debt versus other kinds of debt, such as rent, credit cards, or cellphone bills.

But Connecticut is different. Debt collection cases filed in small-claims court for unpaid medical or dental bills must be classified as health care debt. We worked with the data science consulting firm January Advisors to pull these cases from the Connecticut court database and analyze them. (January Advisors has worked with nonprofits and researchers across the country to collect debt collection data from state courts. The firm did not have any editorial input in our project.)

We started with health care collection cases filed in small-claims court from 2019 to 2024. But this covered only cases involving debts smaller than $5,000. We also wanted to know about cases in which providers sued for bills exceeding $5,000. Connecticut courts don’t assign a “medical” category for large-claim cases. So we pulled all large-claim records for any plaintiff — hospital or nonhospital provider — that appeared in medical small-claims cases. We also included cases with plaintiffs that didn’t appear in that dataset but had common medical terminology in their names, like “hospital” or “DDS.”

We then went through each case manually to confirm that the plaintiff was a medical or dental provider. We determined whether the provider was part of a larger hospital or physician group. And we categorized each plaintiff by a provider type (e.g., hospital system, dental, physician group).

In some cases, the data we pulled was incomplete, so we looked up the court records online and manually entered the information into our database. The Connecticut Judicial Department purges case records from its online portal after a certain amount of time. In those cases, we asked the agency to provide summonses and claims so we could manually enter the case information into our database.

We removed cases with out-of-state defendants or out-of-state plaintiffs and any cases in which missing records made it difficult to confirm information about the provider.

Chris Powell: Hoping for a reality transfusion about medical debt

— Photo by SantyBoyMX

MANCHESTER, Conn.

Connecticut Gov. Ned Lamont is acting as if he has a magic wand that can eliminate $650 million or more in medical debt owed by unfortunate state residents. He has been waving that wand for more than a year and waved it again the other week in his address to the new session of the state General Assembly. The magic is taking longer than expected.

The idea is for state government to pay $6.5 million to a charitable organization that purchases uncollectible medical debt from hospitals, whereupon the charity will offer the hospitals 1 cent per dollar of debt and the hospitals will agree to sell at that rate. Then the charity will inform debtors that they are off the hook.

But society won't be off the hook. For medical debt won't really be extinguished at all by this mechanism but merely transferred -- transferred to everyone else who uses hospitals. Indeed, uncollectible medical debt is already effectively transferred to the rest of hospital patients, private insurers and government insurers through the higher rates hospitals need to keep operating. Services have been provided without payment and their costs have to be recovered somehow.

While hospital rates must be negotiated with insurers and the government, as vital public institutions the hospitals can't be allowed to fail. State government is already deeply involved in negotiations to arrange Yale New Haven Health's purchase of three hospitals looted by the predatory investment company that acquired them several years ago -- Waterbury Hospital, Manchester Memorial Hospital and Rockville General Hospital. A direct or indirect subsidy to Yale from state government may be necessary.

As a practical matter most hospitals in Connecticut are already government agencies, with the government controlling most of what they do, either through statute, regulation, or insurance and reimbursement rates. Just this week the state Office of Health Strategy ordered Sharon Hospital not to close its money-losing maternity ward. A state government that claims the power to order a hospital to operate a maternity ward can claim the power to order forgiveness of medical debt and set debt forgiveness terms.

Key questions about the governor's debt forgiveness idea remain to be answered. 

Will hospitals sell much of their debt so cheaply? They haven't said.

Will government-facilitated forgiveness of medical debt incentivize more people to stiff the hospitals serving them? That seems likely, since the proposed income limits for people qualifying for debt forgiveness are far above poverty thresholds.     

Perhaps most important, since state government already has such power over hospitals, what's the need for a charitable organization to serve as intermediary in debt forgiveness?

The answer seems to be to provide political cover and obscure what will be going on -- the transfer of debt from individuals to the public and the concealment of more of the cost of government in the cost of living.

If state government arranged medical debt forgiveness and qualifications directly, by statute or regulation, the program would compete directly and clearly with all other demands on state government's finances. Every state budget might be forced to determine how much medical debt is to be forgiven each year. 

Instead an intermediary would disperse the expense of debt forgiveness in thousands of transactions, distributed unequally among hospitals, which in turn would distribute the expense unequally in hundreds more transactions with insurers, government agencies, and hospital labor contracts. Political responsibility and blame would land mainly on hospitals.

Why does medical-debt relief need such subterfuge? For the problem is a terrible consequence of the country's medical insurance system, whose creakiness is exposed every day by "Go Fund Me" or similar campaigns on behalf of people with catastrophic injuries or diseases whose treatment costs far exceed any insurance coverage. 

Though individuals or families may be blameless, just victims of bad luck, medical debt can follow them for lifetimes, ruining their credit.

Government is supposed to do for the people the crucial things they can't do for themselves. Covering medical care in catastrophic circumstances should be one of them. Let it be done directly, frankly, and without apology.

Chris Powell has written about Connecticut government and politics for many years (CPowell@cox.net). 

Chris Powell: Medical debt doesn’t vanish; graffiti causes hysteria

MANCHESTER, Conn.

Like the rest of the country, Connecticut is full of people who can't afford their hospital bills. These people may have medical insurance with high deductibles or have exhausted their coverage because of chronic ailments. While nobody is going to prison for medical debt, it can impair credit records and hold people back in life, especially people who were poor to begin with.

Hospitals are often ready to sell the least collectible of their patient debts for a tiny fraction of their nominal value. So with its new budget state government is joining a movement to extinguish the medical debts of people who probably will never be able to repay them. The budget include $6.5 million for distribution to nonprofit organizations that buy medical debt from hospitals and then cancel it. Advocates of the appropriation, including Gov. Ned Lamont, think it might eliminate as much as $650 million in medical debt to hospitals in Connecticut.

While this undertaking is well worth a try, journalism about it has been superficial to the point of misleading. For the debt involved here isn't really being eliminated at all, merely transferred. Indeed, in effect the debt already has been transferred back to the hospitals that have been carrying it. It has been built into hospital operating costs and is being recovered either through efficiencies at the hospitals or higher charges to medical insurers and patients who pay for themselves.

Like nearly everything in medicine, medical-debt-elimination programs are mechanisms of cost shifting. Medical insurers negotiate lower rates with hospitals, causing them to reduce costs or shift them to the less insured. The federal government medical-insurance programs, Medicare and Medicaid, pay less than what hospitals consider the full cost of treatment, and so hospitals must economize again or recover the government discounts with higher charges elsewhere.

Hospitals cannot operate at a loss for long, and if government wants them to stay in business, it has to subsidize them directly or indirectly, as by increasing government insurance payments. If government pays, then all taxpayers do, along with countries that buy the federal government's apparently infinite debt.

Medical care isn't ever really free, and medical debt can't simply be written off. Someone always will be paying for the people who don't pay. Such cost shifting is inevitable in any jurisdiction that won't let people die in the street, but it's not a magic wand.

Medical-debt elimination will be a boon to hard-luck cases and the poor, but it won't reduce the cost of medical care. It won't improve medical-insurance coverage. It won't lift anyone out of poverty. It will only recognize that many people remain poor.

While medical-debt elimination will repair some credit records, it won't prevent the same people from getting stuck with medical debt again. It also will make medicine a little more complicated and may even give people the idea that hospital bills are easily evaded if they hold out long enough. It will validate the principle articulated by the French economist Frederic Bastiat, who two centuries ago anticipated the modern world. Government, Bastiat wrote, is the great fiction by which everybody tries to live at the expense of everybody else.

One reason that the Connecticut General Assembly entertains many questionable proposals is the decline in journalism about the legislative process. Questionable proposals would die faster if local news organizations strove to do frequent surveys of legislators about their positions. As local news coverage has weakened, that kind of political journalism has disappeared.

Instead every other bit of graffiti and vandalism in Connecticut now is causing hysteria, being treated as the rebirth of the Ku Klux Klan or Nazi Party and a tidal wave of "hate" sweeping the state. Such was the case with the recent defacement of the Hartford street mural that celebrates the Black Lives Matter movement.

Perhaps glad to be distracted from murder investigations, Hartford police quickly found the culprit -- a local vagrant with a long criminal record and many pending charges. Since he's not Donald Trump, reporters didn't ask why he wasn't already in jail.

Chris Powell has written about Connecticut government and politics for many years. (CPowell@cox.net)

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