‘I’m not going without food’: Hoosiers burdened by medical debt call for change

( MIRROR INDY ) — For the first time in months, Ronald Brady could buy toilet paper.

In between his shifts as a warehouse worker at Walmart, the 60-year-old brought the rolls back to his home near Fountain Square. He walked past his used Hyundai Sonata, a car he spent years saving up for, only for it to be damaged and nearly stolen in April.

“I prayed for them,” Brady said of the would-be thieves. “I guess for other people, you just go a different route with stealing or whatever you have to do to survive.”

He needed to survive, too. Hospital bills from a hernia surgery and regular blood testing to monitor his high cholesterol left him relying on food pantries. Even with private insurance, medical debt was swallowing his income and creating impossible choices.

“You either buy some food or you pay this bill,” Brady said. “I’m not going without food.”

But then, something miraculous happened: an anonymous donor and the United Way of Central Indiana erased nearly $240 million in medical debt for more than 112,000 Hoosiers like Brady. While the gift eased the burden for some, health care advocates say state lawmakers need to make sweeping changes to medical billing in Indiana. Hospitals here have some of the highest prices in the country.

[ Related: How to get help paying for your medical bills at Eskenazi Health ]

Still, when Brady’s letter came in mid-June, it was as if God opened the sky and pennies rained down from heaven.

“Even though it was a small amount they paid, it was more weight off my shoulders,” he said. “For what people are going through around here these days, it’s a big help.”

One bill, $193 of his $1,300 burden, was relieved. Brady silently thanked the stranger and wished that the gift had covered the rest of his debt, too.

Indiana has worst medical debt rate in the Midwest

Medical debt is like a chain. It rattles as you apply for jobs, loans, housing. The gatekeepers of opportunity can look at your credit score and decide you’re unreliable. Collectors can garnish your wages or put a lien on your house. The burden is ever-present when you or someone you love needs medical care, even in emergencies: Can I pay the price?

“As income goes up or down, people change jobs or become unemployed, there’s a lot of holes they can fall into,” said Erin Macey , director of the Indiana Community Action Poverty Institute, a local nonprofit researching the issue.

Indiana residents have the highest share of medical debt in the Midwest, according to the Consumer Financial Protection Bureau, and the 11th worst rate in the nation. The institute’s 2022 report pointed to many culprits: the state’s poor health outcomes, high health care costs, the number of Hoosiers who are uninsured or underinsured and barriers to accessing hospital charity care.

In Marion County, medical debt disproportionately affects communities of color — which includes African Americans, Hispanic, Asian, Pacific Islanders, American Indians, Alaska Natives and people who are multiracial — who have a 26% share in collections, compared to 17% in white communities. National data reflects this disparity, with Black people more likely to report medical debt than any other racial or ethnic group. People in poor health or living with a disability also have higher rates of medical debt.

“We all have human bodies to take care of, and we have not built a system that allows all people to afford to do that,” Macey said.

The anonymous donor, who was described as having “long standing interest” in Marion County, brought some welcome relief. Undue Medical Debt , a national nonprofit, used their gift to buy the debt in bulk. People who qualified were at or below 400% of the federal poverty level — making less than $124,800 a year for a family of four — or had medical debt that was 5% or more of their annual income.

Legislation stalled by hospital lobby

One-time relief can help people get back on their feet, advocates say, but it doesn’t fix a broken system that kept them down in the first place.

In the announcement of the $1.2-million gift, the donor acknowledged this with a call for numerous policy changes: expanding the number of people who qualify for charity care; requiring hospitals to screen patients for financial assistance before billing them; preventing medical debt from being reported against a patient’s credit score; and pausing debt collection while a patient appeals to their insurance company.

“I am deeply moved by the generosity of this donor,” said Sean Huddleston , the president of Martin University, who spoke on behalf of the anonymous benefactor during a June 17 press conference. “If successful, (the changes) would significantly reduce or possibly eliminate the need for such a bold action in the future.”

Many of these policies were proposed in Senate Bill 276 , filed by Sen. Fady Qaddoura, D-Indianapolis, during the 2024 session. The legislation, which never received a hearing in the Republican-controlled legislature, would have required hospitals to screen patients for financial assistance programs and enroll those who qualified. Many people do not know this kind of help exists or how to apply for it, said Dave Almeida, a lobbyist for Leukemia & Lymphoma Society , a national nonprofit that supported the bill.

“Right now, you have to be your own advocate,” Almeida said. “But people who just learned they are seriously ill have to focus on their own treatment, not navigating charity care.”

The bill also sought to protect people from hospitals or their collectors reporting their debt to credit agencies, which hurts credit scores. Another provision would have protected people’s assets, including their homes or vehicles, even if they have medical debt.

Sen. Ed Charbonneau, R-Valparaiso, who chairs the Senate Committee on Health and Provider Services, declined to give the bill a hearing. A spokesperson for Charbonneau declined to answer questions about the bill.

The bill died because the Indiana Hospital Association, a powerful lobbying force for the state’s hospitals, wanted to wait for proposed federal regulations around medical debt, Qaddoura said. A public commenting period for those regulations closes in August. Lobbyists also pushed back on the bill’s proposal to prevent hospitals from reporting medical debt to credit agencies, Qaddoura said.

A representative from the IHA confirmed the organization met with Senate lawmakers and pushed for the bill to be consistent with the proposed federal rules. IHA did not answer questions about why the hearing was canceled or the association’s opposition to the bill.

In a statement sent to Mirror Indy, IHA spokesperson Laura Kracher called inadequate health care coverage the “root cause” of medical debt. She also noted that Indiana hospitals provided $700 million in financial assistance to patients last year and pay $1.5 billion annually to fund Medicaid and expand coverage under the HIP 2.0 program.

“In many instances, patients can find themselves responsible for their entire medical bill without any help from their health plan, which can leave them vulnerable to significant medical debt,” Kracher wrote.

Qaddoura said he will try again with a new bill in 2025.

A ticking time bomb

While legislation is in limbo, lives hang in balance.

On the southeast side, Rebekah Lewis, 60, and her husband, Mark, are waiting for the bills to pile up once again.

It all started in 2022, when the couple took the proverbial retirement trip to Florida. Mark brought his guitar to play Jim Croce songs for his wife on the beach. But one morning, after rolling over in bed, his neck snapped.

“Cancer had eaten his bone,” Rebekah said.

The next days were a blur, a race to find out if he would survive. Doctors in Indiana delivered the official diagnosis: multiple myeloma , a bone marrow cancer. Rebekah handed over her credit card for the hospital stay.

Nurses at Community North soon found her in tears over a $3,000 bill for one month’s worth of Revlimid , a chemotherapy drug part of Mark’s new treatment plan. The steep cost came out of pocket after Medicare and private insurance. Rebekah had to decide the best way to support her 66-year-old husband: should she go back to work to try to pay for this drug or take care of him?

“You get one diagnosis and everything you worked for your whole life means nothing,” she said.

Rebekah chose being a caregiver over work. The couple prayed and applied for grants. Pooled together, two gifts from the Leukemia & Lymphoma Society and one from the HealthWell Foundation covered all $36,000 of their debt for the medication. Mark also entered temporary remission.

The two danced together in the waiting room to Jim Croce’s “Time in a Bottle.”

“God is good,” Rebekah said. “We just try to find what’s good about the moment and live there.”

Still, the future lurked in the back of her mind. When the tumors come back — and they will because multiple myeloma has no known cure — Mark would need to go back on the costly drug.

Rebekah had spoken to some state politicians about the debt issue. “Something’s got to give,” she said. “There’s got to be somebody smarter than me that can come up with something.”

In the meantime, they would just have to live and dance with a ticking time bomb waiting to go off.

Mirror Indy reporter Mary Claire Molloy covers health. Reach her at 317-721-7648 or email maryclaire.molloy@mirrorindy.org. Follow her on X @mcmolloy7 .