In a troubling development for community health care, PrairieStar Health Center in south-central Kansas has initiated lawsuits against patients for unpaid medical bills, including claims as low as $59. This action has raised questions about the center’s commitment to providing affordable care, given its status as a federally funded nonprofit aimed at enhancing access to health services for low-income families.
In June 2023, Ashley Voss-Barnes received a court summons, indicating that PrairieStar was suing her for $675 in unpaid medical bills while also pursuing her wife for $732. Voss-Barnes, a nurse familiar with navigating the health care system, was perplexed by the lawsuit, especially since she and her wife had previously arranged for an automatic payment plan with the clinic. In her court filing, she stated that the health center never informed them that their payments were insufficient to cover their bills. “If I have something due, then I will try to pay it,” she told ProPublica. “It came out of nowhere.”
Voss-Barnes and her wife eventually established new payment arrangements with a collections agency to avoid wage garnishment, but the couple ended up incurring additional costs in the form of interest, court fees, and legal expenses. The financial burden has left them anxious about potential future lawsuits. Voss-Barnes expressed her belief that they are not alone in facing such predicaments.
According to a ProPublica analysis of state court records, PrairieStar has filed at least 1,000 lawsuits against patients since 2020 for unpaid medical bills. Many of these patients were uninsured and qualified for discounted care. Community health centers like PrairieStar were established during the Civil Rights Movement to serve as medical safety nets for individuals unable to afford primary care. They receive federal grants in exchange for providing access to patients regardless of their financial situation.
Despite this mission, ProPublica’s investigation revealed that several community health centers, including PrairieStar, have resorted to suing patients and garnishing wages. This contradicts their foundational goal of increasing access to care for underserved populations. The investigation identified additional health centers in Kansas, as well as one in Virginia and another in Michigan, consistently filing lawsuits since at least 2020.
In response to inquiries from ProPublica, PrairieStar CEO Bryant Anderson stated that the health center is grappling with significant financial pressures, describing the situation as a “perfect storm.” He emphasized that PrairieStar attempts to communicate with patients multiple times before pursuing collections. He asserted that approximately a third of patients decline to provide income information to apply for sliding-scale discounts, which could alleviate some financial burdens.
Other health center leaders echoed the sentiment that lawsuits are a last resort. Renee Hively, CEO of CareArc, also located in Kansas, acknowledged the challenges but defended the practice of pursuing patient debt through legal means. She referenced a specific case where a patient faced wage garnishment for over a decade due to unpaid medical bills.
In California’s Monterey County, a spokesperson indicated that the health department refrains from suing patients, stating that most debts sent to collections involve small amounts that do not justify legal proceedings. In contrast, many community health centers are under scrutiny for their aggressive collection practices.
While hospitals have been the primary focus of public scrutiny regarding medical debt, community health centers are now facing similar backlash. Federal law mandates that these centers must make “every reasonable effort” to collect debts before writing them off, but the interpretation of “reasonable” varies widely. Experts argue that there is no requirement for health centers to resort to lawsuits or wage garnishment to collect debts.
Medical debt specialists expressed shock at the revelation that community health centers are engaging in such practices, as these institutions are designed to provide care to vulnerable populations. Miriam Straus, a policy adviser for Community Catalyst, noted that such collection activities could hinder patients from seeking necessary care in the future.
On Virginia’s Eastern Shore, another community health center, Eastern Shore Rural Health, has filed over 7,000 lawsuits in the past decade. One couple was sued for as little as $59 in January 2024, a sum that ballooned significantly due to additional costs. Court records reveal that many individuals working low-wage jobs, such as those in poultry processing, have faced garnishments.
The health center’s chief financial officer, Kandy Bruno, explained that they turn to legal action only after exhausting other options, such as offering interest-free payment plans and assistance with Medicaid applications. She acknowledged that pursuing debt through lawsuits is not ideal but indicated that it is a necessary measure under current financial constraints.
In response to this growing issue, Virginia has recently passed legislation aimed at curbing aggressive debt collection practices. Beginning in mid-2024, large medical providers will be prohibited from garnishing wages of patients who qualify for financial assistance. Bruno stated that they will comply with the new law and assess its implications for their operations.
The challenges presented by medical debt highlight the broader issue of access to healthcare in regions where community health centers serve as the primary option for preventive care. In Kansas, the lack of Medicaid expansion has left many individuals without health insurance, increasing reliance on these centers for affordable services.
Efforts to recover medical debt through legal means raise ethical questions about the mission of community health centers. Krista Postai, founder of the Community Health Center of Southeast Kansas, noted that her facility prioritizes maintaining patient dignity and has opted not to outsource collections to third-party agencies. This approach reflects a commitment to keeping healthcare accessible rather than compounding the stress faced by low-income patients.
As the situation evolves, the actions of community health centers will be closely scrutinized, particularly in light of their dual role as providers of essential healthcare services and collectors of patient debts. Addressing the balance between financial sustainability and patient care remains a critical challenge for these organizations.
