Over the past decade, I have spent a considerable amount of time in Washington, D.C., engaging with lawmakers, regulators, and staff on both sides of the aisle. I did not set out to become involved in policy. Like many leaders of privately owned businesses, my focus has always been on building a sustainable company, supporting our employees, and serving the healthcare providers who rely on us.
But as federal and state policies have increasingly shaped the financial realities of healthcare, it has become clear that those of us operating within the system cannot afford to stay on the sidelines.
What concerns me most today is not the intent behind recent policy efforts — it is the growing gap between those intentions and their real-world consequences.
The medical debt debate is only part of the story
There is no denying that medical debt is a serious issue. According to the Kaiser Family Foundation, roughly 100 million Americans carry some form of healthcare-related debt. That reality demands thoughtful solutions.
However, recent efforts to remove medical debt from credit reporting, combined with broader regulatory pressure on collections, risk addressing the symptom rather than the system. Debt does not disappear simply because it is no longer reported. Instead, the financial burden shifts — most often onto providers already operating under significant strain.
From an operational standpoint, when accountability mechanisms are reduced, payment behavior changes. Providers are left with fewer tools to recover revenue, and over time, that lost revenue must be offset elsewhere — through higher upfront costs, reduced services, or tighter access to care.
OBBBA and the compounding pressure on providers
Layered on top of these changes is the proposed “One Big Beautiful Bill Act” (OBBBA), which includes provisions that would further reduce reimbursements across segments of the healthcare system. While large, well-capitalized systems may be able to absorb incremental reimbursement cuts, smaller and rural providers are far less resilient. These organizations already operate on narrow margins, and even modest reductions in revenue can destabilize their ability to serve their communities.
This is where policy discussions in Washington often lose sight of practical impact. When reimbursement declines at the same time that revenue recovery tools are weakened, the pressure is not additive. It is compounding.
The question is not whether the system will adjust. It will. The question is how.
Rural healthcare is the first to feel the impact
In many cases, the answer begins in rural America.
Research from the Cecil G. Sheps Center for Health Services Research shows that more than 130 rural hospitals have closed in the United States since 2010, with many more at risk. These facilities are not just healthcare providers; they are essential infrastructure for entire communities.
When financial pressure forces a rural hospital to close, the consequences are immediate and measurable. Travel times for emergency care increase dramatically, preventive care declines, and outcomes worsen. Policies that reduce reimbursement or weaken collections do not affect all providers equally. They disproportionately impact those with the least margin for error.
A broader concern: The stability of a credit-based system
Beyond healthcare, there is a larger economic question at play.
The U.S. economy relies on credit systems to assess risk and allocate capital efficiently. Medical debt has historically been one component of that system — imperfect, but informative.
As policymakers move to remove medical debt from credit reporting, and as similar conversations begin to emerge around other categories of consumer debt, we are entering uncertain territory. Reduced visibility into repayment behavior does not eliminate risk; it redistributes it. Lenders respond by tightening standards or increasing costs, and those adjustments ultimately affect the same consumers policymakers are trying to protect.
The missing voice in policy discussions
One of the most persistent challenges in Washington is the limited presence of operators — people who work within healthcare finance every day — in the policymaking process .
Too often, decisions are made without sufficient input from providers, revenue cycle professionals, or business leaders who understand how these systems function in practice. The result is policy that may be well-intentioned but is not always well-calibrated. From my perspective, the solution is not to resist regulation. It is to ensure that regulation is informed by operational reality.
Clear rules, applied consistently, create stability. But those rules must reflect how healthcare is actually delivered, billed, and paid for — not how we might prefer it to work in theory.
A path forward
Many policymakers are open to these conversations. The challenge is not a lack of willingness, but a lack of exposure to the full picture.
Healthcare is complex, and the downstream effects of policy decisions often take years to surface. That makes it all the more important to incorporate perspectives from across the system before those decisions are finalized. As the debate over medical debt, reimbursement, and broader healthcare reform continues, it is critical that we take a step back and consider the cumulative impact of these policies.
This is not an abstract discussion. It is about sustaining the organizations, employees, and communities that depend on us. If we fail to account for how these policies interact in the real world, we risk weakening the very system we are trying to improve.
The goal should not be to remove pressure from one part of the system only to create it somewhere else. The goal should be to build a system that is both compassionate and sustainable.
That requires listening to the people living with the consequences — and ensuring they have a seat at the table.
Photo: KLH49, Getty Images
Tim Haag is the President & CEO of State Collection Service, carrying on his family legacy as the third generation of Haag’s to lead the company since its inception in 1949.
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