July 26, 2021

American Medical Debt Twice as High as Previously Thought, Concentrated in States Without Medicaid Expansion

New research published Tuesday in The Journal of the American Medical Association finds that collection agencies held $140 billion in unpaid medical bills last year – a number that has grown rapidly in just a few years. An earlier study examining debts in 2016 estimated that Americans had $81 billion in medical debt.

The new paper also found that almost 18% of all Americans had medical debt in collections, making medical debt the largest source of American debt owed to collection agencies. The $140 billion figure is not all-inclusive, since it only includes debt sold to collection agencies. The paper used data from before the COVID-19 pandemic.

Medical debt was primarily held in states that have yet to expand Medicaid under the Affordable Care Act. In fact, the amount of medical debt held in states that did not accept federal funding to expand Medicaid is now around 20% more than in states that did expand it. In 2020, Americans living in states that did not expand Medicaid owed an average of $375 more than those in states that participated in the expansion.

Medical debts are different than other debts: Failing to pay your utility bills could result in shut-offs, and failing to pay your auto loan could cause your car to be repossessed. Medical debts, in contrast, tend mostly to harm people’s credit reports and peace of mind.

“These numbers are astounding. No person should choose between financial ruin and their health,” said Joseph Peters, Jr., Secretary-Treasurer of the Alliance. “This paper makes it clear that Medicaid expansion can really help people, and we need the twelve remaining holdout states to end their opposition to it.”