To the chagrin of surviving spouses, medical debts in Minnesota can outlive patients

A state senator whose 2001 legislation enabled the collection of medical debts from spouses of deceased patients is calling the practice “repulsive” and wants it to end in Minnesota.

Sen. John Marty, DFL-Roseville, said he has no idea how a bill he co-authored about child support also ended up specifying that Minnesotans are liable for the medical debts of spouses if they live together.

“It’s beyond me,” he said, “other than to say it’s something we ought to repeal.”

DFL lawmakers are trying to ban that practice as part of a broader package of protections for Minnesotans who get stuck with unaffordable medical debts. While providers could still pursue debts through the estates of deceased patients, they couldn’t pursue widowed spouses through collections activities, lawsuits or wage garnishment.

Collections directed at spouses only compound their grief, said Jessica Velasco of Worthington. Her father worked through the pandemic as a meatpacker until he died of COVID-19 complications in 2021. Her mother was pressed to pay $40,000 in bills for his care, she said.

“Now she was fully responsible for that,” Velasco said. “Not only had she lost the love of her life, but also the income of her spouse, making it extremely difficult to make ends meet.”

The House voted April 15 to remove spousal liability for medical debts, and Senate action is expected as well. Gov. Tim Walz and Attorney General Keith Ellison have endorsed the proposal.

Debt collection when patients die is particularly fraught for their survivors, but Minnesota hospital leaders called it a necessary burden. Care at the end of life is particularly expensive for hospitals that already face substantial charity care costs. Minnesota hospitals wrote off $476 million in bills they expected patients to pay in 2022.

The Minnesota Hospital Association opposes eliminating spousal liability altogether, because it believes insurance companies should be responsible for resolving debts for deceased patients. Collecting debts through estates can be time-consuming, and some surviving spouses can afford to pay without that cumbersome process, said Joe Schindler, the association’s vice president for finance policy.

“This proposal would eliminate that obligation, thereby forcing the hospital provider of care to absorb” more expense, said Schindler, who argued for a means test to determine which families could be exempted from collections.

State Sen. Liz Boldon, DFL-Rochester, is a lead author of the bill and said it is needed because Minnesota is an “outlier.” Spousal liability for medical debts was implied in most states under centuries-old common law, but that changed as lawmakers removed outdated family policies that were based on husbands working and wives having no independent income.

Minnesota in 1981 removed the terms “husband” and “married wife” from liability laws, but still held people responsible for spouses’ “necessaries,” a broad category that included medical expenses. Lawmakers returned in 1997 to eliminate spousal liability for anything other than “household articles and supplies furnished to and used by the family.”

Four years later, lawmakers reversed course and made spouses who live together liable for “necessary medical services.”

The abrupt switch caught the attention of Jean Sanderson, a University of Minnesota family law professor who stays current on the legal responsibilities of marriage.

The statutes eliminated spousal liability for medical debts in 1997 and then “whoops, four years later it was back again,” she said.

The original 2001 bill sought relief from criminal prosecution for spouses who were struggling but still trying to pay child support. The medical debt language was added in the version that gained Senate and House passage before then-Gov. Jesse Ventura signed it. Marty said he can’t recall why it was added, though it may have sought to obligate people to pay medical debts of spouses after they separate. Minutes and recordings of House and Senate committee debates don’t explain the addition to the bill, also coauthored by Sen. Warren Limmer, R-Maple Grove.

Minnesota hospitals voluntarily limit collections through an agreement with the attorney general but state lawmakers want to expand those limits to outpatient clinics and add protections. Hospitals would be required under this year’s legislation to schedule non-emergency care for patients, for example, even if they have substantial overdue bills.

The legislation mirrors medical debt recommendations published last month by the National Consumer Law Center, including a prohibition on spousal liability. Lead author Jenifer Bosco said existing liability laws are an “artifact” of a time “when a wife could not sign a contract in her own name.” They also might contradict the federal Equal Credit Opportunity Act, she said, which prohibits spouses from being legally obligated to their partners’ transactions.

Health care leaders warned that the reforms could be an overreach when rural hospitals are closing inpatient floors and maternity units in response to financial pressures, and large providers such as Allina and Fairview are reporting operational losses. Lakewood Health in Staples, Minn., this week reported plans to close its inpatient psychiatric unit.

The Minnesota Medical Association represents the state’s doctors and said in a statement that “any proposed legislation needs to identify ways to ease the impact of medical debt on patients while ensuring that physicians and other providers are appropriately reimbursed for the services they provide.”