Yin on Effects of Mass Medical Debt Forgiveness

Wesley Yin, associate professor of public policy and management, was cited in an article by NOLA News about an initiative in New Orleans to erase $130 million in medical debt held by the city’s residents. The New Orleans City Council voted last year to allocate funds to a New York-based nonprofit that purchases medical debt on secondary markets, then forgives it. Yin, who is working with the nonprofit to observe the effects of debt forgiveness, said that eliminating newer debt is potentially more impactful than eliminating older debt. He also said there are limits to what providers can do to curb the effects of patient debt. “The problem of debt is something that’s beyond what a hospital really controls, and a much larger problem about inequality and financing in health care systems,” Yin said. “The best place to do this is prevention, and just have more generous health insurance to begin with.”


 

Yin on Growing Efforts to Wipe Out Medical Debt

Wesley Yin, associate professor of public policy and economics, spoke to the New York Times about local governments’ efforts to address the high cost of health care by canceling their constituents’ medical debts. People with medical debt are less likely to seek needed care, and carrying a sizable debt load can damage credit and make it difficult to find employment, research shows. So across the United States, city and county officials are using funds from President Joe Biden’s American Rescue Plan to provide medical debt relief to eligible residents. Erasing this debt could be a “game changer” for some people, said Yin, who is studying the impact of medical debt relief programs on people’s livelihoods. He added, however, that governments should also address the root causes of medical debt, including high costs and limited access to good health insurance.


 

Yin on Strategies to Reduce Medical Debt

Wesley Yin, associate professor of public policy and management, spoke to the podcast Tradeoffs about how Americans can reduce their medical debt. Currently, about 100 million Americans have amassed more than $140 billion in medical debt. Yin explained that simply forgiving a person’s medical bills is a short-term solution to the greater problem of accumulating medical debt. When a hospital erases debt and temporarily reduces service costs, patients became more likely to receive care; however, within six months, they are likely to go back to getting less care as their debt again piles up, a study by Yin has found. Yin and his colleagues also published a paper in JAMA showing that states with Medicaid had far less medical debt than those without it. “In the states that expanded Medicaid, the amount of debt basically was halved. And in places that didn’t, it was essentially unchanged,” he told the podcast in a segment beginning at minute 10.


 

Yin on Risks of ‘Buy Now, Pay Later’ Plans

Wesley Yin, associate professor of public policy and economics, spoke to USA Today about the rapid growth in “buy now, pay later” credit, which has come under the scrutiny of the Consumer Financial Protection Bureau. The loans are especially appealing to young shoppers and people with low income or poor credit, and the federal agency found that borrowers may be unaware of late fees and other consumer risks. Yin drew a parallel to the easy credit of the pre-2008 mortgage industry, which helped trigger the Great Recession, but said the macroeconomic implications of the “buy now, pay later” programs are less worrisome. He noted that the growing popularity of this form of credit may be a symptom of a deeper problem in the economy. “Is it a luxury to want an iPhone, or is it a luxury to want a new sofa?” he said. “The fact that people can’t pay for it, I think, is the issue.”


 

Public Policy Students Take On the Health Care Digital Divide Effort to widen access to telemedicine is one of 15 immersive projects aimed at developing policy solutions for real-world clients

By Mary Braswell

When Sophia Li decided to apply to graduate school to pursue her interest in health policy, she could not have known that the field would soon be upended by a protracted global health emergency.

Along with most of her peers in the UCLA Luskin School of Public Affairs’ master of public policy program, Li began her studies in September 2020, when COVID-19 had already taken more than 1 million lives worldwide and the arrival of vaccines was still months away.

When the time came to embark on the public policy program’s exacting capstone project, Li chose to focus on an inequity brought into sharp focus by the pandemic: As they isolated in their homes, more people turned to telemedicine for their health care needs — but that option was not available to people who lacked computers, smart phones and internet service.

“The pandemic really did shine a light on the possibilities that telemedicine brings,” Li said, “but it also showed that, while the upper half are benefiting from this, what does this mean for the lower half that have these barriers to access?”

Li was part of a team that explored this question on behalf of their client, the nonprofit Community Clinic Association of Los Angeles County. On an evening in May, Li and teammates Stacy Songco, who is earning a master of public policy and a doctorate in medicine, Xinyuan Qi, Ziyi Wei and Yixuan Yu boiled down a year’s worth of policy research and analysis into a 20-minute summary.

They were among nearly 70 second-year students to complete 15 applied policy projects this year, a rite of passage before receiving their UCLA master of public policy degrees. The capstone projects challenge students to find solutions to real-life policy dilemmas on behalf of clients in Los Angeles, across the state and nation, and around the world.

Networking with UCLA Luskin alumni had connected Li with the Community Clinic Association, which supports 65 neighborhood clinics in underserved areas. At the time, the nonprofit was “just dipping their toes into the digital divide issue,” she said.

The team spent months speaking with medical staff, local policymakers, internet service providers and, of course, the patients themselves. The conversations took place via Zoom because of COVID restrictions, but also in person, to make sure those without the means to gather virtually would be heard.

By year’s end, the team had developed more than a dozen recommendations, including the creation of a new role of digital navigator — a clinic staff member trained to guide individuals through the often-confounding world of broadband access, as well as benefits they may be entitled to, which change from ZIP code to ZIP code.

The students proposed a mechanism to receive federal funds for this new position. They stressed that information should be provided in multiple languages, and not just online but in printable formats, for those unable to access the internet. And they quickly determined that unlocking digital doors would open up a world of services and opportunities beyond telemedicine.

One of their focus groups spoke of their experiences with the California Lifeline program, which provides discounted landline and cell phone services to low-income households. While some found it confusing, “we had one unhoused individual who said, ‘Actually, you know what? I can walk you through all the paperwork, I can talk to you about how to use this,’” Li said.

“If people from the community could tap their experiences to guide others and receive compensation as a digital navigator, imagine the possibilities.”

The project culminated in a full published report for the Community Clinic Association and a formal presentation before Luskin faculty, staff and students, including the team’s advisor, Public Policy chair Martin Gilens.

Other capstone projects completed by the class of 2022 dealt with how to protect the rights of car wash workers, whether to expand the number of seats on the Los Angeles City Council, how to balance public health and humane treatment of asylum seekers at the border, as well as homelessness, mass transit, criminal justice and more.

“It’s an immersive experience. The students value that, and the marketplace also values that,” said Wesley Yin, an associate professor of public policy and economics who has served as coordinator and advisor in the applied policy projects program.

“There’s a professionalism that makes it much more than a class project,” Yin said. “It equips students with the rich experience and knowledge to seamlessly integrate into an organization.”

Li said her team emerged with unexpected areas of expertise. “The digital divide is a really complicated issue that has everything from some little niche funding source that you need to know about, to complex infrastructure issues and these really technical things that you need to understand,” she said.

As she looks toward graduation, Li reflects on the turns in her education that brought her to this point.

She transferred from Chaffey College to UC Merced, where she earned a bachelor’s degree in public health, then managed the rigors of earning her master of public policy at a time of pandemic. Selected as a Presidential Management Fellow, Li will spend the next two years in a program that helps train young scholars to become the next generation of leaders in federal government.

“It’s been a lot of these 90-degree turns that keep putting me on the right path,” Li said. “So let’s go explore new things.”

View photos of this year’s applied policy project presentations on Flickr.

Applied Policy Projects 2022

Yin on Policy Changes to Reduce Medical Debt

Associate Professor of Public Policy Wesley Yin was cited in a Health Care Journalism article about the burden of medical debt in the United States. Yin said that medical debt, totaling at least $140 billion, is the single largest source of consumer debt in the United States. To address this issue, the White House announced four steps to ease the burden of medical debt on health care consumers, including holding medical providers and debt collectors accountable for harmful practices and forgiving debt for low-income veterans. “Just shining a light on that type of behavior might lead to reducing the most egregious practices from providers,” Yin said. He expressed hope that the “White House’s actions to shine a light on charity care practices will have a positive effect for low-income individuals.” The policy changes may also “nudge providers to be stronger advocates for increased subsidies for health insurance and Medicaid expansion,” he said.


Yin on Burden on U.S. Medical Debt

Associate Professor of Public Policy Wesley Yin’s research into the soaring cost of medical debt in the United States was featured in the UCLA Anderson Review. A study co-authored by Yin and published in the Journal of the American Medical Association found that medical bills sent to collection agencies totaled an estimated $140 billion as of June 2020. That sum, which is bigger than all other sources of debt in collection combined, was tallied even before the pandemic saddled COVID-19 sufferers with unpaid doctor and hospital bills. Medical debt is concentrated in low-income neighborhoods, in the South and in states that refused to expand Medicaid coverage under the Affordable Care Act. “Communities that had been most burdened by medical debt have become even worse off, in absolute and relative terms, due to their leaders choosing not to expand Medicaid,” Yin said. “The results are important because they indicate that these problems are within the control of public policy.”

Wesley Yin

Wesley “Wes” Yin is an Associate Professor of Economics at the UCLA Luskin School of Public Affairs, and the Anderson School of Management. He is also a Research Associate at the National Bureau of Economic Research, and a Faculty Affiliate at the Jameel Poverty Action Lab at MIT. He is currently serving as Vice Chair of the Department of Public Policy at the Luskin School.

Yin’s research focuses on health care, consumer finance and protections, and economic inequality. His recent work analyzes the prevalence of medical debt and its impact on disparities, well-being and financial health; as well as the consequences of health care pricing reforms, insurance marketplace design, and rising industry market power.

His work has been published in leading economics and policy outlets such as the Quarterly Journal of Economics, the American Economic Review, the Review of Economics and Statistics, JAMA, Health Affairs, and the Hamilton Project at the Brookings Institution, and has been featured in or he has written for media outlets such as the New York Times, Washington Post, New Yorker, Vox, and others.

From 2012 to 2014, Yin served in the Obama Administration as Acting Chief Economist and Deputy Assistant Secretary for Microeconomic Policy at the U.S. Department of the Treasury, and as a Senior Economist in the White House Council of Economic Advisers, where he advanced policies aimed at reducing student debt burden, improving affordability and quality of health care, and improving housing market stability and low-income home-ownership. Since 2014, Yin has advised the state of California on health care reforms, including the design of the recent expansion of state premium subsidies for marketplace insurance.

Previously, he was an assistant professor at the University of Chicago and Boston University, and a Robert Wood Johnson Scholar in Health Policy at Harvard University. He received his PhD in economics from Princeton University.

 

Selected Publications  

The Impact of Financial Assistance Programs on Health Care Utilization. 2022. (with Alyce Adams, Ray Kluender, Neale Mahoney, Jinglin Wang, and Francis Wong). Forthcoming at American Economic Review: Insights.

Personalized Telephone Outreach Increased Health Insurance Take-Up for Hard-to Reach Populations. 2022. (w/ Rebecca Myerson, Nicholas Tilipman, Andrew Fehrer, Honglin Li, and Isaac Menashe) Health Affairs 41(1): 129–137.

Medical Debt in the United States, 2009-2020. 2021. (with Ray Kluender, Neale Mahoney and Francis Wong) Journal of the American Medical Association 326(3). Media Coverage: NY Times, Washington Post, Vox, Marketwatch, CBS Evening News, Marketplace. JAMA editorial.

The Role of Behavioral Frictions in Health Insurance Marketplace Enrollment and Risk: Evidence from a Field Experiment. 2021. (with Richard Domurat and Isaac Menashe) American Economic Review 111(5): 1549–1574. [Online Appendix] Media Coverage: Tradeoffs Podcast

The Market for High-Quality Medicine: Retail Chain Entry and Drug Quality in India. 2019. (with Daniel Bennett) Review of Economics and Statistics 101(1) p.76-90 [Appendix]

Insurers’ Negotiating Leverage and the External Effect of Medicare Part D. 2015. (with Darius Lakdawalla), Review of Economics and Statistics 97:2 p.314-331 (an earlier version appears as NBER working paper no. 16251). Media coverage: New Yorker

R&D Policy, Agency Costs and Innovation in Personalized Medicine. 2009. Journal of Health Economics 28(5): 950-962.

Market Incentives and Pharmaceutical Innovation. 2008. Journal of Health Economics 27(4):1060-1077.

Female Empowerment: Impact of a Commitment Savings Product in the Philippines. 2010. (with Nava Ashraf and Dean Karlan) World Development 38(3): 333-344.

The Effect of the Medicare Part D Prescription Benefit on Drug Utilization and Expenditures (with Anirban Basu, James Zhang, Atonu Rabbani, David Meltzer, Caleb Alexander) Lead article at Annals of Internal Medicine 148(3): 169-177. Annals’ Summary for Patients.

Designing Targeting Schemes with Poverty Maps: Does Disaggregation Help?. 2007. (with Berk Özler, Chris Elbers, Tomoki Fujii, Peter Lanjouw) Journal of Development Economics 83(1).

Tying Odysseus to the Mast: Evidence from a Commitment Savings Product in the Philippines. 2006. (with Nava Ashraf and Dean Karlan) Quarterly Journal of Economics 121(2). Winner of TIAA-CREF 2006 Certificate of Excellence.

Deposit Collectors (with Nava Ashraf and Dean Karlan). 2006. Advances in Economic Analysis & Policy 6(2), Article 5.

 

Working Papers

Provider Market Power and Adverse Selection in Health Insurance Markets (with Nicholas Tilipman)

The Burden of Medical Debt and the Impact of Debt Forgiveness (with Ray Kluender, Neale Mahoney and Francis Wong). J-PAL Summary. AEA Pre-registration 1 (Old Debt). AEA Pre-registration 2 (Young Debt).

Trends in Medical Debt During the COVID Pandemic (with Raymond Kluender, Benedict Guttman-Kenney, Neale Mahoney, Francis Wong, and Xuyang Xia)

 

Other Publications and Policy Articles  

Trends in Medical Debt During the COVID-19 Pandemic” (with Benedict Guttman-Kenney, Raymond Kluender, Neale Mahoney, Francis Wong, and Xuyang Xia) JAMA Health Forum. 2022, 3(5), 2022.

Options To Improve Affordability In California’s Individual Health Insurance Market,” (with Peter Lee, Katie Ravel and Nicholas Tilipman), a Covered California report for Gov. Newsom, California State Senate and State Assembly pursuant to AB1810, February, 2019

How retail drug markets in poor countries develop” (with Dan Bennett) VoxDev.org, August, 13th, 2018.

Potential Impacts of Graham-Cassidy-Heller-Johnson on Californians and the Individual Health Insurance Market” (with John Bertko) Covered California Report, September 25, 2017

Evaluating the Potential Consequences of Terminating Direct Federal Cost-Sharing Reduction (CSR) Funding” (with Richard Domurat) Covered California Report, January 26, 2017  [Appendix]

Trump’s “populist” economic proposals come with massive catches. Here’s what to watch for.” Vox, November 18, 2016

Strengthening Risk Protection through Private Long-Term Care Insurance. Brookings Institution, Hamilton Project Discussion Paper 2015-06, June 2015. Policy Brief.

Value of Survival Gains in Chronic Myeloid Leukemia (with John Penrod, J. Ross Maclean, Darius Lakdawalla and Tomas Philipson) American Journal of Managed Care 2012 Nov;18(11 Suppl):S257-64

The impact of Medicare Part D on Medicare-Medicaid Dual-eligible Beneficiaries’ Prescription Utilization and Expenditures (with Caleb Alexander and Anirban Basu), Health Services Research, February 2010, 45(1), pp. 133-151   

Valuing health technologies at NICE: Recommendations for Improved Incorporation of Treatment Value in HTA (with Dana Goldman, Darius Lakdawalla and Tomas Philipson) Health Economics October 2010, 10(11) pp. 1109-1116

Solutions and Challenges to Curing Global Health Inequality Innovations 2(4), October 2007, 2(4), pp. 72-80

Testing Savings Product Innovations Using an Experimental Methodology (with Nava Ashraf and Dean Karlan), Asian Development Bank, Economics and Research Department Technical Paper No. 8. November, 2003

A Review of Commitment Savings Products in Developing Countries (with Nava Ashraf, Nathalie Gons, Dean Karlan) ERD Working Paper, July 2003.

 

Current Teaching

Public Finance and the Economics of Inequality (Econ 415)

Health Care Finance and Management (MBA and MPP elective) (MGMT298 & PP290)

Econometrics for Policy Analysis (MPP Core) (PP208)

Applied Policy Project (APP) Capstone Advisor (PP298A-D)

Yin on National Burden of Medical Debt

Associate Professor of Public Policy Wesley Yin spoke to Verywell Health about the results of his research on the burden of medical debt in the United States. “Medical debt has become the largest source of debt and collections than all other sources combined,” Yin said, referring to recent research he co-authored that found 17.8% of individuals in the U.S. had medical debt in collections as of June 2020. “It just speaks to how important the expansion of Medicaid has been towards financial security, financial well-being, as well as reducing disparities in these communities,” he said. When medical bills are left unpaid, it can negatively impact an individual’s credit score and make it more difficult to qualify for loans. In order to curb medical debt, Yin recommended extending subsidies that would allow patients to purchase more affordable insurance plans with a smaller deductible. He also suggested expanding Medicaid, an approach that has been shown to reduce state spending.

Read the article

Study Measures Americans’ Growing Medical Debt

Over the last decade, medical bills have become the largest source of debt that Americans owe collection agencies, according to new research co-authored by Associate Professor of Public Policy Wesley Yin. The $140 billion in unpaid health care bills, held by about 18% of Americans, now exceeds all other debt in collections combined, according to the paper just published in the Journal of the American Medical Association (JAMA). Only debts referred to collection agencies were measured; other unpaid bills owed to health-care providers would push the total amount of debt even higher. Yin and co-authors Raymond Kluender of Harvard Business School, Neale Mahoney of Stanford University and Francis Wong of the National Bureau of Economic Research examined records from the credit rating agency TransUnion from January 2009 to June 2020, reflecting medical care delivered prior to the COVID-19 pandemic. Their comprehensive look at the evolution of medical debt reveals that, while Americans’ household finances largely recovered after the Great Recession, medical debt continued to grow. Yin said the debt was most concentrated in low-income communities and in the South. He added that, in 12 states that chose not to expand Medicaid coverage, significant disparities grew even worse during the period studied. “Addressing the problem of medical debt in the U.S. health care system must be a high priority,” said the authors of a JAMA editorial accompanying the study. “In addition to the potential consequences for health and health care use, the economic and social ramifications of medical debt are likely equally consequential, if not more so.”