Bobby Peterson, ABC for Health founder and executive director. (Wisconsin Examiner photo)
When Bobby Peterson was a law school intern in 1985, he spent a summer on a project in Barron County learning about rural residents who lacked health coverage.
The team interviewed health care providers and other institutional sources, but they were stuck on how to find uninsured people themselves — until they turned to court records. Perusing lawsuits that health care providers had filed against patients who had outstanding debts, Peterson contacted some of the defendants and asked to interview them.
“A lot of these people had options — they just didn’t have help,” Peterson recalls. They didn’t know about various benefit programs that might have been available. They also lacked an understanding of how to navigate the system and advocate for themselves.
That project was under the auspices of the Center for Public Representation, an educational legal clinic that operated at the University of Wisconsin Law School. The program director, Louise Trubek, directed Peterson to the project after he interviewed to work with the center.
Peterson grew up in a low-income home. The child of blue-collar parents who moved from Milwaukee to the suburb of Butler, he was raised by his mother after his parents divorced.
“I’ve always been interested in access to health care,” he recalls telling Trubek. “I think it’s shocking people go without health care in this country.”
After getting his law degree, taking a break to backpack through Europe and turning down a couple of corporate law opportunities, Peterson was back in Madison and visited with Trubek. Drawing on his work in 1985, she told him, the center had proposed and been awarded a grant to help families with low and moderate incomes navigate the changing marketplace for health care.
The new program would be hiring a couple of attorneys, Peterson recalls her telling him. “She said, ‘You should apply.’”
Over the course of six years in the center’s health benefits counseling program, Peterson says, “we changed the trajectory of a lot of clients’ lives.”
In 1994 — nine years after that first summer experience in Barron County, Peterson went on his own, launching Advocacy & Benefits Counseling for Health Inc., a nonprofit public interest law firm concentrating on advocacy related to health care coverage.
Monday marks ABC for Health’s 30th anniversary — a lifetime over which the organization has grown, expanding its mission while keeping its focus. It’s grown to a staff of 15, most of whom counsel clients confronting medical bills they can’t pay.
“We look at people with medical bills and medical debt and ask, ‘How can we fix things?’” Peterson says. “It’s like a public health version of law — we focus on prevention.”
The offices of ABC for Health, located in the former Mifflin Street Co-op in Madison. (Wisconsin Examiner photo)
In its day-to-day work, ABC for Health counsels people for whom health care has been anything but affordable. That might be someone facing a crushing medical bill who has no way to pay, or someone who has lost a job, and with it, employer-sponsored health insurance.
The counseling could be informing someone about the Affordable Care Act’s health plans — something that didn’t exist until the last decade — or, if they qualify, about BadgerCare (Wisconsin’s name for Medicaid coverage for doctor and hospital services).
If debt is involved, ABC for Health counselors will help clients figure out if they qualify for Medicaid or other benefits programs. But they also will look back to the creditor — the health care provider.
Hospitals have financial assistance programs required by law, for example. But Peterson contends they vary widely in how they operate those programs and how hard they work to inform patients that assistance even exists before sending overdue bills to collection agencies.
Peterson would like to see hospitals routinely help direct indebted patients to Medicaid if they qualify. If hospitals point to low Medicaid reimbursement rates as a defense for not working harder to sign a debtor patient up with the program, Peterson is unsympathetic.
“If you help these people with Medicaid, at least you’re getting paid something, instead of tying them down and compromising their credit scores,” he says.
ABC for Health counselors have also seen clients whose medical debt includes bills that demand additional payment for a treatment or procedure above what Medicaid pays. In Wisconsin, that “balance billing” is illegal, Peterson says. “Some of that debt has no business being collected.”
Beyond direct client services, the nonprofit has also been an outspoken advocate on policy.
ABC for Health researches and reports on trends in lawsuits by health care providers against patients over medical debt — a practice that Peterson contends is socially harmful and should be avoided.
The organization is one of several in Wisconsin that have called on the state to expand Medicaid eligibility in return for a federal subsidy under the Affordable Care Act. And it has been an outspoken critic of Medicaid birth-cost recovery — going to court to demand that a father whose child’s birth was covered by Medicaid, but whose own income is above the limit to qualify for Medicaid, pay back what Medicaid spent.
In the years since its founding, ABC has established several subsidiaries. The first was ABC for Rural Health launched two decades ago to serve Wisconsin communities outside of the state’s urban areas.
HealthWatch Wisconsin is a communications, education and outreach program. Among its recent efforts were videos explaining the Medicaid Unwinding — the reinstatement of annual enrollment requirements for participants in the Medicaid program. The videos were produced by ABC for Health Chief Operating Officer Brynne McBride.
My Coverage Plan Inc. is a tech business that develops applications used by ABC for Health as well as some for public access and some for specific sorts of organizations.
Its products include a web-based calculator that people can use to establish whether their incomes fall above or below the federal poverty guideline, a benchmark that is used to determine eligibility for Medicaid and other programs.
Another program has been designed for federally qualified free and charitable health care clinics to use to help establish what benefit programs their uninsured patients might qualify for. Through June, that program in use at a small group of clinics has helped 1,025 patients and family members address more than $1.4 million in medical debt — wiping out $852,000 of that debt, Peterson said.
Over the organization’s lifetime, it has helped more than 72,500 clients and family members find health coverage and services — a population with greater health needs due to poverty or low income, race or both. Peterson says as many as 20% of Wisconsin’s population — more than 1 million people — might benefit from some of the services ABC for Health offers.
The technological tools have helped ABC for Health increase its reach, according to Peterson, but he sees no shortage of need.
“We doubled the number of people we’ve served from 2022 to 2023,” he says, and this year, “it looks like we’re going to double that again.”
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