This week thousands of Kansans will get a Publishers Clearing House sweepstakes-style surprise. But instead of a knock on the door and a giant check, they’ll find a letter in the mail informing them that some past hospital or doctor bill has been paid off.

Somos Votantes Education Fund, a nonpartisan civic engagement organization focused on the Latino community and connected to the left-leaning voter group Somos Votantes, announced it has purchased more than $42 million in medical debt belonging to nearly 27,000 Kansans.

That was all of the medical debt available in Kansas through Undue Medical Debt, a nonprofit that raises donations to buy medical debt in bulk for pennies on the dollar and forgive it.

Melissa Morales, the president and founder of Somos Votantes, said the education fund brought the debt relief effort to Kansas after medical debt became a hot-button issue in U.S. Sen. Roger Marshall’s reelection campaign against Democrat Adam Hamilton. 

The Republican incumbent’s debt collection policies as an obstetrician-gynecologist a decade ago made national headlines last month when The New York Times reported that Marshall’s Barton County medical practice charged patients 18% interest on unpaid bills, took them to court and sought bench warrants when they didn’t show up. The newspaper found that Marshall’s patients were arrested over unpaid bills 81 times.

“If you live in Kansas, you have heard about medical debt over the course of the last month,” said Morales, who grew up in Liberal, Kansas, and recently moved back to the state. “It brought top of mind a program that my organization had already been working on and I just thought, ‘What an amazing opportunity to be able to bring that home and actually deliver that kind of service to my home state of Kansas.’”

The group’s Seeds of Relief initiative, focused on providing direct economic relief, paid off medical bills for 128,000 people in two Nevada counties last year, and in August it paid off utility bills for 280 Michigan families.

The 26,926 Kansans who had debt forgiven are in Johnson and Wyandotte counties in the Kansas City area and across the state in Butler, Cherokee, Cowley, Crawford, Douglas, Finney, Ford, Geary, Harvey, Leavenworth, Lyon, McPherson, Miami, Montgomery, Reno, Riley, Saline, Sedgwick, Seward and Shawnee counties.

“It’s about providing some economic breathing room for people because the economy is everything,” Morales said. “People cannot focus on literally anything else because the cost of living is so out of control.”

Somos Votantes officials did not say where the Kansas debt originated or how much they paid for it, but Undue Medical Debt tells potential donors that a $1 donation typically pays for about $100 in medical debt. 

Not solving the problem

Since its founding in 2014, Undue Medical Debt has worked with private donors, foundations and state and local governments to buy up more than $53 billion in medical debt. 

The idea is that taking it off patients’ backs will relieve credit scores, help people afford necessities like rent and food and clear a path for them to return to the doctor when they need care.

But some advocates working to alleviate medical debt said the growing debt forgiveness trend doesn’t fix the underlying problem of patients incurring debilitating debt in the first place. Medical debt is the No. 1 cause of bankruptcies in the United States and affects almost a third of adults.

“I love what they’re doing and want them to continue doing it,” said Mary Shannon of Care Over Collections, a Missouri group working to bring awareness to the medical debt problem. 

But Shannon said the intervention doesn’t undo the mental and financial harm done to people who have to confront unaffordable debt, often accumulated from an emergency or illness they could not avoid or plan for.

“My social worker’s perspective is always going to be that we need to look upstream into preventing the debt,” Shannon said, “and (providing) more tools for folks to manage that medical debt outside of collection agencies and courtrooms.”

Recent reporting by The Beacon found that only two Kansas City-area hospitals — the University of Kansas Health System and NKC Health — sometimes sue patients over unpaid bills. In rural counties across Missouri and Kansas, debt collection lawsuits brought by hospitals are common. And there are also lawsuits filed by physician groups, laboratories and other medical organizations.

Undue Medical Debt buys debt from hospitals, physician groups, ambulance companies, collection agencies and debt buyers, a spokesman said. It is unclear where the debt being forgiven in Kansas this week originated. The groups declined to provide those details. But research indicates that the majority of medical debt is from hospitals, meaning it is probably fair to assume some of the debt was hospital-related.

A spokeswoman said the University of Kansas Health System does not sell patient debt, so the area’s largest hospital would not have been included in the Undue Medical Debt buy. 

In the past, Prime Healthcare, which owns Providence Medical Center in Kansas City, Kansas, has sold debt to Undue Medical Debt, according to a press release. 

Leverage to demand change

Forgiving debt won’t force hospitals to change their collection practices, said Matt Keenan, executive director of Kansas Legal Services. He argued that some of the patients having debts forgiven probably shouldn’t have incurred the debt in the first place, based on many hospitals’ financial assistance standards.

Undue Medical Debt’s guidelines call for only buying debt for households with medical debt equal to 5% or more of their annual income, or for those earning 400% the federal poverty level or below — about $109,000 a year for a family of three. People in that financial category with debt from a nonprofit hospital likely qualified for financial assistance, including free or discounted care, Keenan said.

Nonprofit hospitals are obligated to offer free care and other community benefits in exchange for their tax-free status. In Kansas and Missouri, financial assistance standards are up to the hospitals, but hospitals are required under federal law to evaluate whether patients qualify for free care before suing them or taking other extraordinary debt collection measures.

“The system is not working,” Keenan said.

But the groups buying and forgiving the debt are in a position to push for change, he said. After all, if the bills should have never been issued in the first place, getting even a penny on the dollar in repayment is a windfall for hospitals.

In addition to forgiving debt, hospitals should be forced to repay garnished wages, Keenan said, commit to no future lawsuits against patients who have had debt forgiven and work to avoid suing patients who qualify for and should have instead received assistance.

Undue Medical Debt  and Somos Votantes “are in a unique position to extort leverage over these hospitals,” Keenan said of the effort to change how patient bills are handled. “They’re giving them something that they have very little chance of receiving. I would hope they would use that leverage to extract a recognition that practices need to change.”