Medical debt is straining the pockets of Americans – even among the insured – The Hill

Story at a glance


  • High costs of medical care are putting Americans at risk for incurring medical debt.

  • New data show both insured and uninsured patients accrue medical debt, although high-income individuals tend to be spared.

  • Researchers found expanding Medicaid protected patients from this financial burden.

Many Americans are burdened with medical debt, and new research suggests even those with health insurance are not spared.

This common financial problem can worsen social determinants of health (SDOH) like housing and food insecurity, but expanding and improving health insurance coverage could help tackle both of these challenges.

That’s according to the results of a cross-sectional and cohort study published in JAMA Network Open.

Middle- or low-income Americans tend to bear the brunt of this financial hardship, data show, while the highest-income and most educated segments of society tend to be spared. However, individuals living in states that expanded Medicaid under the 2010 Affordable Care Act were less likely to have medical debt.

Those residing in states that refused to expand Medicaid were 40 percent more likely to have medical debt.

“Patients unable to pay medical bills from current income or savings sometimes use credit cards, loans, or mortgages to pay them, negotiate payment plans with health care professionals and hospitals, or fail to pay them,” the authors explained.

This debt can prevent patients from seeking any subsequent care and could impair both mental and physical health.


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To better understand the characteristics of adults who accrue debt, and the health- and insurance-related factors associated with debt, researchers assessed the Census Bureau’s Survey of Income and Program Participation.

Of the 51,872 adults surveyed about 2017, 40,784 regarding 2018 and 43,220 regarding 2019, nearly 11 percent of individuals and over 18 percent of households reported having medical debt.

Around 15 percent of uninsured individuals had medical debt compared with 10.5 percent of those with private insurance.

The median amount of overall debt was around $2,000, but in 2018, the mean amount was much higher at $21,687 overall, reflecting very large debts of a small percentage of debtors.

Mean overall debt across all respondents was $2,306 per US adult and approximately $4,671 per US household. Adults with medical debt reported approximately twice as much out-of-pocket medical spending as others, and tended to pay more towards premiums.

Several additional factors were associated with having debt, including any hospitalization, disability, having private high-deductible or Medicare Advantage plans, and having no coverage.

Patients who acquired medical debt between 2017 and 2019 were more likely to experience worsening SDOH.

Hospitals and clinics could help reduce this financial burden by upgrading financial assistance programs, while clinicians could also screen for adverse SDOH.

But “clinicians’ efforts cannot substitute for policy change,” the authors cautioned.

“Expanding Medicaid coverage nationwide may help reduce medical indebtedness. Eradicating medical debt would require implementing universal coverage that eliminates burdensome out-of-pocket costs.”

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