Health and Wellness

Americans are drowning in medical debt. Many owe hospitals.


For millions of Americans, a trip to the doctor’s office or hospital can be a prescription for debt. But to whom do the estimated 100,000,000 people who are in medical debt owe them?

A new analysis suggests bills for hospital care make up most medical debt in the United States — and that low-income people and people of color are disproportionately affected by overdue medical debt. The Urban Institute’s June survey included data from 9,494 adults aged 18-64.

Respondents whose incomes were at or below the federal poverty level — $12,880 for an individual and $26,500 for a family of four — reported the most debt, with 26.4 percent overdue on a medical bill. This number dropped as incomes rose, with 15.4% of respondents being past due.

Black and Latino respondents had higher debt levels than their White counterparts. 25.9 percent of Black respondents, 19.1 percent of Hispanic/Latinx respondents and 12.8 percent of White respondents were past due.

Nearly three quarters (73%) of respondents owed hospitals at least some of their debts. 79% owed hospitals to those with the lowest income.

Owing a hospital also meant higher amounts of debt across the board — Only 28.5 percent owed hospitals less than $1,000. Only 67.4% of respondents owed non-hospital providers. The past-due balance of a hospital was 26.4 percent, or $5,000.

Survey respondents said that most of them had received calls from collection agents regarding past-due accounts. But a disproportionate number of people at or below the poverty line had faced debt-related lawsuits — 7.6 percent for those below the poverty line compared with 4.5 percent for wealthier respondents.

Many of the debt is due to hospital visits. According to the Kaiser Family Foundation, 72 percent of people with medical debt owe due to a temporary or short-term problem like an emergency department visit.

“We see that individuals with disabilities, and Black and Latino adults are disproportionately represented among adults carrying past-due medical debt,” Gina R. Hijjawi, senior program officer at the Robert Wood Johnson Foundation, which partnered with the Urban Institute on the research, said in a statement. “Consumers need standards in place that protect them from undue medical debt and help them obtain affordable care.”

Researchers claim that their findings demonstrate the ineffectiveness federal policies. They provide tax exemptions to nonprofit hospitals if they provide some financial assistance to people who are unable to pay for care. According to the American Hospital Association’s latest count, about 58 percent of U.S. hospitals are nonprofit institutions.

According to the Kaiser Family Foundation, charity care costs accounted for 1.4% or less of all operating expenses in 2020. Researchers suggest that Medicaid expansion may also be beneficial for patients.

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