Donald D. Hackney

What is the actual prevalence of medical bankruptcies

Purpose Medical bankruptcies occur when an individual experiences an acute or chronic health event, and the costs of care exceed the individual’s ability to pay. In such cases, the individual typically files for bankruptcy. There is an extensive literature that estimates the prevalence of medical bankruptcy, but studies either select a population whose medical care is extremely expensive or chooses ad hoc thresholds for medical bankruptcy categorizations. In both cases, the prevalence of medical bankruptcy is biased. The purpose of this paper is to estimate the actual prevalence of medical bankruptcies in a manner that avoids these limitations. Design/methodology/approach Data are randomly drawn from a single US Bankruptcy Court district. Following the literature, an ad hoc threshold of medical debts which places the bankruptcy filer “at risk” for a medical bankruptcy is postulated. Misclassification analyses are used to estimate the likelihood of a medical bankruptcy filing while adjusting for the use of ad hoc thresholds. Findings The naive prevalence of medical bankruptcy is 23.1 percent, but exceeds 50 percent when accounting for misclassification. Many individuals are “ostensibly” medically bankrupt. They are already seriously indebted, and any outside financial shock, including but not limited to medical bills, can push these debtors into insolvency. Originality/value Bankruptcy is an important social safety net. An improved understanding of the types and magnitudes of medical debts which precipitate a bankruptcy filing can lead to policies that improve outcomes for bankruptcy filers and reduce the social costs of bankruptcy.

Criteria for Sustainable Community Economic Development: Integrating Diversity and Solidarity into the Planning Process

Abstract Fundamental to social provisioning is ensuring that community members have access to employment opportunities that pay living wages and sustain the environment. In a previous study, two of us (Underwood, Friesner and Cross 2014) presented criteria for sustainable community economic development, a three-fold test to comparatively assess economic development policies: ecological holism, community centeredness, and institutional legitimacy. Applying this test generates an iterative, evolutionary process of economic development. Absent from these criteria is the concept of intention, as policy options are not “given,” but rather designed by self-interested groups to manipulate interpretations of these test criteria in advancement of their vested interests — outcomes which can be juxtaposed to the “interests of community.” Here, we integrate two additional principles: economic diversity and solidarity. Economic diversity emphasizes living wages in numerous industries to stabilize exogenous economic shocks. Solidarity, as a unit of socio-economic interdependence, stresses commonality of wellbeing within communities. Integrating solidarity and economic diversity into the criteria for sustainable community economic development improves policy design and outcomes that sustain the environment, while also providing living wage employment for community members.

Regional Differences in Chapter 13 Filings: Southern Legal Culture or Religion?

Chapter 7 is designed for debtors who do not have the ability to pay their existing debts and many times leads to a legal release of most debt. Chapter 13 is designed for debtors who have the ability to pay all or part of their debts in installments over a period of time. Bankruptcy research finds that the southern region of the USA has a significantly higher portion of Chapter 13 filings than the rest of the country, unexplainable by quantifiable demographic, legal, or economic differences. Our results suggest that religion is the driving force behind the abnormally high Chapter 13 filings in the southern USA.

Towards a Working Profile of Medical Bankruptcy

Medical bankruptcy refers to individuals with serious medical conditions who feel compelled to file for bankruptcy to seek relief from their medical debts. Noticeably lacking in the literature is a consistent, evidence-based criterion to define who may be classified as medically bankrupt. A more concrete definition would allow policy makers to understand the magnitude of the problem and allow financial counselors to better inform certain households about seeking bankruptcy protection when faced with medical bills. This study uses data drawn from the U.S. Bankruptcy Court’s Eastern Washington District to create an empirical profile of bankruptcy petitioners with medical debt. We then identify those characteristics statistically associated with being “at-risk” of a medical bankruptcy to better understand and define medical bankruptcy.

Did the time frame associated with the implementation of the Patient Protection and Affordable Care Act noticeably impact consumer bankruptcy filings

Purpose The purpose of this paper is to examine whether the timing associated with the implementation of the health insurance-related provisions of the Patient Protection and Affordable Care Act (ACA) altered the presence and distribution of medical/non-medical debts accumulated by different types of bankruptcy filers. Design/methodology/approach Data were drawn from the US Bankruptcy Court’s Eastern Washington District over the years 2009, 2011 and 2014 using interval random sampling. Binary probit and Tobit analyses were used to model the existence, and distribution, of medical debts and total debts, respectively, at the time of filing. The impact of the time frame associated with the ACA was operationalized via a Chow test for structural dynamic change. Findings Chapter 13 filers in 2014 (post-ACA-based health exchange implementation) were more likely to report medical debts than Chapter 7 filers in the pre-intervention period, and were also more likely to report a larger proportion of outstanding debts owed to a single creditor. Filers claiming health insurance premium expenses in 2011 were (at the 10 percent significance level) more likely to report a more skewed distribution of medical debts. Originality/value The time frame associated with the implementation of the ACA impacts the distribution of medical debts among filers who have sufficient net disposable income to fund a Chapter 13 plan. The polarization of outstanding medical debts may indicate coverage gaps in existing health insurance policies, whose costs would be disproportionately borne by patients operating on thin financial margins.