WINSTON-SALEM, N.C. — Some issues, like immigration or student loans, are too divisive to unite Trinity Moravian Church.

“We’ve got quite a spread of political beliefs,” said the Rev. John Jackman, who leads this 114-year-old red-brick church near Winston-Salem’s old textile mills. Conservative Republicans sit with liberal Democrats. Supporters of President Donald Trump mix with his fierce critics. “It’s definitely a purple congregation,” Jackman said.

But four years ago, when Jackman suggested a new church mission to alleviate medical debt for residents of the wider Winston-Salem area, there was no dissent. “This is the easiest money I’ve ever raised,” he said. “All I do is tell people what we’re doing, and they write me a check.”

Few issues have been more politically explosive in recent years than healthcare, pitting Democrats and Republicans in bitter debates over the Affordable Care Act, Medicaid, and other flash points.

Yet moved by the sense that the medical debts their neighbors faced were deeply unfair, members of Trinity Moravian, no matter their politics, rushed to write $25 or $50 checks to pay off the bills.

They helped advance a movement by churches across the state and the country and inspired North Carolina government officials to tackle medical debt. The effort drew plaudits from conservative radio host Glenn Beck.

The little church’s success also highlighted a patch of common ground in American healthcare — widespread anxiety and frustration that so many patients are ending up in debt.

Earlier this year, Trinity wrapped up its eighth medical debt campaign, part of what the church calls its Debt Jubilee Project. This one raised more than $17,000. That helped retire more than $2.2 million in debt. Medical debt can be bought for pennies on the dollar because creditors believe most debts won’t be paid.

Nationwide, an estimated 100 million adults have some form of healthcare debt. More than half of U.S. adults have had such debt at some point.

At Trinity Moravian Church, which has about 200 members, it wasn’t hard to find stories of crushing medical bills.

“I see people going into debt every minute of every day,” said Catherine Coe, who works in the accounting department of a hospital system. “We’re all just one medical bill from financial ruin.”

Coe grew up coming to Trinity with her grandmother. She drifted away from the church as an adult before rejoining the congregation last year. Coe, who describes herself as a conservative, voted for Trump.

Terri Mabe, who’s been coming to Trinity for decades, is on the other side of the nation’s political divide. She said she can’t stand the president, who she said “had no real concern for the people of this country.”

Mabe, 70, has also seen medical debt up close. She used to work in the construction industry.

“In between projects you are a lot of times without a job,” she said. “Then you get sick. Next thing you know, you owe $5,000, $10,000 that you cannot pay. You’re barely paying your home bills. Then you’re like: ‘I can’t pay it. What do I do now?’”

Both Coe and Mabe said partisan differences don’t matter. “There isn’t a political divide when it comes to medical debt,” Coe said. “It all brings us together.”

Jackman said he got the idea to do something about medical debt during the pandemic, when growing numbers of people turned to the church for help.

“I was hearing about the reason they couldn’t pay their electric bill was because they’d had a few days in the hospital and then they got hit with this huge bill and it snowballed,” he recalled. “And I started hearing this again and again and again.”

Jackman learned about a nonprofit called Undue Medical Debt that buys unpaid medical bills from hospitals and debt collectors so the debts can be retired.

The church’s first campaign, in 2022, set a goal of raising $5,000 to retire about $500,000 in medical debt owed by residents of surrounding Forsyth County. The campaign hit its goal in just six weeks, fueled mostly by donations of less than $50.

Jackman, who’s been a pastor for more than four decades, attributed part of the success to an ethos of the church. “One of our ideas is that we cannot fix everything, but we have to fix what we can in the place where we’re planted,” he said.

Trinity members, no matter their political leanings, also said they see something broken in a system that pushes sick people into debt.

Paul Sluder, 78, who doesn’t identify with a political party, used to work for a credit union. He said he did a lot of debt collecting before he retired.

Most people, he said, wanted to pay what they owed. If they got sick, they often had no choice but to go into debt.

“You have kind of no control. You have to take care of yourself or your loved ones,” Sluder said. “It’s incredibly unfair, and I think the system’s out of whack.”

Polls suggest there’s a lot of common ground around medical debt.

In a for Undue Medical Debt, more than 75% of Republicans and Democrats said collection agencies shouldn’t be allowed to garnish patients’ wages to pay medical debt. And in recent years, bipartisan measures to expand protections from medical debt have passed in blue and red states.

Coe, a Republican, said she would support even more limits on how much medical debt people could be forced to carry. “Why can’t we cap medical debt at a certain dollar amount, and after that it’s either written off or forgiven?” she asked.

After completing the most recent debt campaign, Trinity hosted a special ceremony, assisted by kids from a local Scouting group.

Jackman stood before the congregation and held up a piece of paper with a long list of names, people in the county whose debt had been bought and retired by the church.

“On this day of Jubilee,” Jackman announced, “we act to forgive the debts of many of our neighbors as God has forgiven our debts.”

As the congregation stood, Jackman flicked on a lighter and burned the list of 1,631 names. The paper was consumed by yellow flame. The scouts set off confetti poppers. The choir sang, and the congregation erupted in cheers.

Afterward, members went downstairs for a spaghetti lunch in the church basement, served by the scouts.

Reflecting on the day’s festivities, many members of the congregation said they hoped their work on medical debt could inspire others to bridge political differences and work together.

“There’s just so much division, so much anger,” said Cynthia Tesh, 72.

“We need to look out for one another,” she said. “If we start looking out for one another, things will change. If we start considering other people and not just ourselves, things will change.”

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Recently divorced, the former stay-at-home mother had started working again in her mid-40s, taking a human resources job that paid $41,000 a year. Then, despite having insurance, she was hit with more than $8,000 in medical bills.

“I had my car and a basket of clothes,” Roberts recalled. “Medical bills were not something I could have afforded.”

Roberts sought financial assistance from CentraCare, the St. Cloud-based health system that treated her. It’s a nonprofit charity that receives millions of dollars in federal, state, and local tax breaks. In exchange, it’s obliged to offer charity care to patients who can’t afford their medical bills. But Roberts said CentraCare told her she made too much to qualify.

Roberts instead scrimped on groceries and Christmas gifts for her kids and paid off more than $6,000 over two years. Then CentraCare sued her last year because she hadn’t paid off all the debt.

“They’re supposed to be a nonprofit,” Roberts said. “It’s like, ‘Come on!’”

CentraCare earmarks a tiny fraction of its budget for helping patients with medical bills they can’t pay, but it’s not alone, a Minnesota Star Tribune-ºÚÁϳԹÏÍø News investigation found.

Minnesota’s hospitals and health systems are among the least charitable in the country, the investigation found, providing less financial aid as a percentage of their operating budgets on average than hospitals in almost every other state, including Illinois, Iowa, Nevada, and Texas.

The investigation drew on a detailed review of every hospital charity care program in the state, an analysis of five years of hospital financial data, and dozens of interviews with patients, hospital executives, and state officials.

Nationally, hospitals spend an average of about 2.4% of their operating budgets on charity care, according to federal hospital data compiled by Hossein Zare, a researcher at Johns Hopkins University. Minnesota hospitals spend about a third of that, on average.

Some spend considerably less. Of Minnesota’s 123 general hospitals, 62 devoted less than 0.5% of their operating budgets to charity care from 2020 through 2024, the Star Tribune-ºÚÁϳԹÏÍø News investigation found.

“The system is not working,” said Erin Hartung, director of legal services at Cancer Legal Care, a Minnesota nonprofit that helps patients with medical debt and other financial challenges. “And the burden is falling hardest on the people who are least able to bear it.”

CentraCare’s flagship St. Cloud Hospital spent less than 0.25%, according to the analysis. That works out to $25 in patient aid for every $10,000 spent on hospital operations.

Charity care will become even more vital in coming years as Minnesotans lose health coverage or can’t afford rising copays and deductibles. The state’s uninsured rate rose sharply last year, since 2017, and it’s expected to increase further as budget cuts pushed by President Donald Trump force states to pare Medicaid and other safety net programs. Charity care is also critical to many people with health insurance who can’t afford their bills.

Hospital officials say it’s unfair to expect them to solve this affordability problem when many of their facilities are financially strained. “No amount of charity care from hospitals will ever fully meet the needs of uninsured or underinsured Minnesotans. The need is simply too great,” Minnesota Hospital Association spokesperson Tim Nelson said in a statement.

But state Attorney General Keith Ellison said hospitals have a duty to boost charitable help for all needy patients in exchange for the tax breaks they receive.

“There is a benefit you get from being a nonprofit hospital in the state of Minnesota,” he said. “But do the people get the benefit?”

Several small Minnesota hospitals give financial aid to fewer than two dozen patients a year. Mahnomen Health Center, which recently converted to a rural emergency center, didn’t provide any charity care in eight years, despite serving one of Minnesota’s . Other hospitals serving large low-income populations were among those providing the least charity care, the analysis found.

Several factors help explain why Minnesota hospitals provide so little financial aid. For one, job-based insurance and an expanded Medicaid program offer broad coverage. Hospitals in states with less government assistance and more uninsured people typically spend more on charity care.

But Minnesota patients also face significant barriers accessing financial aid at many hospitals, including inconsistent eligibility standards and extensive applications, the Star Tribune-ºÚÁϳԹÏÍø News investigation found.

To qualify at many hospitals, patients must submit detailed personal information, including bank statements, retirement accounts, mortgage documents, and estimates of other assets such as cars, homes, or livestock.

And because Minnesota has not standardized the criteria for charity care, patients might receive aid at one hospital but not another. The investigation found that some hospitals give free care to patients with an annual household income of $47,000, while others cap it at about $15,000.

Had Roberts driven 30 miles east to Princeton or 35 miles north to Little Falls, she would have found medical providers with more generous financial aid policies than CentraCare. But she didn’t know to look.

Roberts, now 49, has remarried and lives in a split-level home in St. Cloud decorated with inspirational plaques such as “Faith, Family, Friends.” CentraCare recently dropped the lawsuit against her, but only after she took out a loan against her retirement plan to pay off the medical debt. “It just feels very unfair,” she said.

‘We Have To Defend Being Paid’

CentraCare spokesperson Karna Fronden said medical privacy laws prevented her from discussing Roberts’ case. She also declined interview requests about the health system’s charity care spending.

In a statement, Fronden said CentraCare provides assistance in addition to charity care, such as helping enroll patients in insurance. “This helps provide broader, longer-term protection for patients,” she said.

Other hospital leaders said they serve their communities in ways besides forgiving medical bills, including training doctors and nurses and preserving money-losing services such as obstetrics and mental health care.

“Rural hospitals like ours are often portrayed as though we are sitting on piles of cash and simply choosing not to spend it on charity care. That is far from the reality,” said Robert Pastor, chief executive of Rainy Lake Medical Center in International Falls.

“We are the second- or third-largest employer in town, running on razor-thin margins while navigating escalating labor and supply costs and routine underpayment by public programs,” Pastor said. “Meanwhile, many health insurers post billions in profits.”

Hospitals typically are paid less for care provided to Medicare and Medicaid patients. More than 80% of Rainy Lake’s patients are on one of those government programs.

Minnesota hospitals collectively write off about $200 million of what’s deemed bad debt every year after trying unsuccessfully to collect unpaid bills from patients through calls, letters, and even lawsuits. By comparison, they devote about $163 million annually to charity care, state figures show. In 2024, hospitals collectively posted $2.4 billion in net income.

“I feel like I’m put in the position, being the hospital, where we have to defend being paid,” said Patti Banks, the head of Ely-Bloomenson Community Hospital and a senior Minnesota Hospital Association board member.

Some hospitals face intense financial pressures. Thirty-one have lost money on operations in four of the past eight years. HCMC in Minneapolis — the state’s largest safety net hospital, which provides the most charity care — is losing so much money that, without additional taxpayer support, .

But larger health systems such as Mayo Clinic, Essentia Health, and Sanford Health have remained financially sound. And the operating margins at most CentraCare hospitals exceeded 10% in 2024, state data shows.

Medical Debt’s High Toll

Nationwide, health care debt — much of it from hospitals — burdens an estimated 100 million people, increasing their stress and even leading to premature deaths, .

Abby Kelley-Hands, a special education coordinator in St. Paul, has a rare immune condition that causes frequent, severe allergic reactions. Her illness can be controlled only with a costly drug, which a Mayo Clinic doctor prescribed.

When Kelley-Hands briefly lost health coverage in 2021 in an insurance mix-up, she was hit with more than $20,000 in bills. And although she and her husband earned less than $100,000 a year, Kelley-Hands said Mayo denied her financial assistance because she earned too much.

“I was in tears,” Kelley-Hands said. “It was so scary and so hard. And it causes all of this additional stress, which then makes you sicker and less able to even figure things out.”

Kelley-Hands and her husband sold a car and agreed to a payment plan before Mayo would resume her treatment, she said. Her husband now bikes 5 miles to work. They have no dishwasher. And she and her husband took a honeymoon only last fall, seven years after their wedding. “We live very simply,” she said.

Mayo spokesperson Kristyn Jacobson declined to discuss Kelley-Hands’ case.

In 2024, state lawmakers from denying care to patients with outstanding debt. And in 2025, Attorney General Ellison reached an agreement with Mayo to overhaul its charity care program after an investigation found the multibillion-dollar institution was systematically discouraging patients from applying.

After the state began investigating Mayo, the system’s , topping 1.5% of operating expenses in 2024.

‘Optimized To Get Payment’

Complying with a 2023 , Minnesota hospitals now post their financial aid policies online, although several, including CCM Health in Montevideo and Northfield Hospital, did so only after being contacted by the Star Tribune or ºÚÁϳԹÏÍø News.

But many hospitals make financial aid more difficult to find than information about paying bills, said Jared Walker, founder of Dollar For, a nonprofit that helps patients nationally apply for charity care.

“Hospitals have optimized to get payment,” he said. “If you want to get on a payment plan, if you want to get on a credit card, it’s so easy.”

Glacial Ridge Health System in Glenwood posts a “Bill Pay” tab at the . But it takes several clicks to find the hospital’s financial assistance plan. The information couldn’t be found on the site searching for “charity care” or “financial assistance.” The public hospital 130 miles northwest of Minneapolis devoted less than 0.7% of its operating budget to charity care from 2019 to 2024.

Patients in interviews frequently said they weren’t told about charity care.

Joe Robling, 29, was treated at St. Francis Regional Medical Center in Shakopee for a broken pelvis and fractured spine after a 2024 motorcycle accident. His mother, Janet, who helped him navigate the bills, said the hospital never informed him about financial aid.

“They didn’t offer any of that,” she said.

Robling, a construction worker in Henderson, was between jobs and uninsured. “He had zippo,” Janet Robling said. “What he had in reserves were all depleted.”

The Allina Health-affiliated hospital billed him more than $19,000, the Roblings said.

An internet ad connected the family to Dollar For, which helped Robling qualify for charity care five months after his accident.

Allina spokesperson Jennifer Steingas declined to comment on the case, citing medical privacy restrictions, but said the health system has since reached out to the family.

In another case, M Health Fairview’s University of Minnesota Medical Center didn’t offer financial aid to an unemployed and uninsured man from Idaho while he was hospitalized for two months for psychiatric care and amassed $150,000 in bills.

Attorney Margaret Henehan, who represented the man, said the hospital instead offered him a two-year payment plan at $6,500 a month. “He had no income, which he told Fairview,” Henehan said.

The man, who is not identified because of his mental health condition, eventually received charity care after his sister, a doctor, reached out to Henehan for help.

Aimee Jordan, a Fairview spokesperson, said she couldn’t comment on the case because of patient privacy laws, but she said patients who are offered payment plans can always apply for charity care, even after a hospitalization.

A Maze of Standards

State law prohibits hospitals from making “unreasonable” demands of patients when they apply for charity care. But the law sets few specific standards.

The result is a dizzying array of policies, including 11 income thresholds used by Minnesota hospitals to determine whether patients qualify for free care, the Minnesota Star-Tribune-ºÚÁϳԹÏÍø News review found.

HCMC parent company in Minneapolis and Olmsted Medical Center in Rochester offer the highest threshold for free care, at — almost $48,000 a year for an individual.

Sometimes standards vary even between neighboring hospitals. Madelia Health in south-central Minnesota to patients who make less than twice the federal poverty level. About 13 miles away at Mayo’s hospital in St. James, can qualify for aid.

To determine eligibility, some Minnesota hospitals consider only income, but most demand information about patients’ bank accounts as well. More than two-thirds require even more information, including the value of retirement accounts, life insurance policies, property, and vehicles. Madelia’s “may be required to sell recreational vehicles.”

Stringent requirements ensure that limited resources go to patients who need them, said Travis Olsen, chief executive of Hendricks Community Hospital, near the South Dakota border. “We don’t feel it’s fair for someone with lower annual income but yet owns numerous acres of land, debt-free, to be able to qualify for charity care.”

In addition to copies of tax returns, W-2 forms, pay stubs, and bank statements, 53 questions about their finances. These include questions about the make, model, and value of vehicles; the current market value of farm equipment, livestock, and land; and the purchase price and square footage of homes.

Other hospital applications ask patients to detail their monthly spending on food, utilities, and other medical bills.

Olsen said community pressure is more of a deterrent to applying for aid than the application: “People are too proud to pick up an application. We all know each other.”

But Walker at Dollar For said the biggest barrier is complexity. “The drop-off rates are much higher the more questions you ask and the more documentation you have to provide,” he said.

Arleen Mullenax had a cancerous tumor removed from her neck at Mayo in Rochester. Assembling her aid application and following up with the hospital billing department amid her “cancer fog” was almost more than she could take, she said.

“I knew as a former office manager I had to stay on top of it,” she said. “But it was the most daunting thing I had to do as a patient.”

Fixing the System

Ellison and several state lawmakers say Minnesota’s hospitals should make it simpler for patients to access charity care.

They’ve called for, among other things, common eligibility standards and a standard application across hospitals. New York and Maryland already have both.

“Eliminating as many barriers as possible for people is really important,” said state Sen. Liz Boldon, who also said she hopes lawmakers can enact these standards next session.

The Minnesota Hospital Association has opposed standardizing financial assistance, saying hospital boards are in the best position to assess the need for charity care in their communities. “Adding mandates for providers across the state will not close that gap, and will only increase bureaucratic and procedural barriers to patient care,” spokesperson Nelson said.

Ellison also has pushed to require hospitals to use a process that automatically screens and qualifies low-income patients for financial aid without requiring an application.

Some hospital systems, including South Dakota-based Sanford Health, already use software that checks patients’ eligibility based on information such as their credit history, said Nick Olson, the system’s chief financial officer. At Sanford Health’s 10 hospitals in Minnesota, about a quarter of the patients who receive financial aid get it this way, he said.

Nearly all Sanford hospitals devote more than 1% of their operating expenditures to charity care — higher than most hospitals in the state.

Screening software can be costly. Several executives at small Minnesota hospitals said they can’t afford it. But there are other options. In California, Los Angeles County is developing a public system to allow hospitals to quickly assess patients’ eligibility so they don’t have to buy a system themselves.

Other states — including Texas and Nevada — have laws requiring hospitals to provide minimum amounts of charity care.

Back in St. Cloud, Roberts said that when she drives past CentraCare’s $200 million expansion at its Plaza campus in St. Cloud, she wonders why Minnesota hospitals don’t live up to higher standards themselves.

“They have all the money,” she said. “But they can’t grant a good person some grace?”

Minnesota Star Tribune staff writers Bill Lukitsch and Victor Stefanescu contributed to this report.

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She and her family lived in a neatly landscaped neighborhood near Cleveland. They had a six-figure income and health insurance. Then, four years ago, when Monroe was pregnant with twin girls, something started to feel off.

“I kept having to come into the emergency room for fainting and other symptoms,” recalled Monroe, 43, who works for an insurance company.

The babies were fine. But after months of tests and hospital trips, Monroe was diagnosed with a potentially dangerous heart condition.

It would be costly. Within a year, as she juggled a serious illness and a pair of newborns, Monroe was buried under more than $13,000 in medical debt.

Part of the reason: Like tens of millions of Americans, she had a high-deductible health plan. People with these plans typically pay thousands of dollars out of their own pockets before coverage kicks in.

The plans, which have over the past two decades, are getting renewed attention thanks to President Donald Trump and his GOP allies in Congress.

Many Republicans are reluctant to extend government subsidies that help cover patients’ medical bills and insurance premiums through the Affordable Care Act.

And although GOP leaders have yet to coalesce around an alternative, several leading Republican lawmakers have said Americans who don’t get insurance through an employer should get cash in a special health care account, paired with a high-deductible health plan. In such an arrangement, someone could choose a plan on an ACA marketplace that costs less per month but comes with that can top $7,000.

“A patient makes the decision,” Sen. Bill Cassidy (R-La.) said . “It empowers the patient to lower the cost.”

In a last month, Trump said, “The only healthcare I will support or approve is sending the money directly back to the people.”

Conservative economists and GOP lawmakers have been making since high-deductible health plans started to catch on two decades ago.

Back then, a backlash against the limitations of HMOs, or health maintenance organizations, propelled many employers to move workers into these plans, which were supposed to empower patients and control costs. A change in tax law allowed patients in these plans to put away money in tax-free health savings accounts to cover medical bills.

“The notion was that if a consumer has ‘skin in the game,’ they will be more likely to seek higher-quality, lower-cost care,” said Shawn Gremminger, who leads the National Alliance of Healthcare Purchaser Coalitions, a nonprofit that works with employers that offer their workers health benefits.

“The unfortunate reality is that largely has not been the case,” Gremminger said.

Today, deductibles are almost ubiquitous, with the with job-based coverage approaching $1,700, up from around $300 in 2006.

But even as high deductibles became widespread, medical prices in the U.S. skyrocketed. The average price of a knee replacement, for example, from 2003 to 2016, more than double the rate of overall inflation.

At the same time, patients have been left with thousands of dollars of medical bills they can’t pay, despite having health insurance.

About 100 million people in the U.S. have some form of health care debt, a 2022 survey showed.

Most, like Monroe, are insured.

Although Monroe had a health savings account paired with her high-deductible plan, she was never able to save more than a few thousand dollars, she said. That wasn’t nearly enough to cover the big bills when her twins were born and when she got really ill.

“It’s impossible, I will tell you, impossible to pay medical bills,” she said.

There was another problem with her high-deductible plan. Although these plans are supposed to encourage patients to shop around for medical care to find the lowest prices, Monroe found this impractical when she had a complex pregnancy and heart troubles.

Instead, Monroe chose the largest health system in her area.

“I went with that one as far as medical risk,” she said. “If anything were to happen, I could then be transferred within that system.”

Federal rules that require hospitals to post more of their prices can make comparing institutions easier than it used to be.

But unlike a car or a computer, most medical services remain difficult to shop for, in part because they stem from an emergency or are complex and can stretch over numerous years.

Researchers at the nonprofit Health Care Cost Institute, for example, estimated that of total health care spending for Americans with job-based coverage was for services that realistically could be shopped for.

Fumiko Chino, an oncologist at the MD Anderson Cancer Center in Houston, said it makes no sense to expect patients with cancer or another chronic disease to go out and compare prices for complicated medical care such as surgeries, radiation, or chemotherapy after they’ve been diagnosed with a potentially deadly illness.

“You’re not going be able to actually do that effectively,” Chino said, “and certainly not within the time frame that you would need to when facing a cancer diagnosis and the imminent need to start treatment.”

Chino said patients with high deductibles are often instead slammed with a flood of huge medical bills that lead to debt and a cascade of other problems.

She and other researchers found in presented last year that cancer patients who had high-deductible health insurance were more likely to die than similar patients without that kind of coverage.

For her part, Monroe and her family were forced to move out of their house and into a 1,100-square-foot apartment.

She drained her savings. Her credit score sank. And her car was repossessed.

There have been other sacrifices, too. “When families get to have nice Christmases or get to go on spring break,” Monroe said, hers often does not.

She is thankful that her children are healthy. And she continues to have a job. But Monroe said she can’t imagine why anyone would want to double down on the high-deductible model for health care.

“We owe it to ourselves to do it a different way,” she said. “We can’t treat people like this.”

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LISTEN: Bad credit can keep you from getting a job, a car loan, or an apartment to rent. For many Americans, health care debt is to blame. ºÚÁϳԹÏÍø News senior correspondent Noam N. Levey appeared on WAMU’s “Health Hub” on Nov. 12 to explain why new federal guidelines on health care debt and credit reports worry some consumer protection advocates.

More than 100 million Americans are estimated to have health care debt. In response, more than a dozen states have instituted laws to keep these unpaid bills off consumer credit reports.

The Trump administration has been chipping away at these protections.

The Consumer Financial Protection Bureau, headed by President Donald Trump’s budget director, issued new guidance that challenges state laws, saying only the federal government can decide what can go in a credit report. Consumer advocates say that move could undercut state-level protections and worsen the financial strain on Americans burdened by medical bills.

ºÚÁϳԹÏÍø News senior correspondent Noam N. Levey appeared on WAMU’s “Health Hub” on Nov. 12 to explain why state laws like these could be especially important in the wake of the One Big Beautiful Bill Act, set to kick millions off Medicaid, and the potential lapsing of enhanced tax credits for people buying health insurance through the Affordable Care Act marketplaces.

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

More than a dozen states, including Washington, Oregon, California, Colorado, Minnesota, Maryland, New York, and most of New England, have enacted laws in recent years to keep medical debt from affecting consumers’ credit.

And more states — including several in conservative regions of the Midwest and Mountain West — have been considering similar protections, spurred by bipartisan concerns that medical debt on a credit report can make it harder for people to get a home, a car, or a job.

Nationwide, about 100 million people have some form of health care debt, with millions burdened by $10,000 or more in unpaid bills.

But , the Consumer Financial Protection Bureau asserts that federal law bars states from restricting medical debts from credit reports, arguing that only the federal government has this authority.

“Congress meant to occupy the field of consumer reporting and displace state laws,” the bureau concluded in an “interpretive rule” signed by Russell Vought, the White House budget director and acting head of the CFPB.

The guidance, which offers a new interpretation of the Fair Credit Reporting Act, reverses policies advanced under former President Joe Biden that sought to empower states to expand protections for people with medical debt.

The Trump administration’s latest move will not immediately roll back existing state protections.

But advocates for patients and consumers warn that the new guidance may stall progress elsewhere, just as millions of Americans are poised to lose federal aid that helps them buy health insurance through the Affordable Care Act. The aid is tied up in the current budget showdown between congressional Republicans and Democrats.

“You’d be hard-pressed to find a crueler regulatory interpretation,” said Elisabeth Benjamin, a vice president for the Community Service Society of New York. The nonprofit has pushed for medical debt protections in that state.

Lucy Culp, who oversees state lobbying efforts by Blood Cancer United, formerly known as the Leukemia & Lymphoma Society, warned that the Trump administration’s guidance could reverberate across the country. “This rule will have a chilling effect on states’ willingness to pass these critical patient protections,” she said.

The CFPB did not respond to a request for comment.

The new CFPB guidance might spur more litigation challenging state restrictions on medical debt credit reporting.

Trade groups representing credit reporting agencies and debt collectors went to court early this year challenging regulations issued by the Biden administration that would have removed medical debt from credit reports nationwide. They argued that the administration exceeded its authority in issuing the credit reporting restrictions.

The federal restrictions would have helped an estimated 15 million people. But the Trump administration chose not to defend the new regulations, and a federal judge in Texas appointed by Trump ruled that the regulations should be scrapped. They never went into effect.

The Consumer Data Industry Association, which represents credit agencies and has argued that regulating medical debt should be left to the federal government, welcomed the new guidance from the Trump administration.

“There should be one national standard to govern how information is provided to consumer reporting agencies and what information can appear on a consumer’s credit report,” association president Dan Smith said in a statement.

Broader health insurance protections could prevent more Americans from sinking into debt and depressing their credit scores.

But millions of Americans to lose health coverage in the coming years as a result of the tax and spending bill signed by the president in July.

“Millions of Americans are avoiding medical care, putting off needed surgeries, skipping essential treatments,” said Allison Sesso, president and chief executive of Undue Medical Debt, a nonprofit that buys up and retires patients’ debts and advocates for broader patient protections.

“This isn’t just a health care issue,” Sesso added. “It’s an economic crisis that’s keeping families from building wealth and fully participating in the economy. When credit scores are dinged by medical bills, everyone loses.”

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Mary Catherine Johnson is a retired small-business owner from outside Rochester, New York. She voted for Donald Trump three times.

Lexy Mealing, who used to work in a physician’s office, is from Long Island. She’s a Democrat.

But the women share a common bond. They both survived breast cancer.

And when the American Cancer Society Cancer Action Network organized its annual citizen lobby day in Washington last month, Johnson and Mealing were among the more than 500 volunteers pushing Congress to keep cancer research and support for cancer patients at the top of the nation’s health care agenda.

The day is something of a ritual for groups like the cancer organization.

This year, it came as Democrats and Republicans in Washington slid toward a budget impasse that shut down the federal government. But these volunteers transcended their political differences and found common ground.

“Not one person here discussed if you’re a Democrat, if you’re a Republican,” said Mealing, one of 27 volunteers in the New York delegation. “Cancer doesn’t care.”

Every one of the volunteer lobbyists had been touched in some way by the deadly disease, which is expected to kill people in the U.S. this year.

Johnson said each of her mother’s 10 siblings died from cancer, as did a lifelong friend who died at age 57, leaving behind his wife and two young daughters.

Like many of the New York volunteers, Johnson also said she’s worried about the state of politics today.

“I think we’re probably the most divided that we’ve ever been,” she said. “That scares me. Scares me for my grandchildren.”

Katie Martin, a cancer volunteer from outside Buffalo, also worries. She and her daughter recently drove past political protesters screaming at one another on the street.

 “My daughter is silent and then starts asking, ‘What is this?’ And I don’t know how to explain it, because it doesn’t even make sense to me,” she said. “It’s very heartbreaking.”

Mealing said she can barely watch the news these days. “A lot of Americans are very stressed out. There’s a lot of things going on.”

Americans are indeed split over many issues — immigration, guns, President Trump. But helping people with cancer and other serious illnesses retains broad bipartisan support, polls show.

In , 7 in 10 voters said it’s very important for the federal government to fund medical research. That included majorities of Democrats and Republicans.

“It’s rare in today’s environment to see numbers like that,” said Jarrett Lewis, a Republican pollster who conducted the survey for patient groups. “But almost everybody in this country knows somebody who’s had cancer.”

Similarly, a recent found that three-quarters of U.S. adults, including most Republicans who align with the Make America Great Again, or MAGA, movement, want Congress to extend subsidies that help Americans buy health insurance through Affordable Care Act marketplaces.

These subsidies, which are critical to people with chronic illnesses such as cancer, are among the main sticking points in the current budget impasse in Congress.

As the cancer volunteers gathered in a conference hotel in Washington, they focused on their shared agenda: increasing funding for cancer research, retaining insurance subsidies, and expanding access to cancer screening.

“We may not see eye to eye politically. We might not even see eye to eye in social circumstances,” said Martin, the Buffalo-area volunteer. “But we can see beyond those differences because we’re here for one cause.”

The state delegations practiced the pitches they would make to their members of Congress. They ran through the personal stories they would share. And they swapped tips for how to deal with resistant staff and how to ask for a photo with a lawmaker.

On the morning of their lobby day, they reconvened in a cavernous ballroom, decked out in matching blue polo shirts and armed with red information folders to leave at each office they would visit.

They got a pep talk from a pair of college basketball coaches. Then they headed across town to Capitol Hill.

The army of volunteers — from every state in the country — hit 484 of the 535 Senate and House offices.

Not every visit was an unqualified victory. Many Republican lawmakers object to extending the insurance subsidies, arguing they’re too costly.

But lawmakers from both parties have backed increased research funding and support for more cancer screening.

And the New Yorkers felt good about the day. “It was amazing,” Mealing said as the day wrapped up. “You could just feel the sense of, ‘Everybody stronger together.’”

When evening came, the volunteers met on the National Mall for a candlelight vigil. It was raining. Bagpipes played.

Around a pond near the Lincoln Memorial, some 10,000 tea lights glimmered in little paper bags. Each luminary had a name on it — a life touched by cancer.

John Manna, another New Yorker, is a self-described Reagan Republican whose father died from lung cancer. He reflected on the lessons this day could offer a divided nation.

“Talk to people,” he said. “Get to know each other as people, and then you can understand somebody’s positions.  We have little disagreements, but, you know, we don’t attack each other. We talk and discuss it.”

Manna said he would be back next year.

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Millions of people are expected to lose health insurance in the coming years as a result of the tax cut legislation Trump signed this month, leaving them with fewer protections from large bills if they get sick or suffer an accident.

At the same time, significant increases in health plan premiums on state insurance marketplaces next year will likely push more Americans to either drop coverage or switch to higher-deductible plans that will require them to pay more out-of-pocket before their insurance kicks in.

Smaller changes to federal rules are poised to bump up patients’ bills, as well. New federal guidelines for covid-19 vaccines, for example, will to stop covering the shots for millions, so if patients want the protection, some may have to pay out-of-pocket.

The new tax cut legislation will also raise the cost of certain doctor visits, requiring copays of up to $35 for some Medicaid enrollees.

And for those who do end up in debt, there will be fewer protections. This month, the Trump administration secured permission from a federal court to that would have removed medical debt from consumer credit reports.

That puts Americans who cannot pay their medical bills at risk of lower credit scores, hindering their ability to get a loan or forcing them to pay higher interest rates.

“For tens of millions of Americans, balancing the budget is like walking a tightrope,” said Chi Chi Wu, a staff attorney at the National Consumer Law Center. “The Trump administration is just throwing them off.”

White House spokesperson Kush Desai did not respond to questions about how the administration’s health care policies will affect Americans’ medical bills.

The president and his Republican congressional allies have brushed off the health care cuts, including hundreds of billions of dollars in Medicaid retrenchment in the mammoth tax law. “You won’t even notice it,” at the White House after the bill signing July 4. “Just waste, fraud, and abuse.”

But consumer and patient advocates around the country warn that the erosion of federal health care protections since Trump took office in January threatens to significantly undermine Americans’ financial security.

“These changes will hit our communities hard,” said Arika Sánchez, who oversees health care policy at the nonprofit New Mexico Center on Law and Poverty.

Sánchez predicted many more people the center works with will end up with medical debt. “When families get stuck with medical debt, it hurts their credit scores, makes it harder to get a car, a home, or even a job,” she said. “Medical debt wrecks people’s lives.”

For Americans with serious illnesses such as cancer, weakened federal protections from medical debt pose yet one more risk, said Elizabeth Darnall, senior director of federal advocacy at the American Cancer Society’s Cancer Action Network. “People will not seek out the treatment they need,” she said.

Trump promised a rosier future while campaigning last year, and “expand access to new Affordable Healthcare.”

Polls suggest voters were looking for relief.

About 6 in 10 adults — Democrats and Republicans — say they are worried about being able to afford health care, according to , outpacing concerns about the cost of food or housing. And medical debt remains a widespread problem: As many as 100 million adults in the U.S. are burdened by some kind of health care debt.

Despite this, key tools that have helped prevent even more Americans from sinking into debt are now on the chopping block.

Medicaid and other government health insurance programs, in particular, have proved to be a powerful economic backstop for low-income patients and their families, said Kyle Caswell, an economist at the Urban Institute, a think tank in Washington, D.C.

Caswell and other , for example, that Medicaid expansion made possible by the 2010 Affordable Care Act led to measurable declines in medical debt and improvements in consumers’ credit scores in states that implemented the expansion.

“We’ve seen that these programs have a meaningful impact on people’s financial well-being,” Caswell said.

Trump’s tax law — which will slash more than $1 trillion in federal health spending over the next decade, mostly through Medicaid cuts — is expected to leave 10 million more people without health coverage by 2034, according to the from the nonpartisan Congressional Budget Office. The tax cuts, which primarily benefit wealthy Americans, will add $3.4 trillion to U.S. deficits over a decade, the office calculated.

The number of uninsured could spike further if Trump and his congressional allies don’t renew additional federal subsidies for low- and moderate-income Americans who buy health coverage on state insurance marketplaces.

This aid — enacted under former President Joe Biden — lowers insurance premiums and reduces medical bills enrollees face when they go to the doctor or the hospital. But unless congressional Republicans act, those subsidies will expire later this year, leaving many with bigger bills.

Federal debt regulations developed by the Consumer Financial Protection Bureau under the Biden administration would have protected these people and others if they couldn’t pay their medical bills.

The agency issued rules in January that would have removed medical debts from consumer credit reports. That would have helped an estimated 15 million people.

But the Trump administration chose not to defend the new regulations when they were challenged in court by debt collectors and the credit bureaus, who argued the federal agency had exceeded its authority in issuing the rules. A federal judge in Texas appointed by Trump ruled that the regulation should be scrapped.

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Cox, who is a property manager at a real estate company in Globe, has tenants who rely on the safety-net program. And at the domestic violence shelter where she volunteers as president of the board, Cox said, staff always look to enroll women and their children if they can.

But Cox, who is 65, has mixed feelings about Medicaid. “It’s not that I don’t see the need for it. I see the need for it literally on a weekly basis,” she said. “I also see a need for revamping it significantly because it’s been taken advantage of for so long.”

It wasn’t hard to find people in Globe like Cox with complicated views about Medicaid.

Gila County, where Globe is located, is a conservative place — almost 70% of voters went for President Donald Trump in November. And concerns about government waste run deep.

Like many rural communities, it’s also a place where people have come to value government health insurance. The number of Gila County residents on Medicaid and the related Children’s Health Insurance Program has nearly doubled over the past 15 years, according to data from the Georgetown University Center for Children and Families. Today, almost 4 in 10 residents are on one of the plans for low- and moderate-income people or those with disabilities.

So as congressional Republicans consider plans to from Medicaid, the debate over the program hits close to home for many Globe residents, even as some welcome the prospect of tighter rules and less government spending.

For Heather Heisler, the stakes are high. Her husband has been on Medicaid for years.

“We’re ranchers, and there’s not much money in ranching,” said Heisler, who gets her own health care from the Indian Health Service. “Most people think there is, but there isn’t.”

Heisler was selling handicrafts outside the old county jail in Globe on a recent Friday night when the town hosted a downtown street fair with food trucks and live music.

She said Medicaid was especially helpful after her husband had an accident on the ranch. A forklift tipped over, and he had to have part of his left foot amputated. “If anything happens, he’s able to go to the doctor,” she said. “Go to the emergency room, get medicines.”

She shook her head when asked what would happen if he lost the coverage. “It would be very bad for him,” she said.

Among other things, proposed tax legislation written by House Republicans would require working-age Medicaid enrollees to prove they are employed or seeking work. The bill, which passed the House and has advanced to the Senate, would also mandate more paperwork from people to prove they’re eligible.

Difficult applications can dissuade many people from enrolling in Medicaid, even if they’re eligible, . And the nonpartisan more than 10 million people will likely lose Medicaid and CHIP insurance under the House Republican plan.

That would reverse big gains made possible by the 2010 Affordable Care Act, which has allowed millions of low-income, working-age adults in places like Globe to get health insurance.

Nationally, Medicaid and CHIP have expanded dramatically over the past two decades, with enrollment in the programs surging from about in 2005 to more than last year, according to federal data.

“Medicaid has always played an important role,” said Joan Alker, who runs the Georgetown University Center for Children and Families. “But its role has only grown over the last couple of decades. It really stepped in to address many of the shortcomings in our health care system.”

That’s particularly true in rural areas, where the share of is higher, residents have lower incomes, and communities are reliant on industries with skimpier health benefits such as agriculture and retail.

In Globe, former mayor Fernando Shipley said he’s seen this firsthand.

“A lot of people think, ‘Oh, those are the people that aren’t working.’ Not necessarily,” said Shipley, who operates a State Farm office across the road from the rusted remains of the Old Dominion copper mine. “If you’re a single parent with two kids and you’re making $20 an hour,” he added, “you’re not making ends meet. You’ve got to pay rent; you’ve got to feed those kids.”

Not far away, at the local hospital, some low-wage workers at the registration desk and in housekeeping get health care through Medicaid, chief financial officer Harold Dupper said. “As much as you’d like to pay everyone $75,000 or $80,000 a year, the hospital couldn’t stay in business if that was the payroll,” he said, noting the financial challenges faced by rural hospitals.

The growing importance of Medicaid in places like Globe helps explain why Republican efforts to cut the program face so much resistance, even among conservatives.

“There’s been a shift in the public’s attitude, and particularly voters on the right, that sometimes government plays a role in getting people health care. And that’s OK,” said pollster Bob Ward. “And if you take away that health care, people are going to be angry.” Ward’s Washington, D.C., firm, Fabrizio Ward, works for Trump. He also polls for a coalition trying to protect Medicaid.

At the same time, many of the communities where Medicaid has become more vital in recent years remain very conservative politically.

More than two-thirds of nearly 300 U.S. counties with the biggest growth in Medicaid and CHIP since 2008 backed Trump in the last election, according to a ºÚÁϳԹÏÍø News analysis of voting results and enrollment data from Georgetown. Many of these counties are in deep-red states such as Kentucky, Louisiana, and Montana.

Voters in places like these are more likely to be concerned about government waste, polls show. In one recent , 75% of Republicans said they think waste, fraud, and abuse in Medicaid is a major problem.

The actual scale of that waste is hotly debated, though relatively few enrollees are abusing the program.

Nevertheless, around Globe, Republican arguments that cuts will streamline Medicaid seemed to resonate.

Retiree Rick Uhl was stacking chairs and helping clean up after lunch at the senior center. “There’s a lot of waste, of money not being accounted for,” Uhl said. “I think that’s a shame.” Uhl said he’s been saddened by the political rancor, but he said he’s encouraged by the Trump administration’s aggressive efforts to cut government spending.

Back at the street fair downtown, David Sander, who is also retired, said he doubted Medicaid would really be trimmed at all.

“I’ve heard that they really aren’t cutting it,” Sander said. “That’s my understanding.”

Sander and his wife, Linda, were tending a stall selling embroidery that Linda makes. They also have a neighbor on Medicaid.

“She wouldn’t be able to live without it,” Linda Sander said. “Couldn’t afford to have an apartment, make her bills and survive.”

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Underscoring the massive scale of America’s medical debt problem, a New York-based nonprofit has struck a deal to pay off old medical bills for an estimated 20 million people.

, which buys patient debt, is retiring $30 billion worth of unpaid bills in a single transaction with Pendrick Capital Partners, a Virginia-based debt trading company. The average patient debt being retired is $1,100, according to the nonprofit, with some reaching the hundreds of thousands of dollars.

The deal will prevent the debt being sold and protect millions of people from being targeted by collectors. But even proponents of retiring patient debt acknowledge that these deals cannot solve a crisis that now touches around 100 million people in the U.S.

“We don’t think that the way we finance health care is sustainable,” Undue Medical Debt chief executive Allison Sesso said in an interview with ºÚÁϳԹÏÍø News. “Medical debt has unreasonable expectations,” she said. “The people who owe the debts can’t pay.”

In the past year alone, Americans borrowed an estimated $74 billion to pay for health care, a nationwide found. And even those who benefit from Undue’s debt relief may have other medical debt that won’t be relieved.

This large purchase also highlights the challenges that debt collectors, hospitals, and other health care providers face as patients rack up big bills that aren’t covered by their health insurance.

Pendrick’s chief executive, Chris Eastman, declined several requests to be interviewed about the debt sale, which has not been previously reported. But Eastman acknowledged in that collecting medical debts has grown more challenging as regulators have restricted how collectors can pursue patients.

Pendrick has now shuttered, which Sesso said provided strong motivation for this deal. “This was a really great opportunity to get a debt buyer out of the market,” she said.

Undue Medical Debt a decade ago, leveraging charitable donations to buy medical debt from debt trading companies at steeply discounted prices and then freeing patients from the obligation to pay.

The nonprofit now buys debts directly from hospitals, as well. And it is working with about two dozen state and local governments to leverage public money to relieve medical debt in communities from Los Angeles County to Cleveland to the state of Connecticut.

The approach has been controversial. And Undue Medical Debt’s record-setting purchase — financed by a mix of philanthropy and taxpayer dollars — is likely to stoke more debate over the value of paying collectors for medical debts.

“The approach is just treating the symptoms and not the disease,” said Elisabeth Benjamin, a vice president at the Community Service Society of New York, a nonprofit that has led efforts to restrict aggressive hospital collections. Benjamin and other advocates say systemic changes such as ensuring hospitals offer sufficient financial aid to patients and reining in high medical prices would be more valuable in preventing people from sinking into debt.

But many government officials see retiring people’s unpaid medical bills as part of a larger strategy to make it easier for patients to avoid debt in the first place.

“Turning off the tap is what’s really important in the long run,” said Naman Shah, a physician who directs medical affairs at the Los Angeles County Department of Public Health. The county is local hospital financial aid programs for patients. But Shah said debt relief is key, as well.

 “It’s easy to criticize band-aids when you’re not the one who’s cut,” he said. “As a physician, I take care of people who have cuts, and I know the importance of stitching them back up.”

Undue Medical Debt’s latest deal, which it is spending $36 million to close, will help patients nationwide, according to the nonprofit. But about half the estimated 20 million people whose debts Pendrick owned live in just two states: Texas or Florida.

Neither has expanded Medicaid coverage through the 2010 Affordable Care Act, a key tool that bolsters patients’ financial security by protecting them from big medical bills and debt.

The patients eligible for debt relief have incomes at or below four times the federal poverty level, about $63,000 for a single person, or debts that exceed 5% of their incomes.

About half the debts are also more than seven years old. These have been donated to Undue Medical Debt by Pendrick, the group reported.

The nonprofit plans to pay for the rest of the debts over the next year and a half, though all collections have stopped against patients. It also plans to spend an additional $40 million — or $2 a person — to process the debts, find patients, and inform them that their debts have been relieved.

Sesso, Undue’s chief executive, said she hopes the debt purchase will keep policymakers focused on enacting longer-term solutions to the nation’s medical debt crisis.

She applauded state leaders for taking steps to bar medical debts from their residents’ credit scores. But she said action is also needed in Washington, D.C. However, the Trump administration has suspended regulations enacted under former President Joe Biden that would have barred credit reporting of medical debt nationally, and congressional Republicans are now moving to revoke the new rules.

“There is a limit to what state and local governments can do to solve this problem,” Sesso said. “It’s really a national problem that has to be solved at the national level.”

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Eight years later, two industry groups have been notably restrained as GOP lawmakers consider sweeping new Medicaid cuts: the American Medical Association and the American Health Care Association, which represents nursing homes.

At the same time, the two groups are lobbying Republicans, seeking support on other priorities.

The AMA is lobbying lawmakers to reverse a nearly 3% cut in Medicare’s fees for physicians. And the AHCA has pushed Congress to roll back regulations enacted under President Joe Biden that mandate better staffing ratios at nursing homes.

Representatives of the two groups declined to comment on the record about any connections between the Medicaid fight and their other legislative priorities.

But AHCA spokesperson Rachel Reeves said the nursing home group, which has issued a statement defending Medicaid, is communicating with lawmakers about the importance of the program for people with low incomes and disabilities. “We will make sure that the voices of our community are heard and that the message is loud and clear: Congress must protect our seniors who rely on Medicaid,” she said. Medicaid is the primary payer for nursing home care, covering nursing home residents.

Nevertheless, other advocates and congressional Democrats said they’re frustrated by the two groups. “The time to speak out is now,” Sen. Ron Wyden, the senior Democrat on the Senate Finance Committee, told ºÚÁϳԹÏÍø News. “Americans will know which organizations stood up against harmful cuts to Medicaid when this fight is over.”

Medicaid, a state-federal insurance plan that together with the related Children’s Health Insurance Program covers about 80 million Americans, is in the crosshairs as congressional Republicans seek to trim several trillion dollars in federal spending to offset the $4.5 trillion cost of extending tax cuts enacted in President Donald Trump’s first term.

Medicaid cuts on the scale being contemplated would put coverage for millions of Americans at risk. That has alarmed advocates who work with people covered by the program, including children, Americans with disabilities, and low-income older adults. Other advocacy organizations who work with these patients have been much more active.

Last week, more than 400 pediatricians traveled to Washington, D.C., to speak to members of Congress about the importance of Medicaid. More than 100 leaders of safety-net hospitals that serve low-income patients around the country did the same.

Patients’ advocates such as the American Cancer Society Cancer Action Network have defended Medicaid. Last month, state medical societies sent a letter to congressional leaders warning of dire consequences if Medicaid cuts are enacted. And this week, more than 750 members of the American College of Obstetricians and Gynecologists are expected in Washington, where the group says they’ll be lobbying to preserve Medicaid funding.

“Slicing hundreds of billions of dollars from federal funding will force states to cut the care children and families depend on or raise taxes on hard-working Americans,” said Chip Kahn, chief executive of the Federation of American Hospitals, another trade group fighting to defend Medicaid.

Building coalitions was critical in previous health care debates, said Ron Pollack, the former head of patient advocacy group Families USA. Pollack helped lead the push for the 2010 Affordable Care Act. “We succeeded in the past because we stuck together,” he said.

Eight years ago, the AMA and AHCA were key that turned back Republican efforts to repeal the Affordable Care Act, often called Obamacare.

The AMA, the nation’s largest physician group, to Congress throughout 2017, warning lawmakers in a March 17, 2017, letter that they should “keep upmost in your mind the potentially life altering impact your decisions will have on millions of Americans.”

And the AHCA’s president was a leading voice opposing repeal, which at one point “the biggest threat that the sector has faced in at least 20 to 25 years.”

This year, the AMA hasn’t sent a single letter or issued any news releases opposing Medicaid cuts. By contrast, the group has issued since January on the lack of congressional action on physician fees.

The AHCA issued its first public defense of Medicaid in this year’s debate — a document it called a — only the day after House Republicans adopted a budget resolution that threatens the program’s funding. When the group issued its 2025 last week, “Priority #1” focused on staffing, including repealing the Biden-era staffing mandate. “Protecting Medicaid” was “Priority #2.”

The Medicaid debate will likely drag on for months as GOP leaders in the House and Senate try to cobble together a bill to extend tax cuts.

Medicaid’s defenders say they’re still looking for more voices to speak up.

“Republicans have said outright that silence is consent,” Wyden said. “If health care organizations don’t speak out against the GOP’s plans to cut health care, Republican lawmakers are going to assume those organizations are on board with their agenda.”

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