The Washington PostDemocracy Dies in Darkness

Study paints stark picture of how some get mired in collections because they can’t pay medical bills

More medical debt was in collections than any other kind of debt, according to the study published in JAMA.
More medical debt was in collections than any other kind of debt, according to the study published in JAMA. (David Goldman/AP)

Medical bills can be stressful. Some are surprises. Others are intimidatingly large. And many Americans just cannot pay on time.

Now, a study in JAMA sheds light on just how much medical debt has been sent for collection in the United States.

Researchers used data from a randomly selected group representing 10 percent of all people with TransUnion credit reports — about 40 million individuals — between 2009 and 2020. Though the average amount of medical debt fell to $429 by 2020, 17.8 percent of people had medical bills that were past due.

There were stark regional differences in the number of people whose debt had been assigned for collection. In the Northeast, 10.8 percent of people had overdue medical bills, in contrast to 17.8 percent in the Midwest and 23.8 percent in the South. More medical debt was in collections than any other kind of debt.

The people living in areas with the lowest income levels owed the most. Those groups also experienced the greatest decline in medical debt if their states expanded Medicaid between 2009 and 2020.

Overall, those living in states that didn’t expand Medicaid had much lower drops in debt during the period than those whose states did expand the program.

The researchers estimate that there is about $140 billion in medical debt in the United States. Since the numbers reflect only care provided before the pandemic, the real figure may be much higher.

Those findings are concerning, write researchers from the University of Michigan at Ann Arbor in an editorial accompanying the study. They point out correlations between medical debt and lower usage of health-care resources, higher morbidity and poor mental health.

Unlike secured debt such as mortgages, they write, medical debt can force debtors into “a spiral of economic disadvantage” that can last generations.

The authors argue that medical debt, like poverty, housing status or race, should also be considered a social determinant of health.

The debt and its burdens, they write, are a reminder of how those factors “reinforce and perpetuate inequities in health and inequities in economic promise and prosperity.”

Loading...