Nearly 20 percent of DC adults are burdened by unpaid medical bills, and that number could soon increase. Considering hundreds of billions of dollars in looming Medicaid cuts for Americans and stalled federal reforms, a new report released today by Tzedek DC details the problem for DC residents and offers solutions the DC Council can implement as a state-level government.
The report, "More Than a Band-Aid: Systemic Changes to Protect DC Residents from Medical Debt," shows how medical debt drives financial hardship, worsens health outcomes, and deepens racial and economic disparities in the District.
“With Medicaid under attack and federal protections weakening, DC must act now to shield our residents,” said Ariel Levinson-Waldman, Founding President and Director-Counsel of Tzedek DC. “Addressing medical debt head-on can help thousands of families regain financial stability and improve health outcomes and make the system fairer and smarter.”
“Medical debt is a critical issue that affects DC residents’ physical, mental, and financial health,” said Councilmember Christina Henderson, Chair of the DC Council’s Committee on Health. “Tzedek DC’s medical debt report details the scope of the problem and identifies areas for improvement. I look forward to working with my colleagues and stakeholders to reduce medical debt for District residents.”
The report outlines specific policy solutions for DC, including limiting medical debt interest rates, banning medical debt from credit reports, requiring transparency from hospitals’ financial assistance programs, and strengthening enforcement tools and compliance incentives through the DC Office of the Attorney General. The report also recommends reforming harmful medical debt collection tactics such as wage garnishment and property liens against residents’ homes on the basis of medical debt.
“Medical debt is a leading reason people are contacted by debt collectors, disproportionately affecting Black and Latino families. But, unlike other types of debt, medical debt is unpredictable, and that makes it a poor judge of anyone's creditworthiness,” said Berneta Haynes, senior attorney at the National Consumer Law Center. “People do not plan to get sick or hurt, which is why we support Tzedek DC’s report and their proposals to reduce the burden of medical debt by eliminating credit reporting of medical debt and preventing medical debt from occurring.”
DC has already helped eliminate $42 million in medical debt for more than 62,000 District residents through a 2024 DC-funded initiative by the Mayor that Tzedek DC was proud to help facilitate. But without systemic reforms, the organization warns, emergency relief will have only been a temporary fix, and more ad hoc emergency relief measures will be needed.
The report highlights how medical debt disproportionately impacts Black residents, individuals with disabilities, and mothers, further widening DC’s severe racial wealth gap. Patients facing medical debt often delay necessary care, worsening chronic conditions, and driving up long-term costs for the community.
The full report, personal stories, and Tzedek DC’s policy solution recommendations are available here.
About Tzedek DC, Our Medical Debt Work, and the Health Equity Fund
Tzedek DC’s name is drawn from the ancient Jewish teaching “Tzedek, tzedek tirdof,” or “Justice, justice you shall pursue.” Headquartered at the University of the District of Columbia David A. Clarke School of Law, and with offices also in Ward 8, Tzedek DC is a nonprofit organization. Our mission is to safeguard the legal rights and financial health of DC residents with lower incomes facing the often-devastating consequences of debt collection and credit-related obstacles, including those arising from medical debt. This mission is carried out as anti-racism work in response to the massive wealth gaps tracking race in DC and nationwide. Tzedek DC seeks to serve and empower its client base, which is comprised of 90% Black residents, 60% women, and 25% disabled community members. Our strategic approach combines three synergistic activities: (i) free direct services—legal representation and advice, and financial counseling; (ii) working in coalition to make systemic change; and (iii) providing bilingual community legal education on debt collection, identity theft, and credit management. Since 2017, Tzedek DC has served over 4,000 client households in legal matters and catalyzed systemic reforms benefiting hundreds of thousands of DC residents.
A portion of Tzedek DC’s medical debt work is funded by the Health Equity Fund, as administered by the Greater Washington Community Foundation in partnership with the Health Equity Committee. The Health Equity Fund is designated to improve the health outcomes and health equity of residents of the District of Columbia. The historic fund is one of the largest philanthropic funds of any kind focused on community-based nonprofits that serve District residents. Given that 80 percent of DC’s health outcomes are driven by social, economic, and other factors, compared to just 20 percent by clinical care, the Health Equity Fund adopts an economic mobility frame to address the root causes of health inequity and advances a sustainable network of people, organizations, and projects to ensure equitable health outcomes for Black, Brown, Indigenous, People of Color and other marginalized populations in DC.
We are especially grateful to the Health Equity Fund for the support and shared vision of health equity and racial and economic justice.