Medical Debt

Nearly one in five Southerners holds medical debt in default. In some Southern counties, as many as 44% of adults hold medical debt.

Share of individuals with medical debt in collections 

February 2022

Source: Urban Institute, Kaiser Family Foundation. Note: Universe is people with a credit bureau record. Debt in collections includes past-due credit lines that have been closed and charged-off on the creditor’s books as well as unpaid bills reported to the credit bureaus that the creditor is attempting to collect.

As of February 2022, credit bureau data revealed that 17% of Southerners had medical debt, compared to 11% for non-Southerners. In some Southern counties, up to 44% of individuals had medical debt in collections. In fact, 8 of the 10 states with the highest percentages of residents with medical debt were Southern: West Virginia (24%), South Carolina (22%), North Carolina (20%), Louisiana (18%), Arkansas (18%), Tennessee (18%), Georgia (17%), and Kentucky (17%).

When the Covid health emergency officially ends, many people will lose their public health insurance.¹ Residents of states that have not expanded Medicaid are particularly at risk. A recent analysis finds that residents of states that refused Medicaid expansion were 40% more likely to have medical debt than those in Medicaid-expanded states.² Medical debt forces residents to make tough decisions everyday, ultimately worsening both housing and food insecurity (Likelihood of Eviction or Foreclosure, Food Insecurity) .^3,4

The 7 Southern states that have not expanded Medicaid (AL, GA, FL, MS, NC, SC, and TN) can reduce medical debt levels by adopting Medicaid expansion. States that expanded Medicaid by 2014 saw a greater decline in medical debt among their residents than did states that failed to expand Medicaid.⁵

1. “Time to Get It Right: State Actions Now Can Preserve Medicaid Coverage When Public Health Emergency Ends”. Wagner, Erzouki. Center on Budget and Policy Priorities. May, 2022. https://www.cbpp.org/research/health/time-to-get-it-right-state-actions-now-can-preserve-medicaid-coverage-when-public 

2. “Prevalence and Risk Factors for Medical Debt and Subsequent Changes in Social Determinants of Health in the US”. Himmelstein, Dickman, McCormick, et al. JAMA Network. September, 2022. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2796358?resultClick=1

3. “Health Care Debt in the U.S.: The Broad Consequences Of Medical And Dental Bills”. Lopes, Kearney, Montero, Hamel, and Brodie. Kaiser Family Foundation. June, 2022. https://www.kff.org/report-section/kff-health-care-debt-survey-main-findings/

4. “Upended: How Medical Debt Changed Their Lives”. Levey, Pattani. Kaiser Health News. August, 2022. https://khn.org/news/article/diagnosis-debt-investigation-faces-of-medical-debt/

5. “Medical Debt in the US, 2009-2020”. Kluender, Mahoney, Wong, et al. JAMA Network. July, 2021. https://jamanetwork.com/journals/jama/fullarticle/2782187