Oregon Law Cuts Medical Debt Collectors by 872 Per County

**Oregon’s 2019 nonprofit hospital debt‑relief law cut the number of people pursued by medical debt collectors by at least 872 per county, a JAMA Network Open cohort study shows.

Oregon’s 2019 statute requires nonprofit hospitals to forgive or reduce medical bills for patients earning up to 200% of the federal poverty level before referring accounts to debt collectors. The law applies to nearly all hospitals in the state, as all but two are nonprofit. Researchers from Tulane, Northeastern, the Colorado School of Public Health, and VCU examined county‑level data from Oregon and a set of comparison states to assess the policy’s impact.

The study found at least 872 fewer people per Oregon county facing collection actions for medical bills compared with counties in states that limit similar assistance to Medicaid patients only. Lead author Tatiane Santos said hospitals that can expand financial assistance could substantially reduce medical debt in their communities, especially as upcoming Medicaid cuts threaten coverage. Under the law, individuals earning up to about $32,000 annually or families of four earning up to $66,000 qualify for full or partial bill forgiveness before any collection effort.

These results suggest that broader income‑based financial assistance policies can lower medical‑debt collection rates, though the observational design shows association, not proven causation. Policymakers considering similar measures should note that effective enforcement and patient awareness are needed to sustain impacts over time. Hospitals may improve outcomes by sliding‑scale discounts that reach earners up to 400% of the poverty level, as the law already encourages.

Watch for whether Oregon’s enforcement remains strong after the initial rollout and how other states adapt the model amid federal Medicaid reductions.