Americans are drowning in debt. Here’s where they have it the worst.

Share of population with any debt in collections

Nearly half the residents of Louisiana have debt that has gone into collections, making that state America's capital of past-due debt, according to a new national map of indebtedness released by the Urban Institute this week.

The debt numbers are derived from anonymized consumer-level records shared with Urban's researchers by a major credit bureau. Unpaid bills that creditors have either closed or are trying to collect are considered “in collections.” For example, unpaid credit card debt typically goes into collections after 180 days, according to the Urban Institute.

Nationwide the data shows that 33 percent of Americans hold debt that is currently in collection. The median amount of debt in collections is $1,450.

But those figures show striking regional variation. In Louisiana, 46 percent of adults have debt in collection, the highest share in the nation. Rates of past-due debt are generally highest in southern and western states, and lowest in the upper Midwest. In Minnesota, for instance, only 17 percent of adults have debt in collections, the lowest rate in the nation.

At the county level, 68 percent of the residents of tiny Allendale County, S.C., (pop. 9,433) have debt currently in collections, the highest county rate in the nation. Cook County Minnesota can boast the nation's lowest prevalence of past-due debt, at just 6 percent.

Previous research by the Urban Institute has identified health insurance coverage as a chief driver of indebtedness: People who have health insurance tend to be less likely to fall behind on their bills.

At the neighborhood level, this relationship shows up vividly in these side-by-side maps of debt in collections (L) and insurance coverage (R) in Minnesota.

Urban's researchers looked at this relationship nationwide and found that “a 1 percentage-point increase in the share of population without health insurance is associated with a 0.16 percentage-point increase in the likelihood of having debt in collections and a 1.3 percent increase (equal to $20) in the average amount of debt in collections.”

Nationwide, nearly 1 in 5 households has medical debt in collections with a median amount of $681. But again, that particular number varies broadly: The prevalence of past-due medical debt is 10 times higher in Louisiana (30 percent) than it is Minnesota (3 percent).

In many counties in Texas and Louisiana, over 60 percent of the population carries past-due medical debt.

Share with medical debt in collections

The numbers underscore the connection between physical and financial health. Among the more astonishing facts about life in America today is that we spend more money on health care than any other developed nation, but we also die younger than people in those nations.

Urban's numbers show that those sky-high health-care costs are saddling many Americans — nearly 20 percent of them — with debt they cannot pay.