Canāt Pay Medical Bills? Trump Officials Suggest Getting a Loan, New York Times, June 11, 2026, by Reed Abelson
In the dense 1,121-page final rule issued last month about how the Affordable Care Act market will operate next year, the administration suggested that insurers consider offering loans to cash-strapped customers.
Under this approach, people who develop a costly disease or need unexpected emergency care would be able to turn to their health insurer for loans to cover their share of the bill. The debt, though, would have to be repaid, presumably with interest.
At a time when more than a third of American households already have some kind of medical debt, experts expressed dismay at the possibility of adding to the strained budgets of people already dealing with higher health care costs.
āThe last thing you want to do is to increase deductibles and load people up with more medical debt,ā said Neale Mahoney, an economist at Stanford University. āIt seems to be hugely out of touch with where people are.ā
At least one insurer is equipped to start lending customers the money to cover big medical bills: UnitedHealth Group, the giant that owns the nationās largest health insurer. The company operates a bank through its Optum unit, which offers health savings accounts, where people can accumulate pretax money to pay for medical expenses, and also lends money to doctors.
āWe did the math,ā schoolteacher David Stahl said. āIf you donāt use health care, it makes much more sense to use the H.S.A.ā But unforeseen accidents outstripped those savings because he had a $10,000 deductible. His son broke his arm, and he dislocated his shoulder.
Dr. John W. Scott, a trauma surgeon and health services researcher at the University of Washington, said that borrowing money for medical care would not address the fundamental issue of rising health care expenses for the average household. Offering loans through insurers, Dr. Scott said, āseems to be a restructuring of who they owe the debt to, and that is the opposite of a solution.ā
Comment:
By Don McCanne, M.D. and Jim Kahn, M.D., M.P.H.
Merging the go-it-alone consumer philosophy of the Trump administration with the profit interests of private insurers, the Affordable Care Act will soon offer a creative solution to the unaffordability of care for beneficiaries with high deductible, high cost-sharing ACA policies.
Itās simple: Insurers will offer more plans that pay for less medical care, deflecting high costs to patients to pay out of packet. And ā hereās the innovation ā when these expenses are unaffordable, the insurers can provide loans, further indebting sick patients.
Thus insurers increase profit by reducing spending. And they expand business portfolios to include banking (or, will it be loan-sharking?). Patients will have a Hobsonās choice: boost insurer income by taking on debt, or skip needed medical care.
Wait a minute. Is that the way itās supposed to work? Isnāt everyone supposed to receive the care they need, paid for out of a common risk pool funded by progressive income and wealth taxes, making it affordable for everyone? Single payer, of course. Slash administrative costs and insurer profits, and use those savings to fund care.
But hereās the catch. That solution would undermine Trumpās goal of transferring the cost of benefits for workers and their families to wealth management programs for the affluent (thatās what health savings accounts really are). His goal of enriching the rich clashes with our goal of assuring affordable health care.
Isnāt it time that we provide needed health care for everyone and fund the system based on the ability to pay? Workers and low-income families would pay the taxes that are affordable to them. The same would be true of billionaires (and, now, trillionaire) since their contributions would be modest as a portion of their income and wealth, leaving them ample resources for any opulent lifestyle.
Letās keep up the fight for single payer, Medicare for All. This is a huge step toward making America really great again.
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