Oregon Slashes Medical Debt With 2019 Hospital Law

Hundreds of Oregonians are dodging medical debt collectors thanks to a state law that forces hospitals to consider what patients can actually afford before demanding payment.

Since 2019, Oregon has required its nonprofit hospitals to clear or reduce medical bills for patients earning less than $32,000 a year as individuals or $66,000 for a family of four. Those making up to double that amount get at least 25% off their bills and access to payment plans based on what they can pay.

The policy worked. A study published this year in the Journal of the American Medical Association found that at least 872 fewer people per Oregon county ended up being chased by debt collectors for medical bills compared to states with weaker protections.

Researchers from Tulane University, Northeastern University, the Colorado School of Public Health, and Virginia Commonwealth University studied the law's impact across all 36 Oregon counties. They compared Oregon's results to states that only offer similar debt relief to Medicaid patients, not working families who earn too much for government insurance but still struggle with hospital bills.

Nearly every hospital in Oregon is a nonprofit, which made the law's reach especially powerful. Federal law requires nonprofit hospitals to have financial assistance policies, but Oregon went further by setting specific income thresholds and requiring hospitals to check eligibility before sending bills to collections.

The Ripple Effect

The study's timing matters more than ever. Congress passed a tax and spending law in 2025 that's expected to strip health insurance from more than 15 million Americans, according to the Congressional Budget Office. That means millions more families could face crushing medical bills with nowhere to turn.

Lead researcher Tatiane Santos, an assistant professor at Tulane's School of Public Health, says Oregon's approach offers a solution other states can copy. "Hospitals that have the ability to provide more financial assistance could substantially reduce medical debt in their communities," she said in March.

The law made its biggest impact in its first few years, though researchers noticed the progress beginning to level off by 2022. Santos points to two ongoing challenges: making sure hospitals keep enforcing the rules and ensuring patients actually know they qualify for help.

State officials and advocates now face the work of keeping the law's momentum going, especially as more families lose insurance coverage and walk through hospital doors worried about costs they can't handle.

Oregon proved that protecting families from medical debt isn't just possible, it's measurable, and other states are watching closely.