Recent stories, such as “Collecting ill will with debt ‘sharks’ ” (front page, April 21) have painted Minnesota’s nonprofit hospitals and health systems as predatory debt collectors, but nothing could be further from the truth.

As caregivers, our mission is to serve our patients and communities, not to burden them with debt. Collecting debts is the last thing we want, but we find ourselves in an impossible position between insurance companies and patients. On one end, we are increasingly being squeezed by payers with rising rates of denials and unending costly administrative burdens just to get paid for the care we provide to our patients. On the other end, we are being put in the difficult position to collect the growing portion of a medical bill from patients whose insurance coverage increasingly leaves them financially exposed.

We are the beating heart of our communities — from urban to rural — here to provide care to our patients when and where they need it, 24 hours a day, every day of the year. Yet, the truth is that the system designed around health care financing is fundamentally broken. It is pushing us and our patients toward a breaking point. Time is short for our health system and the patients and communities who depend on us as the ultimate safety net. Some considerations:

The illusion of coverage — how high-deductible health plans are failing Minnesotans

Insurance companies set the rules.

Patients are left holding the bill for sky-high deductibles for “coverage” that does not cover their care needs. Often, insurance won’t cover or pay for the care patients receive, leaving the health care providers to pursue patients for payment, something we never want to do.

While public policy debates and news coverage around the state of health care often focus on the idea that insurance equals coverage, the reality is that it does not. And it is the patients who are left in a position to learn that brutal reality, often when they are in their highest time of need. For over a decade, policy discussions have centered around expanding insurance coverage, but this focus has inadvertently led to the growing problem of “underinsurance.” As a result, patients are drowning in unaffordable deductibles and copays despite having insurance because the coverage they’ve been offered doesn’t adequately meet their health care needs.

In Minnesota alone, 62.6% of private-sector workers have highdeductible health plans, higher than the national average of 55.7%. Minnesotans also face higher deductibles than the national average, with deductibles 7.9% higher in 2021. This shift in insurance plans has left more patients unable to afford their share of the costs despite having coverage. It’s a financial nightmare that neither patients nor providers signed up for. The reality is that this is not a simplistic problem and the discussion should not be either.

The government does not cover the cost of care

More than half of Minnesotans now receive health care paid for by public programs, and that number continues to grow. As the largest payer, the government sometimes reimburses as low as 68 cents on the dollar of the actual cost of care. These patients make up about two-thirds of those who our nonprofit hospitals and health systems serve.

The shortfall from government underfunding is staggering. In 2021 alone, Minnesota hospitals faced a total shortfall of about $2.3 billion, including $500 million in unpaid boarding losses, $1 billion in Medicare reimbursement shortfall and $837 million in Medicaid reimbursement shortfall. As a result, 67% of nonprofit hospitals and health systems operated in the red last year, which is unsustainable and is forcing hospitals and health systems to cut services to stay open. This underfunding drives up the cost of care for everyone as hospitals struggle to survive.

We are here to provide care to patients, not collect debts

At Minnesota’s nonprofit hospitals and health systems, we do everything we can to protect patients’ access to care and shield them from the medical debt that often results from insurers’ unwillingness to pay. There are no patients who come through our doors who we don’t treat — and no patients who aren’t offered every possible opportunity to manage the costs their insurers won’t cover.

In addition to the quarter-billion dollars in charity care we provided last year, we offer financing and payment plans and we exhaust all other options to ensure that patients get the care they need without facing financial ruin. We are here to heal, not to collect debts. But when insurers fail to fulfill their obligations, we have an impossible choice between pursuing payment or writing off the cost of care, which drives up costs for all other patients.

The path forward: Protecting access to care

The rise in medical debt is a symptom of a larger fundamental problem: an underfunded health care system that relies on a broken finance model. Minnesota’s hospitals and health systems are committed to protecting access to care, but we cannot do it alone.

It’s time for an honest and urgent discussion about the challenges facing nonprofit health care in Minnesota and the need for adequate reimbursement and support to ensure we can continue to serve our communities in their time of need. We welcome a solutions-oriented conversation about health care finance and affordability. Still, we need policies that address underfunding, not those that scapegoat hospitals and patients who are already managing of a deeply flawed system.

Every Minnesotan deserves access to the care they need, which means ensuring that hospitals and patients have access to a just and sustainable payment system. Together, we can find a path forward that protects access to care and ensures the longterm viability of our nonprofit hospitals and health systems.

Dr. Rahul Koranne is president and CEO of the Minnesota Hospital Association.