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

The story at a glance


  • The high costs of medical care put Americans at risk of incurring medical debt.

  • New data shows that both insured and uninsured patients are racking up medical debt, although high-income people tend to be spared.

  • The researchers found that expanding Medicaid protected patients from this financial burden.

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

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

This is according to the results of a cross-sectional and cohort study published in JAMA Network Open.

Middle- and lower-income Americans tend to bear the brunt of these financial hardships, the data shows, while the wealthier and more educated segments of society tend to be spared. However, people living in states that expanded Medicaid under the Affordable Care Act of 2010 were less likely to have medical debt.

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

“Patients unable to pay their medical bills from their current income or savings sometimes use credit cards, loans or mortgages to pay them, negotiate payment plans with healthcare professionals and hospitals, or do not don’t pay them,” the authors explained.

This debt can prevent patients from seeking further care and could harm mental and physical health.


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To better understand the characteristics of adults who accumulate debt and the health and insurance-related factors associated with debt, researchers evaluated the Census Bureau’s survey of income and program participation.

Of the 51,872 adults surveyed around 2017, 40,784 around 2018, and 43,220 around 2019, nearly 11% of individuals and more than 18% of households reported having medical debt.

About 15% of uninsured people had medical debt, compared to 10.5% of those with private insurance.

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

The average aggregate debt for all respondents was $2,306 per American adult and about $4,671 per American household. Adults with medical debt reported about twice as many medical expenses as others and tended to pay more for premiums.

Several additional factors were associated with indebtedness, including any hospitalization, disability, having high-deductible private plans or Medicare Advantage, and not having coverage.

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

Hospitals and clinics could help reduce this financial burden by improving financial aid programs, while clinicians could also screen for unwanted SDOHs.

But “clinician efforts cannot substitute for policy change,” the authors warned.

“Expanding Medicaid coverage nationwide can help reduce medical debt. Eradicating medical debt would require establishing universal coverage that eliminates onerous out-of-pocket costs.