Long before the D.C. Council’s passage of medical debt reform, Dorothy Paul suffered from panic attacks triggered by a bill she received for her hearing aids.
After appealing for coverage and financial assistance, and submitting testimony to be read to the council, Paul said she’ll be more informed about her options during future hospital visits.
“It would have been devastating for me because I don’t have the funds like that after paying all my monthly bills,” said Paul, a Ward 6 resident whose only income is Social Security. “It would have put me in a situation where I would have had to depend on… other people to kind of chip in or maybe have meals over [at] relatives’ houses every now and then.”
In June, the D.C. Council unanimously approved the Medical Debt Mitigation Amendment Act of 2025. The legislation, introduced by D.C. Councilmember Christina Henderson (I-At large), requires health care facilities to offer payment plans to low-income patients with unpaid medical bills.
Other provisions prohibit wage garnishment, home liens, lawsuits, collection actions, and reporting of medical debt to credit reporting agencies. The legislation also establishes uniform income eligibility criteria while requiring documentation to prove income. On the bill’s eight-month journey to council approval, Tzedek DC, a public interest center at the University of the District of Columbia’s David A. Clarke School of Law that Paul contacted for help, counted among the organizations that provided their thoughts on the issue of medical debt relief.
In 2024, after turning 65 and receiving Medicare coverage, Paul received hearing aids. She would do so after five visits to MedStar Washington Hospital Center, a $200 payment, and the signing of a financial responsibility waiver. Five months later, MedStar billed Paul $2,400 for the hearing aids while Medicare sent a letter stating that it wouldn’t cover her purchase.
By then, the 30-day warranty for the hearing aids had long expired.
“If I had known that the hearing aids would have been my responsibility, and that my insurance would not cover it, then I would have had other options,” Paul said.
In his testimony before the council’s Committee on Health last December, Sam Pannell, a policy associate at Tzedek DC, spoke about Paul’s unsuccessful attempts to receive financial assistance from MedStar, saying that the local hospital never confirmed the receipt of her two paper applications. Paul also told The Informer about her and Tzedek DC staff attorney Jennifer Holloway’s attempt to confirm the accuracy of the email address listed on the application.
She said their requests for information went unanswered.
“That was my first time, even knowing that I could get financial assistance,” Paul said. “We continued to call in [and] eventually they just removed the bill.”
But Paul wouldn’t find out about the resolution until April, when she got her hearing aids repaired. Months earlier, when the hearing aids stopped working, Paul didn’t visit MedStar, out of what she called fear of her debt.
“They probably would have fixed them anyway,” Paul said, “but in my mind I just felt like if I go to have them fixed and they can bring up that ‘you never paid.’ So I was afraid to be turned down because that bill was still on the record.”
D.C. Councilmember Christina Henderson Strikes a Balance with Tzedek DC and Local Hospitals
With enforcement powers granted to DC Health and the D.C. Office of the Attorney General (OAG) through the Medical Debt Mitigation Amendment Act of 2025, health care facilities would be mandated to provide patients with “good faith estimates” about costs before treatment, except in case of emergency.
“Some of this will require DC Health to get better in terms of sharing information with OAG, which is not often an agency that DC Health naturally works with,” Henderson, chair of the council’s Committee on Health, told The Informer. “But because we were so collaborative in the craft[ing] of the legislation, I think everybody has their marching orders for when this legislation finally becomes law.”
Henderson introduced what would ultimately become the Medical Debt Mitigation Amendment Act of 2025 two years after the D.C. government, in collaboration with the nonprofit Undue Medical Debt, cancelled $42 million in medical debt for more than 62,000 District residents.
Months prior to her legislative action, Tzedek DC, who weighed in on the legislation, published a report showing that at least 1 out of 10 D.C. residents had unpaid medical bills. The report, titled “More Than a Band-Aid: Systemic Changes to Protect DC Residents from Medical Debt,” highlighted the disproportionate effects of medical debt on Black residents, mothers, and people with disabilities.
The report also showed how medical debt caused delays in necessary care, worsened chronic conditions, and increased the cost of long-term care for the community. Many of Tzedek DC’s recommendations made it into Henderson’s bill.
“My hope is that with this legislation, it does help provide some consumer protection,” said Henderson, chair of the council’s Committee on Health. “Unfortunately, this bill is… not dealing with retroactive debt that is already approved, and we already know that a lot of District residents already have some unpaid medical bills, but hopefully, this will provide some relief going forward.”
As explained in the Committee on Health’s April 7 committee print, the Medical Debt Mitigation Amendment Act of 2025 went through a name change, along with the creation of a new term— health care facility FAP— to clearly designate entities responsible for creating financial assistance policies and providing such services to patients.
The committee also narrowed the scope of “medical debt” and “medical lending product” in the legislation to only include medical credit cards and installment loans issued exclusively for medical services and lending products. After discussion with the DC Hospital Association, the Committee on Health also added a definition of “medically necessary health services” to exclude cosmetic procedures from coverage in the legislation.
Another compromise made it so that health care facilities wouldn’t need to screen every patient for financial assistance eligibility if they: provide “robust” notice of financial assistance programs and proactively screen uninsured patients, those receiving local and federal assistance, those experiencing housing insecurity, and those already deemed eligible for financial assistance within a six-month window.
“I think Tzedek definitely desired for us to go further on some things,” Henderson told The Informer, “wanting to really have something that had teeth and protections for residents and consumers. We had to work with our hospitals in making sure that we could get something that not everybody might have been happy [with], but that everybody was comfortable with moving forward.”
Tzedek DC: Nearly a Decade of Medical Debt Assistance
Tzedek DC was founded in 2017 by Ariel Levinson-Waldman, a civil rights litigator and former senior counsel to the D.C. Attorney General Karl Racine. It’s the District’s first legal services organization sponsored by the local Jewish community.
Though Tzedek DC serves all eight wards, 90% of their clients are Black residents living in Wards 7 and 8. Those seeking the agency’s services often have thousands of dollars of medical debt appear on their credit report, making it difficult to apply for housing, employment and other lines of credit.
“Medical debt is held by our Black residents, at least a rate of twice as often as our white residents,” said Levinson-Waldman, Tzedek DC’s founding president and director-counsel, “with all the health equity impacts in terms of people being either barred or too anxious to seek the care that they’re entitled to.”
In years past, residents with disabilities who were ineligible for traditional credit cards applied for a medical credit card, which, according to Holloway, carries deferred interest rather than 0% interest as often advertised. She calls the Medical Debt Mitigation Amendment Act of 2025 a step forward in preventing the exploitation of vulnerable communities.
“The bill limits when patients can be offered such medical credit cards,” Holloway explained. “So if anyone’s under anesthesia, in the treatment area or if they’re receiving treatment, providers cannot help complete the application. It should be fully the patient’s decision.”
As Stephen B. Jefferson Sr. promotes and coordinates more than 150 events this year about the council’s medical debt reform, he told The Informer about the power of being in the know, especially as someone who, for more than a decade, struggled to pay debt while fighting cancer.
“Education is always the key,” said Jefferson, Tzedek DC’s community outreach coordinator, “and to be able to table and talk to the community and tell them about the wonderful program we have to combat medical debt has been a huge blessing.”
