Bombarded with calls and letters from bill collectors, Nila Payton can’t recall precisely how she ended up owing $4,000 in medical debt to her employer, UPMC.
But she knows more than half came from a rough 2018, after she endured a difficult pregnancy, surgery to remove her gallbladder, and the treatment of her newborn in the neonatal intensive care unit for several weeks because of a medical crisis.
“I remember saying at the end of 2018, ‘I hate 2018. The only good thing about it was my baby being born,’” she said. “It was a very stressful year.”
And, she added: “The bills only made it harder.”
Though the 41-year-old mother carried UPMC health insurance through her job as an administrative assistant in pathology at UPMC Presbyterian Hospital, and co-insurance through Medicaid that UPMC recommended, the bills from 2018 arrived on top of bills from prior years and grew with more recent bills.
That resulted in her debt going to the dreaded bill collector, who called her several times a week on her cell and work phones, causing her more stress, even though UPMC said its policy bans collectors from making more than one call a week.
“It just breaks my heart knowing that we are basically starving for UPMC when it comes to our health care,” said Ms. Payton, who is not alone in that view.
SEIU, the national union that has been trying to organize workers at UPMC Presbyterian-Shadyside hospital for a decade, claims that a survey conducted in 2019 of hundreds of the 3,500 hourly workers shows that about 60% of the respondents owed money to the hospital giant for health care costs.
At a time when UPMC is generating hundreds of millions in profits annually, the growing concern over medical debt is being raised by local workers as health care costs are rising and new transparency rules now allow consumers to compare prices between hospitals.
In an emailed response to the Post-Gazette, UPMC declined to respond to questions about the union survey or provide the number of workers who owe medical debt. It said that its coverage plans provide “significant value to our lower paid employees that few, if any, in health care do,” adding that “UPMC’s benefits are considerably better than other health care organizations in western PA…”.
Though the debt owed by hospital workers has stirred debate in other parts of the nation — often as part of union organizing — SEIU and other unions that reach out to hospital workers say the issue is far more pervasive at UPMC than at other large hospital institutions.
“We aren’t aware of medical debt at other health systems the way we are with UPMC workers,” said Matthew Yarnell, president of SEIU Healthcare PA, which has organized workers at hospitals across the country, including nurses at West Penn Hospital in Pittsburgh.
Over the past two years, the union has turned the spotlight on medical debt as one of the three pillars of its campaign at public rallies to organize UPMC workers. The other two pillars are increasing wages to $20 an hour, and allowing workers the freedom to form a union.
The union claims that pressure in recent years is what prompted UPMC in November to announce a series of financial and health care sweeteners. They included not only giving its employees $500 cash bonuses and a 5% raise for the starting pay of hourly workers, but also freezing employees’ health care costs for a year and creating a UPMC-funded health savings account for lower wage workers to help pay medical costs.
UPMC said it has not been pressured, but that the enhancements were a way to say “thank you” to employees.
Christoria Hughes, a former dietary worker at Presbyterian who helped to start the union movement a decade ago but retired this past fall still owing UPMC about $4,000, said the pay and benefit boost is not nearly enough.
“Even when they give you something, in the end you’re barely breaking even,” Ms. Hughes said.
In its emailed response to the Post-Gazette, UPMC compared its wages and worker health insurance options to those at Allegheny Health Network, its biggest local rival, claiming UPMC offers much lower monthly premiums to its employees.
“Our entry level and service worker benefits are better than AHN’s,” said UPMC, adding that it offers a benefit known as ‘first dollar coverage’ that waives the first $1,000 in medical expenses for low-wage workers and $2,000 for those with families.
UPMC said its “silver” level, standard EPO plan — which provides a local network of doctors and hospitals — costs its lowest wage workers $36 a month in premiums for an individual, compared to $103 a month for a similar AHN plan.
But AHN said that the plan a majority of its employees choose is also an EPO that offers $300 deductibles and $2,500 out-of-pocket maximums for its lowest wage earners, with a monthly premium of $75.
UPMC’s silver plan offers its employees who make less than $18.04 an hour a $700 deductible for individuals and out-of-pocket expenses limited to $3,050 a year.
But while AHN, which provides coverage for workers from its insurance company, Highmark, has been steeped in labor disputes with unions represented by SEIU, employee medical debt has not been an issue as it has been for UPMC.
Asked whether the debt is a problem for its employees, AHN said in an emailed response it didn’t have data on how many of its workers owe money for medical costs, but said AHN offered “generous benefit coverage” to them, including “out-of-pocket cost protections.”
SEIU said it takes in many factors when comparing the costs of both systems, including feedback from its members, but when it comes to UPMC, “the fundamental question for [the] workers is: Is it acceptable that our biggest employer and charity — one that made $1 billion in profit last year — forces their own employees to choose between paying their medical bills and their rent?”
National experts say the debate over hospital workers buried in medical bills is a result of a larger trend of employers and insurers constantly shifting more costs onto workers through co-pays and higher deductibles.
“In some ways this is a perfect little microcosm of all the issues of health care pricing,” said Jessica Curtis, an independent consultant in Boston who works on hospital medical debt issues.
Still, with UPMC reaping hundreds of millions of dollars in profits annually and holding billions in reserve, having its employees owing it money for care in its own hospitals is troubling, Ms. Curtis said.
The dispute over worker medical debts at UPMC is “in many ways just a classic, textbook case of everything that’s wrong with hospital finances,” she said.
There are no studies on how common the problem is among hospitals, multiple experts said.
But experts such as Jenifer Bosco, staff attorney for the National Consumer Law Center, said the many individual cases where it does arise shows it’s a larger problem that has just not been studied more broadly.
“There aren’t good numbers” about how many health care workers owe money to their employers, said Ms. Bosco, of NCLC, a nonprofit with offices in Washington, D.C., and Boston that advocates for low-income people. “But there is a growing sense that it is a problem across the country.”
Ms. Bosco was co-author of a 2019 NCLC report that proposed, to state and federal governments, the Model Medical Debt Protection Act to help people in dealing with medical debt.
She said she had found multiple examples across the nation where the issue was being debated between hospitals and their workers.
One of the most egregious cases was revealed in a series of ProPublica stories in 2019 at Methodist Le Bonheur Healthcare in Memphis, where the hospital was regularly suing its own employees for medical debt.
UPMC’s policy prohibits the hospital — as well as third-party debt collectors — from suing its employees for medical debt, or taking any other extraordinary action beyond employing debt collectors.
But Ms. Bosco said “this one [at UPMC] feels extra egregious” because UPMC is both the employer, health care provider and insurer.
Most employers are not tied to the insurance firms that cover their workers, and often try to persuade insurers to cut costs.
At UPMC and other hospitals that insure their employees, “you have an entity basically negotiating with itself,” Ms. Bosco said. “It’s hardly an arms-length transaction.”
Mark Rukavina, a program director at Community Catalyst, a national nonprofit headquartered in Boston that advocates for health equity, said his group has increasingly heard stories about health care workers owing money to the organizations that employ them.
“We’ve heard it a lot in connection to labor issues,” he said. “But we know it’s bigger than that.”
Because the issue was repeatedly raised, he included the topic in an article he penned in May for his group’s blog, titled “Hospital Billing and Financial Practices: First Do No Harm,” in which he called on hospitals to, among other things, try to eliminate medical debt for their workers.
“Recognize that employees are often also patients and subject to harmful billing and collection processes, work to reduce or forgive employees’ medical debt,” he wrote as one of seven bullet-point recommendations to hospitals to help their own employees.
One reason to eliminate medical debt for employees is the stress it causes, said Allison Sesso, executive director of RIP Medical Debt, a nonprofit in Long Island City, N.Y., that raises money to pay off medical debt held by third-party collectors.
“Knowing you have medical debt creates mental stress for people,” she said. “And people who work in hospitals are already in high stress situations with COVID. You’d think it would be easy to take this one thing off their plate.”
During a year-long campaign called Helping COVID Heroes that began in 2020, RIP Medical Debt retired over $200 million in debts for more than 100,000 first responders.
Among those 100,000 who were helped, 26% were nurses, who collectively held $48 million in medical debt, and 1.5% were doctors with a total of $2.8 million in past bills.
RIP Medical Debt’s data does not indicate how much of the debt belonged to health care workers’ employers, but Ms. Sesso said the organization knows at least some owed money to their employers based on interviews.
Ms. Payton, the UPMC employee with more than $4,000 in debt, said that once her debt began to grow, the UPMC billing department told her she should apply for Medicaid, which is government health insurance provided to lower-income people.
Ms. Payton makes $19.04 an hour, after getting a pay raise last year from $17.39 an hour. Her $39,600-a–year pay is the sole source of income for her family; her husband has been unable to find a job that would make it profitable for him to work rather than stay home and care for their two young children.
After talking to many of her coworkers, she said she found that she was not the only UPMC employee who was told to apply for Medicaid. “Me and many of my coworkers were directed to apply for government assistance,” she said.
UPMC said in an emailed response to the Post-Gazette that “referring individuals to Medicaid is not our standard practice.”
But even making such a suggestion to its employees means that it’s “now joining the ranks of the Walmarts and McDonald’s that they look at Medicaid [for financial help for employees]” because of how much it pays its workers, said Ms. Curtis, the consultant.
“What it really makes me wonder is, of all the things they could do to help their employees, starting at the hospital itself should be the first,” she said. “It also tells me that the people setting up the benefit packages [for UPMC’s lower-wage earners] are not sitting down with the revenue cycle [department at UPMC] and sharing that data” about how many workers owe medical debt to UPMC.
“You’d think they’d sit down and say, ‘Geez, look at how many of our folks [who are in debt to us] are our own employees,’” she said.