II 

118TH CONGRESS 

2D SESSION S. 4289 

To cancel existing medical debt, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MAY 8, 2024 

Mr. SANDERS (for himself and Mr. MERKLEY) introduced the following bill; 

which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To cancel existing medical debt, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Medical Debt Cancella5 tion Act’’. 

6 SEC. 2. GRANTS TO CANCEL MEDICAL DEBT OWED BY PA7 TIENTS. 

8 Section 2799B–10 of the Public Health Service Act, 

9 as added by section 3, is amended by adding at the end 

10 the following: 


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1 ‘‘(e) GRANTS TO CANCEL MEDICAL DEBT OWED BY

2 PATIENTS.— 

3 ‘‘(1) IN GENERAL.—The Secretary shall estab4 lish a grant program under which the Secretary, be5 ginning not later than 1 year after the date of enact6 ment of the Medical Debt Cancellation Act, awards 

7 grants on a competitive basis to hospitals in the 

8 United States in order to eliminate all eligible med9 ical debt owed by residents of the United States to 

10 such hospitals. 

11 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 

12 grant under this subsection, a hospital shall— 

13 ‘‘(A) submit an application to the Sec14 retary at such time, in such manner, and con15 taining such information as the Secretary may 

16 require; and 

17 ‘‘(B) agree to submit to the Secretary such 

18 reports regarding the use of grant funds as the 

19 Secretary may require. 

20 ‘‘(3) PRIORITIZATION.—In awarding grants 

21 under this subsection, the Secretary shall— 

22 ‘‘(A) prioritize awards to hospitals that— 

23 ‘‘(i) are safety net hospitals; and 

24 ‘‘(ii) agree to cancel, at a minimum, 

25 all medical debt that is— 


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1 ‘‘(I) 15 months old or less; 

2 ‘‘(II) owed by low-income and 

3 vulnerable patient populations; and 

4 ‘‘(III) attributable to emergency 

5 and non-elective care; and 

6 ‘‘(B) ensure that awards are distributed to 

7 hospitals across diverse geographical areas of 

8 the United States. 

9 ‘‘(4) SUPPLEMENT, NOT SUPPLANT.—Grants 

10 awarded to a hospital under this subsection shall be 

11 used to supplement, and not supplant, other sources 

12 of funding and investments made by the hospital for 

13 the purposes of providing financial assistance to pa14 tients. 

15 ‘‘(5) EXPANSION OF MEDICAL DEBT CANCELLA16 TION.—Not later than 2 years after the date of en17 actment of the Medical Debt Cancellation Act, the 

18 Secretary shall expand the program under this sub19 section to allow providers and health care facilities 

20 other than hospitals, and individuals, to receive med21 ical debt cancellation. 

22 ‘‘(6) GUIDANCE.—Not later than 1 year after 

23 the date of enactment of the Medical Debt Cancella24 tion Act, the Secretary shall instruct Federal health 

25 care programs to eliminate medical debt collections. 


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1 ‘‘(7) CONSULTATION.—In carrying out this sub2 section, the Secretary shall consult with relevant 

3 Federal agencies, departments, and health pro4 grams, patient advocates, community-based organi5 zations with experience in medical debt cancellation, 

6 providers, and other key stakeholders. 

7 ‘‘(8) REPORTING.—Beginning 2 years after the 

8 date of enactment of the Medical Debt Cancellation 

9 Act, and annually thereafter until the date on which 

10 the program under this subsection sunsets pursuant 

11 to paragraph (10), the Secretary shall submit to rel12 evant congressional committees a progress report on 

13 the implementation, administration, and impact of 

14 the program under this subsection. 

15 ‘‘(9) DEFINITIONS.—In this subsection— 

16 ‘‘(A) the term ‘eligible medical debt’— 

17 ‘‘(i) means the out-of-pocket unpaid 

18 amount owed by a resident of the United 

19 States for items or services furnished to 

20 such individual by a hospital, provided 

21 that— 

22 ‘‘(I) such medical debt is in com23 pliance with applicable Federal laws 

24 and regulations, including— 


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1 ‘‘(aa) the medical billing re2 quirements of subsection (a); 

3 ‘‘(bb) the medical debt col4 lection requirements of sub5 section (b); and 

6 ‘‘(cc) the contracting limita7 tion under subsection (c); 

8 ‘‘(II) such medical debt is with 

9 respect to items and services fur10 nished to an individual on or before 

11 the date of enactment of the Medical 

12 Debt Cancellation Act; and 

13 ‘‘(III) any dispute resolution 

14 process under section 2799B–7 is 

15 complete; and 

16 ‘‘(ii) excludes— 

17 ‘‘(I) any amount paid or payable 

18 by any Federal health care program; 

19 and 

20 ‘‘(II) with respect to items and 

21 services furnished to an individual by 

22 the hospital, any amount that is in ex23 cess of the sum of the amount reim24 bursable by a Federal health care pro25 gram or other payer and copayment 


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1 amounts under such a program or 

2 other health insurance plan with re3 spect to such items and services. 

4 ‘‘(B) the term ‘Federal health care pro5 gram’ has the meaning given such term in sec6 tion 1128B(f) of the Social Security Act. 

7 ‘‘(10) SUNSET.—The authorities under this 

8 subsection shall sunset on the date the Secretary 

9 certifies all eligible medical debt in the United 

10 States has been canceled under this subsection.’’. 

11 SEC. 3. REQUIREMENTS FOR MEDICAL BILLING PRACTICES 

12 AND MEDICAL DEBT COLLECTION; MEDICAL 

13 PAYMENT ASSISTANCE. 

14 (a) IN GENERAL.—Part E of title XXVII of the Pub15 lic Health Service Act (42 U.S.C. 300gg–131 et seq.) is 

16 amended by adding at the end the following new section: 

17 ‘‘SEC. 2799B–10. REQUIREMENTS FOR MEDICAL BILLING 

18 AND MEDICAL DEBT COLLECTION; MEDICAL 

19 PAYMENT ASSISTANCE RESOURCE. 

20 ‘‘(a) MEDICAL BILLING REQUIREMENTS.—In the 

21 case of a health care provider or facility that furnishes 

22 items or services to an individual, such provider or facility 

23 shall, not later than 45 days before the date on which pay24 ment for such items or services is due— 


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1 ‘‘(1)(A) determine whether such individual is el2 igible for assistance with respect to such payment 

3 pursuant to the charity care or financial assistance 

4 policy of such provider or facility; and 

5 ‘‘(B) if such individual is eligible for such as6 sistance, provide information to such individual re7 garding such assistance; and 

8 ‘‘(2) on or after the date on which the medical 

9 payment assistance resource list under subsection 

10 (d)(1) is made available, provide such individual 

11 with such list. 

12 ‘‘(b) MEDICAL DEBT COLLECTION REQUIRE13 MENTS.— 

14 ‘‘(1) IN GENERAL.—In the case of a health care 

15 provider or facility that furnishes items or services 

16 to an individual, if payment for such items or serv17 ices is past due, such provider or facility shall— 

18 ‘‘(A) not later than 30 days after the date 

19 on which the payment was due, provide to such 

20 individual a statement (in clear and under21 standable language) that includes— 

22 ‘‘(i) subject to paragraph (2)(A), the 

23 total amount of the payment that remains 

24 due; 


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1 ‘‘(ii) a description of the attempts 

2 made by such provider or facility to deter3 mine whether such individual is eligible for 

4 assistance (as described in subsection 

5 (a)(1)) with respect to the payment; and 

6 ‘‘(iii) in each of the 15 most com7 monly language (other than English), as 

8 determined by the Secretary, information 

9 about language-assistance services related 

10 to the payment that are available to indi11 viduals with limited English proficiency; 

12 and 

13 ‘‘(B) not later than 30 days after a pay14 ment related to such items or services is made, 

15 provide to such individual a detailed receipt of 

16 such payment and a statement of the amount 

17 that remains due, if applicable. 

18 ‘‘(2) LIMITATIONS ON MEDICAL DEBT

19 AMOUNTS.— 

20 ‘‘(A) UNINSURED INDIVIDUALS.—In the 

21 case of items or services furnished to an unin22 sured individual by an organization that is de23 scribed in section 501(r)(2) of the Internal Rev24 enue Code of 1986 and is exempt from taxation 

25 under section 501(c)(3) of such Code, such orVerDate Sep 11 2014 15:50 Jun 08, 2024 Jkt 049200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S4289.IS S4289

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1 ganization may not collect payment from such 

2 individual with respect to such items or services 

3 in an amount greater than the amounts gen4 erally billed (within the meaning of section 

5 501(r) of such Code). 

6 ‘‘(B) INTEREST RATE.—A health care pro7 vider or facility may not collect interest on past8 due payments for items or services furnished to 

9 an individual. 

10 ‘‘(c) LIMITATION ON CONTRACTING FOR PURPOSES

11 OF MEDICAL BILLING AND MEDICAL DEBT COLLEC12 TION.—A health care provider or facility may not enter 

13 into a contract with an entity for purposes of collecting 

14 payment with respect to items or services furnished by 

15 such provider or facility unless such entity agrees to com16 ply with the requirements described in subsections (a) and 

17 (b) for such provider or facility with respect to such pay18 ment. 

19 ‘‘(d) MEDICAL PAYMENT ASSISTANCE RESOURCE

20 LIST.— 

21 ‘‘(1) IN GENERAL.—Not later than 1 year after 

22 the date of the enactment of the Medical Debt Can23 cellation Act, the Secretary shall make publicly avail24 able on the website of the Department of Health and 

25 Human Services a comprehensive list of Federal, 


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1 State, and local programs that provide financial as2 sistance with respect to payment for items or serv3 ices furnished by a health care provider or facility. 

4 ‘‘(2) UPDATES.—The Secretary shall update 

5 the list described in paragraph (1) not less fre6 quently than annually.’’. 

7 (b) EFFECTIVE DATE.—The amendments made by 

8 subsection (a) shall apply with respect to items and serv9 ices furnished on or after the date that is 1 year after 

10 the date of the enactment of this Act. 

11 (c) COORDINATION AND CONSULTATION.—In car12 rying out this section, the Secretary of Health and Human 

13 Services shall— 

14 (1) coordinate with relevant Federal depart15 ments and agencies, including the Consumer Finan16 cial Protection Bureau and the Department of the 

17 Treasury; and 

18 (2) consult with relevant stakeholders including 

19 patient advocates, community-based organizations 

20 with experience in medical debt cancellation, and 

21 health care providers. 

22 SEC. 4. MEDICAL DEBT COLLECTION. 

23 (a) COLLECTION OF MEDICAL DEBT.— 

24 (1) IN GENERAL.—The Fair Debt Collection 

25 Practices Act (15 U.S.C. 1692 et seq.) is amended 


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1 by inserting after section 818 (15 U.S.C. 1692p) the 

2 following: 

3 ‘‘§ 818A. Collection of medical debt 

4 ‘‘(a) IN GENERAL.—No debt collector or creditor may 

5 collect or attempt to collect debt that arose from the re6 ceipt of medical services, products, or devices if such debt 

7 was incurred by a consumer before the date of enactment 

8 of this section. 

9 ‘‘(b) PRIVATE RIGHT OF ACTION.—Any consumer 

10 who is harmed by a violation of subsection (a) may bring 

11 a civil action in the appropriate United States district 

12 court against the debt collector or creditor that violated 

13 subsection (a) for— 

14 ‘‘(1) compensatory damages, including for eco15 nomic losses and for emotional harm; 

16 ‘‘(2) punitive damages; and 

17 ‘‘(3) reasonable attorney’s fees and costs of the 

18 action to a prevailing plaintiff.’’. 

19 (b) TECHNICAL AND CONFORMING AMENDMENT.— 

20 The table of sections for the Fair Debt Collection Prac21 tices Act (15 U.S.C. 1692 et seq.) is amended by inserting 

22 after the item relating to section 818 the following: 

‘‘818A. Collection of medical debt.’’. 


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1 SEC. 5. MEDICAL DEBT REPORTING. 

2 (a) IN GENERAL.—Section 605(a) of the Fair Credit 

3 Reporting Act (15 U.S.C. 1681c(a)) is amended by adding 

4 at the end the following: 

5 ‘‘(9) Any information related to debt that arose 

6 from the receipt of medical services, products, or de7 vices accrued by a consumer.’’. 

8 (b) NOTICE REQUIREMENTS.—Each credit reporting 

9 agency that removes information from the consumer re10 port of a consumer to comply with section 605(a)(9) of 

11 the Fair Credit Reporting Act, as added by subsection (a) 

12 of this section, shall notify the consumer of the removal. 

13 (c) EFFECTIVE DATE.—The amendment made by 

14 this section shall take effect on the date that is 30 days 

15 after the date of enactment of this section. 

Æ 


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