After a recent Urban Institute report found that most people with past-due medical debt owe money to hospitals, the American Hospital Association (AHA) turned the blame elsewhere: short-term limited duration health plans and high-deductible health plans.

Of the more than 15% of American adults who have past-due medical debt, about 73% owe some or all of the money to hospitals, according to the Urban Institute’s report, published last week. It also found that adults with disabilities are more likely than adults without disabilities to have past-due medical debt, and that Black and Latino adults are more likely to have past-due medical debt than White adults.

The report “highlights the issue of medical debt but fails to examine two of the chief driving forces of this debt: inadequate enrollment in comprehensive health care coverage and high-deductible health plans that intentionally push more costs onto patients,” wrote Molly Smith, group vice president for public policy at AHA, in a Monday blog post.

Short-term limited duration health plans and health sharing ministries frequently “appeal” to consumers due to reduced cost, Smith said.

“The reason they are cheaper is because when you read the fine print you discover they cover fewer benefits and include few-to-no consumer protections, like required coverage of pre-existing conditions and limits on out-of-pocket costs,” Smith declared. “Subscribers for these types of plans often find themselves responsible for their entire medical bill without any help from their health plan and can accumulate significant medical debt.”

High-deductible health plans have similar problems, Smith added. 

“These plans are specifically designed to increase patients’ financial exposure through high cost-sharing – the amount the subscriber must pay out-of-pocket. Yet, many individuals enrolled in these plans find they can’t manage the gap between what their insurance pays and what they themselves owe as a result,” she said. “It’s not a mystery why high-deductible health plans contribute to medical debt.”

Ending “deceptively inadequate health plans” is needed due to current and upcoming gaps with coverage, Smith said. This includes the fact that some states have not expanded Medicaid, and that up to 18 million people could lose coverage once Medicaid redeterminations resume April 1 after being on hold for three years.

Smith listed several possible solutions to combat medical debt. These solutions include only selling high-deductible health plans to those who have proven that they have the means to afford the cost-sharing, and lowering maximum out-of-pocket cost-sharing limits.

“Hospitals and other providers do not determine how much insured patients owe for their care. Instead, that amount is set by the health plan,” Smith declared. “While every hospital has a financial assistance policy to help those most in need, they can only help so much and so many. And no matter how generous, hospital financial assistance will never be a substitute for a health plan that covers preventive and necessary care at an affordable price on the front and back end of coverage.”

America’s Health Insurance Plans (AHIP) did not immediately return a request for comment.

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