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I've Got 99 Problems But a Bill Ain't One: Hospital Billing Caps and Financial Distress in California




We examine the financial consequences of the 2007 California Fair Pricing Law (FPL), a law that places a price ceiling on hospital bills for uninsured and financially vulnerable individuals. Using difference-in difference-in-differences models, we exploit cross-sectional variation in exposure to the law to estimate the causal effects of the FPL on different measures of financial distress. We find that the law reduces the medical and non-medical debt burden of individuals targeted by the law, with the likelihood of incurring non-medical debt in collections declining by 14.5 percent and the number of non-medical collections declining by 31 percent. The law also reduces the probability of having medical and non-medical debt balances between $1 and $1,000 in collections by 16.5 percent and 40 percent, respectively. Our results suggest that hospital billing regulations have direct and indirect effects on the personal financial outcomes of uninsured and financially vulnerable individuals.

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  • Yaa Akosa Antwi & Marion Aouad & Nathan Blascak, 2023. "I've Got 99 Problems But a Bill Ain't One: Hospital Billing Caps and Financial Distress in California," Working Papers 23-20, Federal Reserve Bank of Philadelphia.
  • Handle: RePEc:fip:fedpwp:96847
    DOI: 10.21799/frbp.wp.2023.20

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    References listed on IDEAS

    1. Silvia Helena Barcellos & Mireille Jacobson, 2015. "The Effects of Medicare on Medical Expenditure Risk and Financial Strain," American Economic Journal: Economic Policy, American Economic Association, vol. 7(4), pages 41-70, November.
    2. Brevoort, Kenneth & Grodzicki, Daniel & Hackmann, Martin B., 2020. "The credit consequences of unpaid medical bills," Journal of Public Economics, Elsevier, vol. 187(C).
    3. David Card & Carlos Dobkin & Nicole Maestas, 2008. "The Impact of Nearly Universal Insurance Coverage on Health Care Utilization: Evidence from Medicare," American Economic Review, American Economic Association, vol. 98(5), pages 2242-2258, December.
    4. Alyce Adams & Raymond Kluender & Neale Mahoney & Jinglin Wang & Francis Wong & Wesley Yin, 2022. "The Impact of Financial Assistance Programs on Health Care Utilization: Evidence from Kaiser Permanente," American Economic Review: Insights, American Economic Association, vol. 4(3), pages 389-407, September.
    5. Kyle J. Caswell & John H. Goddeeris, 2020. "Does Medicare Reduce Medical Debt?," American Journal of Health Economics, University of Chicago Press, vol. 6(1), pages 72-103.
    6. Aouad, Marion & Brown, Timothy T. & Whaley, Christopher M., 2019. "Reference pricing: The case of screening colonoscopies," Journal of Health Economics, Elsevier, vol. 65(C), pages 246-259.
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    More about this item


    inancial distress; consumer credit; hospitals; health care;
    All these keywords.

    JEL classification:

    • G51 - Financial Economics - - Household Finance - - - Household Savings, Borrowing, Debt, and Wealth
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • H75 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Government: Health, Education, and Welfare

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