Ariz. U’s Butler On Tackling Medical Debt Without Lawyers – About Your Online Magazine


Stacy Butler invokes several figures to emphasize the legal problems that many Americans face each year because of their medical debt. Among them: Debt collection lawsuits account annually for 25% of civil suits filed in the United States, and half of them are filed for non-payment of medical care.

But many are not receiving legal support when facing collection claims. Eighty-six percent of low-income Americans receive little or no assistance for civil legal problems, said Butler, director of the Innovation for Justice program at the University of Arizona’s James E. Rogers Law School.

Stacy Butler, director of the Innovation Program for Justice at the University of Arizona’s James E. Rogers School of Law, is overseeing several pilot projects aimed at making legal advice more accessible to the average American.

An alliance between the university and three nonprofits in Utah was designed to answer that question. Under Utah’s “sandbox” regulatory program, non-legal professionals with the groups will offer legal support to citizens on financial issues related to their medical care, in an effort to reduce the barriers that low-income citizens face to receive legal assistance. proper.

The Utah restricted area allows attendees to provide legal services outside the existing regulatory framework, including allowing individuals without attorney certification to provide limited legal advice.

The innovation lab designed two separate pilot projects taking advantage of the loosened restrictions, both approved in early May. Pilots include a medical debt diversion program designed to support people after they face court subpoenas and a project with community workers offering legal advice on top of the health services they already offer. Once the projects guarantee funding, the innovation laboratory will train professionals who will offer legal advice.

Launched in 2018, the innovation lab aims to design and test “disruptive solutions to the justice gap,” said Butler. His work also includes a program in Arizona that trains defenders in domestic violence shelters to provide legal advice on protection orders and family law. Arizona and Utah relaxed state regulations around the practice of the law in 2020.

For Butler, the projects are a response to a “deeply broken system” that has made the price of a lawyer too high for most Americans. “The idea that you need this highly paid guardian to do [the legal system] effective for you, I just think it’s a failure of democracy, “she said.

In a conversation with Law360, Butler talked about problems with the US legal system, why the innovation lab decided to focus on the issue of medical debt in Utah and how the new programs will work in practice. The discussion was edited for reasons of length and clarity.

Before regulatory reforms were passed in Arizona and Utah last year, was this program focusing on issues of regulatory reform and the possible expansion of legal services?

Our lab really started when conversations on the subject were starting, so the advocacy program we are running in Arizona was one of our first projects. It was a project we took on because we saw that Arizona was considering this move towards regulatory reform. What would it mean for someone without a J.D. to give legal advice. We are doing this because people who need access to the civilian legal system cannot afford lawyers. We are really going to use regulatory reform to build things for people who can’t afford lawyers.

What led the program to tackle medical debt? What made this the problem that Utah pilots will address?

We had already worked in the debt collection area. That was one of the reasons why we were interested. Debt collection is also the most frequent type of civil litigation in the United States. Twenty-five percent of civil suits filed in the United States are for debt collection. Medical debt represents half of the debt collection nationally and a third of the debt collection in Utah. Therefore, for potential impact, medical debt collection is a big part of the civil process in Utah.

And like any other civil justice issue for low-income populations, it has significantly damaging cascade effects. Someone ends up with a medical debt trial in Utah, they have a 77% chance of getting their salaries up. In some jurisdictions, you can still be arrested for unpaid sentences. Finding housing is more difficult if you have a debt collection judgment on your record. Therefore, we are very interested in trying to resolve all the collateral damage that negative involvement with the civilian legal system can produce.

How did the innovation office partner with organizations that will expand their existing services to include limited legal advice?

We spoke with various stakeholders in the community about the issue of medical debt and the possibility of finding new ways to provide legal services to people with medical debt. And we try to map the entire system and look for opportunities to affect change. After seeing where the good points are, we follow up with organizations that seem well positioned to promote a new type of legal service. But before we sent the sandbox app, we built prototype versions and tested them with people from the community, to ensure that we developed a concept that had legs to support itself.

What were your conclusions about how the prototypes worked?

One of the surprising things we learned from prototype testing was when we shared this idea in the field with people with medical debts, we asked, “What would it mean for you to go to your credit counseling agency and find out that they could also help you with billing of medical debts? Or ask a food bank social worker who can identify for you: ‘Hey, is this account something you need to resolve?’ What we hear from people is that they prefer to have the help and assistance of a consultant trusted community rather than a lawyer.

The general perception was that lawyers are expensive, lawyers are scary, I don’t know how to find lawyers. I prefer someone who feels they belong to my community.

When this program is working at its best, how will it work in practice?

National statistics show that 1 in 3 Americans is experiencing a civil legal need and 1 in 9 recognizes the need as a civil legal. So much of what these advocates can do is to alert people to the fact that what appears to be a human problem is likely to be a problem of justice. And that you have rights and responsibilities linked to that problem. There are things you can do now to protect yourself, to resolve this before you go to court. He is trying to bridge this justice awareness gap: this large population of people with legal needs and not recognizing them and, even when they do, facing a huge gap in terms of how many legal aid groups they can serve.

Community health workers will do this differently than defenders of court diversion will do. But both are focused on trying to solve problems and get people to fair and equitable results, without having to get involved with the judicial system.

You noted earlier that the public’s perspective on lawyers is that they’re expensive and scary. What contributed to this belief?

In part, I think it’s just a lack of opportunity for people in the low-income community to connect with legal services. Many of the civilian legal needs of the low-income population are defendants. They are defending eviction, defending debt collection. They are being taken to a lawsuit that they do not want. If your only experience with lawyers is that they are the ones who evict you from your home and sue you for your debt, this will not naturally seem like a place to turn to for help.

Several states are considering reforms similar to those instituted in Utah and Arizona. Why is it important that it expands beyond these two states?

It is important for all states to consider regulatory reform for the legal profession, because it is a deeply bankrupt system. Rebecca Sandefur has this analogy, it is as if you send your child to a public school, but you have to pay someone full-time to accompany your child during the school day. This sounds crazy. We only think about school, well, that’s what we do, we send our children, we pay with our taxes, it must work for all of us, because it’s our system. The legal system is the same. It should work for everyone, because we pay for it.

– Edition by Brian Baresch.

All Access is a series of discussions with leaders in the field of access to justice. Questions and answers have been edited for greater length and clarity.

Have a story idea for Access to Justice? Please contact us at accesstojustice@law360.com.

Paula Fonseca