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Illustration: Annelise Capossela/Axios

As millions of Americans lost their jobs and fell sick with the coronavirus this summer, hospitals in some of the hardest-hit states were getting back to the business of suing their patients.

Why it matters: The Americans least likely to be able to pay their medical bills are the same people who are vulnerable to the virus and its economic fallout.

The big picture: Almost all of the roughly two dozen Community Health Systems hospitals in Florida, Texas and Arizona have sued patients since the pandemic began. Many paused or slowed down in the spring, but then resumed business as usual over the summer — when these states were being hit hardest.

  • These hospitals have filed dozens — sometimes hundreds — of cases per county between Jan. 1 and Aug. 14 of this year, according to Axios’ review of court records in the counties that make them available online.
  • A random sampling of those lawsuits show that hospitals have sued to collect medical bills ranging from less than $1,000 to, in one case, $125,999.53.

Case in point: In June, the Western Arizona Regional Medical Center filed a lawsuit against Blair Smiley — for the third time in two years. She thought the hospital was only pursuing one lawsuit against her until she spoke with me on the phone.

  • Smiley isn’t sure what medical care the latest lawsuit involves, or how much the hospital is suing for. She suspects it might stem from taking her daughter to the hospital twice last year when she was uninsured. Her daughter, who just turned 10, now uses a feeding tube.
  • Smiley works for a funeral home, and her husband is a disabled veteran. She said her hours have been reduced, partially because of pandemic-related limits on funerals, and she doesn’t make enough to pay off her medical bills. She tried to figure out a payment plan with a debt collector, but couldn’t afford that rate, either.

In another case, Lake Granbury Medical Center, a hospital located near Fort Worth, Texas, is suing a patient, Richard Piper, for nearly $35,000, plus court fees, attorneys’ fees and interest.

  • “I am [writing] this response to inform you of my inability to [pay] this outstanding medical Debt, I only bring home a check of 525 dollars a week and [am] helping two daughters with my grandkids,” Piper wrote earlier this month in a letter to the judge in the case.
  • He added that he was in the hospital for 4 or 5 days. “When I went to the hospital I told them I had no insurance and I could not afford it, every day I asked to leave and was told no...When I was discharged, I asked for some kind of relief to help pay this[,] and was not given an option.”
  • Piper said in an interview that his daughter lost her job during the pandemic, and that his hours at work have been cut "way back." He also thinks the prices charged by the hospital are outrageous. “If I had money, and I could afford a lawyer, I would countersue the hospital for price gouging," he said. "When they want to charge you $19 for a band-aid, that’s ridiculous.”

Where it stands: Hospitals’ aggressive legal actions against former patients was already deeply controversial before the pandemic — before millions of people lost their jobs, and in many cases their health insurance at the same time, or had their wages cut.

The other side: “It is the strong preference of our affiliated hospitals to work directly with patients to resolve their bills, and financial assistance programs are available. Legal action is always the last avenue considered, and it is only considered after evaluating a patient’s ability to pay,” CHS said in a statement.

  • “Our affiliated hospitals offer resources to help patients understand their financial responsibilities and the support available to pay their bill, such as charity care, discounts and flexible payment plans… Sometimes legal action is the only path through which patients will engage in a conversation about the amount they owe for healthcare services that have already been provided.”
  • “Individuals who are currently a defendant in a collection suit and who have had a change in their financial status due to COVID-19 are urged to call 866-450-0044.”

The bottom line: The health system’s pre-pandemic issues haven’t gone away, and in some ways, they’ve only gotten bigger.

Go deeper

Health expert: Black and Latino homelessness will spike without pandemic relief package

Photo: Axios

Black and Latino Americans are facing “terrible financial problems” due to COVID-19, health expert Robert Blendon said on Tuesday at a virtual Axios event.

Why it matters: The pandemic has hit communities of color harder than white Americans, and the population of homeless Black Americans and Latinos will only increase if there is no emergency federal aid, Brendon said.

UPS and Ford prepare for vaccine distribution with ultra-cold freezers

Photo: Jeff Kowalsky/AFP via Getty

UPS and Ford Motor Company have both announced they ordered portable, ultra-low temperature freezers for storing coronavirus vaccines when they become available.

Why it matters: While the promising vaccine developed by Pfizer and BioNTech is 95% effective, it can only be stored at or around -70 degrees Celsius.