2021年7月24日，人们在华盛顿特区示威，支持“全民医保”。
People demonstrated in support of ‘medicare for all’ in Washington DC on 24 July 2021.
专家表示，权宜之计无法解决数百万人负担不起所需医疗服务这一根本问题。近年来，部分共同欠下数十亿美元医疗费用的数百万美国人看到了债务被免除，今年援助力度更是大幅增加。
Stopgap measure does not solve fundamental problem that millions can’t afford the healthcare they need, experts say Some of the millions of Americans who collectively owe billions of dollars for medical expenses have seen their debt forgiven in recent years, and there has been a dramatic uptick in aid this year.
但专家指出，这种减免仍仅覆盖未偿余额的一小部分，只是权宜之计，无法解决根本问题：美国人因负担不起所需医疗服务而陷入严重财务困境。
But the relief still only covers a small fraction of the outstanding balance and is just a stopgap measure that does not solve the fundamental problem: people in the US get into serious financial trouble because they can’t afford the healthcare they need, experts say.
“解决医疗服务可负担性危机才能最终触及问题核心，”非营利组织“关怀重于催收”的主任玛丽·香农说，该组织致力于教育收到账单的患者了解他们的选择。
“Addressing the affordability crisis in healthcare is what will ultimately get at the heart of the issue,” said Mary Shannon, director of Care Over Collections, a nonprofit that educates patients who receive bills about their options.
据非营利健康研究机构KFF统计，2024年美国人欠下的医疗债务至少达2200亿美元。约1400万人欠款超过1000美元，300万人欠款超过1万美元。
In 2024, people in the United States owed at least $220bn in medical debt, according to KFF a nonprofit health research group. About 14 million owed more than $1,000, and 3 million people owed more than $10,000.
“费用非常高昂，且部分人没有医疗保险，因此一旦生病、受伤或需要医疗服务，他们无法支付极高的费用，”KFF高级政策分析师艾玛·韦格说。
“Costs are very high, and some people have no health insurance, so when they get sick or injured or need healthcare, they have no way to pay the extremely high charges,” said Emma Wager, KFF senior police analyst.
韦格表示，即使有保险的人往往也面临高额免赔额或高额自付比例条款，这意味着他们仍可能觉得账单难以负担。
Even people with insurance often have high deductibles or high cost-sharing provisions in their plans, which means they could still find the bills unaffordable, Wager said.
患者经常拖欠医疗费用。根据《健康事务学者》期刊的数据，2024年，美国21%的家庭有逾期医疗账单。根据消费者金融保护局的数据，2021年，送交催收机构的账单中，超过一半是医疗费用。
Patients often fall behind in their payments. In 2024, 21% of US households had a past-due medical bill, according to the journal Health Affairs Scholar In 2021, more than half of the bills sent to collectors were for medical care, according to the Consumer Financial Protection Bureau Undue Medical Debt, founded in 2014 by former debt collection executives, helps address the problem by purchasing large portfolios of debt from healthcare organizations and collection agencies at a steep discount.
Undue Medical Debt成立于2014年，创始人为前债务催收高管，该组织通过以大幅折扣价从医疗机构和催收机构手中购买大量债务组合，帮助解决这一问题。据该组织称，1美元捐款可抹除约100美元的医疗债务。
According to the organization, a $1 donation erases about $100 of medical debt.
该组织不接受个人申请，但收入在联邦贫困线四倍或以下，或医疗债务占年收入5%或以上的人群符合资格。
The organization does not take requests from individuals, but people who earn four times the federal poverty level or less, or with medical debt that is 5% or more of their annual income, are eligible.
Undue Medical Debt并非唯一帮助人们支付医疗费用的组织。例如，另一家非营利组织Dollar For允许患者申请财务援助以减免或降低医疗债务，据该组织称，已提供超过1.17亿美元援助。HealthWell Foundation帮助支付处方药自付额、保险费和免赔额等费用。纽约社区服务协会成功推动了州立法，如《公平医疗债务报告法》，该法案禁止医院和提供者向消费者报告机构提供患者医疗债务信息。
Undue Medical is not alone in helping people pay for their medical care. For example, Dollar For, another nonprofit, allows patients to apply for financial assistance to forgive or reduce their medical debt and has provided more than $117m, according to the organization. The HealthWell Foundation helps with prescription copays and insurance premiums and deductibles, among other expenses. The Community Service Society of New York successfully advocated for state legislation like the Fair Medical Debt Reporting Act which prohibits hospitals and providers from providing consumer reporting agencies information about a patient’s medical debt.
Undue Medical Debt的资金来源于私人捐赠者以及州和地方政府。例如，在伊利诺伊州，州政府提供了1000万美元给Undue Medical Debt，该组织利用这笔资金为该州居民提供了超过11亿美元的医疗债务减免，据州政府称。与患者收到医疗服务提供者寄来的令人恶心的账单不同，受助者收到的是告知其债务已被免除的惊喜通知。
Undue Medical gets its funding from private donors and state and local governments. For example, in Illinois, the state provided $10m to Undue Medical, which used the funds to provide more than $1.1bn in medical debt relief for its residents, according to the state Unlike when people get those nausea-inducing bills from providers, recipients get surprise notices informing them that their debt has been absolved.
该组织表示，已提供533亿美元的医疗债务减免。其中约一半是在今年提供的。该组织将这一激增归因于其在技术方面的投资，使其能够更快地处理档案，以及与政府的合作伙伴关系增加。
The organization states that it has provided $53.3bn in medical debt relief. About half of that was provided this year. The organization attributes that spike to its investment in technology that allows it to process files more quickly and its increased partnerships with governments.
“不知不当医疗债务组织总裁兼首席执行官艾莉森·塞索说：“我希望收到信函的每个人都能更放心地回到医生那里，获得他们所需的治疗，而不必担心财务后果。”
“I am hopeful everyone that receives a letter feels more comfortable going back to the doctor and getting the care that they need and are not scared about the financial consequences,” said Allison Sesso, president and CEO of Undue Medical.
尽管如此，塞索承认，这种财务援助只是“为当下需要帮助的人提供的权宜之计”。塞索说：“我们建立了一套以利润而非以人为本的激励体系。”
Still, Sesso acknowledges that the financial assistance is a “stopgap for people that need help today”. “We have set up a system that incentivizes profits over people,” Sesso said.
倡导者认为，为了从源头上推动变革，医疗服务提供者必须做更多工作，让患者知晓他们提供财务援助。
To affect change upstream, providers must do more to make patients aware that they offer financial assistance, advocates argue.
例如，根据密苏里健康基金会和洛恩研究所2025年的一项研究，在密苏里州，几乎所有综合医院都提供免费或折扣医疗，但不到四分之一的成年人表示他们从提供者那里获得了关于这些项目的信息。
For example, in Missouri, almost all general hospitals offer free or discounted care but less than a quarter of adults said they received information about the programs from a provider, according to a 2025 study from the Missouri Foundation for Health and the Lown Institute.
各州正在努力增加对有需要患者的财务援助。联邦法律要求非营利医院制定财务援助政策，但未规定任何最低资格要求；根据研究医疗问题的非营利组织联邦基金会的数据，已有18个州进一步要求所有医院——包括营利性医院——提供带有最低资格标准的财务援助。
States are working to increase financial assistance to patients who need it. Federal law requires nonprofit hospitals to establish a financial assistance policy but does not specify any minimum eligibility requirements; 18 states have gone further and required all hospitals – including for-profit ones – to offer financial assistance with minimum eligibility standards, according to the Commonwealth Fund a nonprofit that studies health care issues.
KFF健康新闻报道，还有六个州拥有“推定资格”法律，要求医院筛选患者以确定其是否符合援助资格，如果符合，则主动免除债务。
Six states also have “presumptive eligibility” laws, which require hospitals to screen patients to determine if they qualify for assistance and if so, proactively erase the debt, KFF Health News reported.
拜登政府还通过了一项规定，禁止将医疗债务列入信用报告，但特朗普政府和行业团体请求联邦法院叫停该措施，法官照做了。不过，根据联邦基金会的数据，有16个州禁止或限制将此类债务列入信用报告。
The Biden administration also passed a rule that banned the inclusion of medical debt on credit reports, but the Trump administration and trade groups asked a federal court to block the measure, which a judge did But 16 states prohibit or restrict the inclusion of such debt on credit reports, according to the Commonwealth“It has a major impact on people’s credit ratings,” said Sara Collins, Commonwealth senior scholar for expanding coverage and access.
“它对人们的信用评级有重大影响，”联邦基金会扩大覆盖面和获取渠道高级学者萨拉·柯林斯说。“人们遇到的医疗问题并非他们的过错，但由于没有保险覆盖来偿还，他们却背负上了医疗债务。”
“People have healthcare problems that are not their fault, and yet they are being saddled with medical debt because they don’t have the coverage to pay it off.”
2019年，蒂芙尼·米勒怀孕仅26周时就临产了。她的女儿布里在新生儿重症监护室住了三个多月，随后还需要物理治疗和职业治疗。尽管作为心理健康个案工作者的米勒有保险，她仍积累了2000多美元的债务。
In 2019, Tiffany Miller was just 26 weeks pregnant when she went into labor. Her daughter, Brie, spent more than three months in the neonatal intensive care unit and then required physical and occupational therapies. Even though Miller, a mental health caseworker, had insurance, she still accumulated more than $2,000 in debt.
“我是一个非常有信仰的人，所以我一直在祈祷，因为这些债务很多都在我的信用报告上，”现年40岁、居住在伊利诺伊州奥罗拉市的米勒说。
“I’m a very faith-based person, so I had just been praying a lot because a lot of this debt was on my credit report,” said Miller, 40, who lives in Aurora, Illinois.
今年5月，她收到了“Undue Medical”寄来的一封信，告知她的债务已被抹除。
In May, she received a letter from Undue Medical informing her the debt had been erased.
她以为是诈骗，但做了一些调查后得知这是真的。与此同时，布里现在是一个健康的七岁女孩。
She thought it was a scam but did some research and learned it was real. Meanwhile, Brie is now a healthy seven-year-old.
哈里斯说：“感觉就像那些多年积累的财务重担，有几个被卸下来了。”
Harris said: “It just felt like those financial weights that have accumulated over the years, like a couple of them were taken off.”