A new proposal before the D.C. Council aims to overhaul how medical debt is incurred, reported, and collected in the District of Columbia, setting what could become one of the most comprehensive local frameworks for protecting consumers from the long-term effects of unpaid medical bills.
The background: The Medical Debt Mitigation Amendment Act of 2025 was introduced by Councilmember Christina Henderson and co-sponsored by seven other members. The legislation follows a June 2025 report from Tzedek DC showing that nearly 90,000 residents, roughly 20% of the District’s population, carry unpaid medical bills. Advocates say that medical debt can push families toward bankruptcy, eviction, or food insecurity, and note that much of it stems from sudden medical emergencies rather than discretionary spending.
The Council previously took steps to relieve medical debt in 2024, when the District’s Department of Health Care Finance used grant funds to cancel $42 million in debt for 62,000 residents. That initiative, however, was a one-time forgiveness effort and did not address the systemic factors that lead to recurring debt.
The proposal: The new bill would move upstream, focusing on prevention and long-term relief. It would:
- Standardize financial assistance policies across large healthcare facilities, setting uniform income eligibility criteria and requiring hospitals to provide clear estimates of care costs before treatment (except in emergencies).
- Expand consumer protections, including requiring payment plans for low-income patients, capping out-of-pocket charges, and banning medical debt from being reported to credit bureaus.
- Restrict collection practices, prohibiting wage garnishments, property liens, and lawsuits against patients eligible for discounted care.
- Regulate medical credit products, forbidding healthcare facilities from promoting medical lending cards or loans and banning preauthorization credit card holds before treatment.
- Create enforcement mechanisms, empowering D.C. Health and the Office of the Attorney General to oversee compliance and levy fines of up to $10,000 per week for violations.
Councilmember Henderson said the legislation “takes a more upstream approach” by addressing the causes of medical debt rather than offering temporary relief.
Why it matters: The bill comes as federal and local health insurance changes threaten to reduce coverage for some residents, potentially increasing the number of uninsured and underinsured patients. If enacted, D.C. would join a growing list of states and municipalities enacting medical debt protections, a trend that could reshape how healthcare providers, collectors, and credit bureaus handle unpaid medical bills nationwide.
