Outside of Stony Brook University Hospital. (Courtesy: George Caratzas)
Patients unable to pay their medical debts can face lawsuits filed by the hospitals that cared for them, with state-run facilities responsible for more than 40 percent of such cases in New York. Now, state legislators are hoping to put an end to the practice.
State Sen. Gustavo Rivera, D-Bronx, who chairs the Senate Health Committee, sponsored Senate Bill S359, which “prohibits state-operated hospitals from suing patients for medical debt.” The bill currently sits in the Senate Rules Committee.
“Our healthcare system is in crisis,” said Rivera, in an email. “Patients who cannot afford their medical bills often fall into debt that healthcare providers then pursue through collections or lawsuits. We currently have a healthcare system that prioritizes profits over patients, and today, more than ever, New Yorkers are struggling to access quality care and afford the high costs of health insurance and out-of-pocket expenses.”
Helen Hayes Hospital, Roswell Park Comprehensive Cancer Center, Stony Brook University Hospital, SUNY Downstate University Hospital of Brooklyn and Upstate University Hospital, all New York State-run public and nonprofit hospitals, combined to file 16,466 medical debt suits between 2019 and 2023, while the state’s other 213 public and nonprofit hospitals brought 23,910 lawsuits. Today, the five state-operated institutions sue more than three thousand patients per year in the State Supreme Court, while represented by lawyers from the Attorney General’s office.
Those facilities receive over $530 million annually in federal Disproportionate Share Hospital funding, allocated to institutions that serve Medicaid and uninsured patients, and benefit from local, state and federal tax exemptions. Additionally, in 2025, only Stony Brook University Hospital (10th) and Upstate University Hospital (12th) rank among the state’s top 25 hospitals by net patient revenue, or the estimated payments facilities expect to collect from patients, according to Definitive Healthcare, a healthcare data and analytics platform.
Despite those advantages and their comparatively modest patient volumes, the five aforementioned institutions have continued to take patients to court over outstanding medical debts laboriously.
“If they’re not prevented from doing it, then they’re going to do it,” said Rebecca Antar, the health law unit director at The Legal Aid Society. All five hospitals declined or did not respond to requests for comment.
In New York, as well as nationally, low-income communities and communities of color bear a higher burden of medical debt. From 2019 to 2023, nearly 80 percent of the 7,057 lawsuits filed by Roswell Park Comprehensive Cancer Center and Upstate University Hospital were against patients who lived in zip codes where the median income was under 300 percent of the federal poverty level. Moreover, 47 percent of the suits were filed against patients who resided in zip codes with a higher proportion of residents of color when compared to the national average, according to a 2024 report by the Community Service Society of New York (CSSNY).
“It’s related to structural discrimination,” said Breno Barga, a senior fellow in the family and financial well-being division at the Urban Institute. “People of color have access to jobs that are not as good as jobs of people who are white.”
Non-white workers are frequently concentrated in lower-paying occupations that are less likely to provide health insurance coverage and sick days compared to white workers, according to Barga.
“All of those factors are likely to affect both your health but also how much you have to pay for health services,” said Barga.
However, some progress has been made toward addressing these inequities.
CSSNY’s End Medical Debt campaign has yielded encouraging signs towards its namesake goal. The organization has spearheaded eight New York State medical debt reforms, resulting in a 99.8 percent decline in the number of medical debt lawsuits filed by New York hospitals and a 78 percent decrease in the proportion of New Yorkers with medical debt in collections, according to a just-released CSSNY report.
“As a result of our advocacy, many nonprofit hospitals stopped, or slowed suing patients beginning in 2020,” said Jeff Maclin, a spokesperson for CSSNY, in an email.
For the five state-operated hospitals, the financial payoff from suing patients is minimal. If any of those institutions collected the median damages from every patient they sued, it would still hardly register in their budgets. For example, as detailed in Senate Bill S359’s sponsor memo, Upstate University Hospital’s $16 million in lawsuits for a year amounted to just 1.07 percent of its $1.5 billion annual operating budget. Nevertheless, the bill’s passage would still likely warrant a strong response from these facilities.
“Banning litigation altogether, if you remove that option, there’s a concern that it would lead to hospitals being very careful about providing care,” said Miriam Laugesen, an associate professor at Columbia University’s Mailman School of Public Health. “That would probably be what the hospitals would argue. That, ‘If that’s the case, then we’re going to need much better assurance from people as to their ability to pay,’” Laugesen said.
Regarding emergency care, the Emergency Medical Treatment and Labor Act, a federal law enacted in 1986, “ensures public access to emergency services regardless of ability to pay.”
“I think that providing stronger consumer protections is a much better policy approach than banning,” Laugesen said.
About the author(s)
Alex Streinger is a Master of Science student at Columbia University's Graduate School of Journalism.