Calls mount to ‘de-weaponize’ medical debt

Hospital group opposes relief measures, citing ‘satisfying care experience’
The Medical Debt De-Weaponization Act is designed to help families struggling with medical debt.
Published: Jun. 15, 2023 at 10:42 PM EDT
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CHARLOTTE, N.C. (WBTV) - Terry Belk’s medical debt started mounting when his wife was diagnosed with breast cancer.

She had health insurance, a strong will to live and a doting husband. Her focus should have been on her health, but instead she was preoccupied with medical debt. Her insurance only covered a percentage of her medical expenses.

“She was actually afraid to go back to the hospital because of the bills,” Belk said.

Those bills, what the Belk’s owed, totaled more than $23,000.

“I just said, listen, let us just get better.”

After undergoing six months of chemotherapy, she was in remission but thousands of dollars in debt to Atrium Health, one of the largest hospital systems in the U.S.., based here in Charlotte.

Belk said the law firm that represents Atrium in debt collections, McIntosh Law Firm, suggested that he and his wife sign a Deed of Trust with Atrium to reconcile the outstanding medical debt. As a result Atrium retains a partial claim on the equity of his home, court records show.

He says he felt pressured into accepting the deal. For him it was a quick remedy so he could focus on his wife and her health.

“I felt I didn’t have a choice or the money to fight this system,” he said.

“They were heartless.”

WBTV has found that it is not unusual for Atrium, a non-profit hospital, to file lawsuits against patients when they have unpaid medical debt. We spent weeks at the Charlotte-Mecklenburg Courthouse pulling thousands of medical debt lawsuits from Atrium, and found that oftentimes these lawsuits turn into judgments, which can eventually turn into property liens on homes.

For almost two decades Belk has been burdened with medical debt. Not only has he ceded thousands of dollars in equity on his home for his wife’s medical debt, he has battled Atrium over unpaid medical bills for his own radiation therapy for prostate cancer.

Belk is not alone. One in five North Carolinians have medical debt in collections, totaling more than one million people. According to a report from State Treasurer Dale Folwell’s office, North Carolina is one of the most expensive states for health care in the nation. The majority of this medical debt is owed to hospitals.

Advocates for greater medical cost transparency say stories like Belk’s illustrate the lack of consumer protections against the billing and collection practices of nonprofit hospitals and the need for legislative action to address the lack of price transparency, high facility fees and high upcharges on services.

In 2012, Sandra’s cancer came back, Belk quit his job to be with his wife of 25 years, and she spent the last months of her life at home.

“She died thinking about medical debt,” Belk said.

Last year Belk felt it was time to go public with his story and become an advocate for others. He’s no stranger to stirring up good trouble, he was the Chairman of the Political Action Committee of the local NAACP in Charlotte in the 1990s.

Belk is now on the frontline fighting the hospital industry and its billing practices. Earlier this year he spoke at a town hall on medical debt at Central Piedmont Community College with state leaders. Among them was Folwell, who spearheaded the Medical Debt De-Weaponization Act, a bill, which if passed, would put North Carolina near the top of the list for states with the best consumer protections against medical debt.

Medical debt is an issue Folwell has spotlighted for years. His office has released five reports exposing the profiteering practices of nonprofit hospitals, the latest of which reveals how the pay for CEOs of nonprofit health facilities has doubled in less than five years.

Folwell believes the Medical Debt De-Weaponization Act could serve as a corrective. The bill would shield family members from incurring the medical debt of a spouse or family member, protect peoples’ access to itemized bills, require hospitals to screen patients for charity care and limit how much hospitals charge for visiting facilities.

The bill passed unanimously in the N.C. Senate in May, but for the last month it has sat in the House Rules Committee with no movement.

“We are one vote away in North Carolina from being at the bottom of the ladder in the United States in terms of protecting the consumers of North Carolina regarding medical debt, to being number two in the country if this legislation were passed,” Folwell said.

Medical debt consumer protection legislation has proven to be an issue where Republicans and Democrats can find common ground.

This year Colorado passed a bill that will lower interest rates and require greater transparency in costs of treatment and prohibit debt collections during an appeals process. Arizona passed, by 70 percent, a similar constitutional referendum. And last year the state legislature in New York passed a bill that would prohibit hospitals from putting liens on property due to medical debt.

“So this is an example of where Democrats, Republicans, unaffiliated and libertarians can come together,” Folwell said.

When asked what the key hurdle might be that’s blocking this bill from passing, the Treasurer smiled and used a term of his own coinage, “the hospital cartel.”

The ‘Hospital Cartel’

Political observers say the hospital industry is one of the most powerful special interest groups in Raleigh. The North Carolina Healthcare Association represents more than 100 hospitals. Their website highlights the bills they’ve blocked and the bills they currently oppose, including the Medical Debt De-Weaponization Act.

“I would say that if anyone is trying to stop this legislation, it would be them because they’ve tried to stop all the legislation that we’ve put forward to bring transparency to healthcare and healthcare billing,” said Folwell.

The NCHA pays well for its political influence. In 2022, the NCHA was one of the top three special interest groups in Raleigh, spending more than $680,000 lobbying state lawmakers.


Since 2022, when the Medical Debt De-Weaponization Act was first introduced, NCHA has contributed more than $260,000 in political campaign donations, campaign finance records show.


“The hospital cartel, you know they don’t come in the front door,” Folwell said.

“That’s not how cartels work.”


WBTV requested an interview with NCHA’s CEO, Steve Lawler, or another representative but the organization declined to answer questions on camera.

A spokeswoman sent a statement instead.

“Hospitals want all patients to have a satisfying care experience, including with the financial process, and they strive to deliver on that every day,” the statement said in part.

The fate of future consumer medical debt protections rests in the hands of the N.C. State House and House Speaker Tim Moore.

Since 2022 Moore has received the maximum campaign contribution from the NCHA; he has also accepted more than $180,000 in campaign contributions from other health care entities, including $5,000 from a political action committee affiliated with Atrium Health.

WBTV reached out to Speaker Moore’s office regarding his position on the bill and did not get a response.

While the Medical Debt De-Weaponization Act sits idly in the House, medical debt continues to influence what can be life and death decisions for many North Carolinians.

Terry Belk says more needs to be done.

“Most of the people, they can pay if they get sick,” Belk said. “But the people that they’re representing, most of them can’t. So let’s have some compassion.”

“Let’s pass this bill and make it a law.”

Meanwhile Belk found himself back in the hospital for an emergency surgery on his gallbladder and had no choice but to go to Atrium Health, it was the only hospital close by that was in network with his insurance.

“The last thing I wanted to be is to be back at Atrium,” said Belk.

Belk now owes another $6,000 to Atrium.

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