Oregonians are struggling under the weight of $390 million in medical debt, and hospitals have been particularly aggressive about collecting it. A recent report found that many hospitals are flouting a 2019 state law that requires them to determine whether patients are eligible for financial assistance before sending the debt to collections.

For some, that failure to screen patients for eligibility is almost certainly intentional, rather than a mere administrative oversight. Four out of every nine Oregon patients in debt collection are likely eligible for a 100% discount on their care’s out-of-pocket costs, according to that report from the nonprofit Dollar For. Yet, less than 1% of patients sued for medical debt have access to legal help, meaning those patients likely aren’t aware of their options.

Unfortunately, Oregon lawmakers may soon inadvertently exacerbate this abuse.

Two pieces of legislation, Senate Bill 533 and House Bill 2385, would expand a federal program that hospitals have used to price-gouge patients. The bills would also eliminate already-limited opportunities for oversight within the program.

That would especially hurt Oregonians suffering from chronic illnesses like lupus, a debilitating disease that causes a person’s immune system to attack itself. It results in inflammation throughout the body, causing everything from rashes to extreme pain, fatigue organ damage and it has no cure.

Black, Native American, Asian, and Hispanic individuals account for more than six in ten people with lupus in the United States. And they disproportionately bear the socioeconomic impacts of the disease. Black and African American people with living with lupus are twice as likely to lose their jobs after their diagnosis and 10 times more likely to live in underserved areas than their white counterparts.

It’s no surprise that a large share of lupus patients are also on Medicaid, the health insurance program for low-income Americans.

It is precisely these patients that the federal program — known as 340B — is meant to help. The program allows eligible hospitals and other providers to purchase medications at deeply discounted rates. Congress expected that providers would use those savings to help uninsured, low-income and underserved patients in their communities.

Unfortunately, 340B has also evolved into a hospital markup program that allows large healthcare systems to generate massive profits at the expense of vulnerable patients.

Hospitals frequently charge vulnerable patients full price for the 340B medicines they purchased at a discount — and pocket the difference. Oregon hospitals earn over three times more in 340B profits than they spend on discounted care for patients. Nearly 70% of Oregon’s 340B hospitals provide less charity care than the national average.

And that’s not to mention that hospitals contract with roughly 750 pharmacies outside the state. So, those 340B savings aren’t truly flowing to the underserved Oregon communities that need them most.

All told, hospitals and health systems across the country take in nearly $65 billion from 340B markups alone, accounting for about 10% of America’s total spending on brand-name medicines.

Instead of expanding an opaque program with known loopholes, state lawmakers should reform 340B to ensure the savings actually make their way to patients. They could start by increasing accountability for hospitals, including by requiring them to report basic information about 340B medication claims.

Millions of Oregonians are battling chronic illnesses. They need their representatives in Salem to make healthcare more affordable — not just expand a program that hospitals can abuse for profit.

Greg Dardis is an assistant professor at Portland State University and program director for Kaleidoscope Fighting Lupus, which is based in Lake Oswego. He researches issues pertaining to autoimmunity and healthcare and has actively advocated for those living with lupus and lupus nephritis for the past nine years.