Medical debt is leaving many people in the U.S. unable to afford groceries or pay their mortgages — even among the insured, research published Friday has found.
Researchers say the findings, published in the journal JAMA Network Open, provide additional evidence that medical debt is a driver of both health and financial inequities in America, and highlights the need for policy reform.
"The kinds of things we saw in our study are virtually nonexistent in most other wealthy nations," said the study’s lead author David Himmelstein, a professor at the CUNY School of Public Health at Hunter College in New York City. The U.S. needs a "real big change."
People with medical debt are "much more likely to be evicted, much more likely to be unable to pay for their utilities and much more likely to be food insecure," Himmelstein said.
The study analyzed three years of data from the Surveys of Income and Program Participation, a survey conducted by the U.S. Census Bureau that is meant to provide information on the incomes of American households.
The researchers found that while the uninsured ran the highest risk of collecting medical debt, it was also common among people with private insurance — particularly those with high deductible plans or those on Medicare Advantage, a type of private insurance plan that provides Medicare benefits.
"Even if you have what most of us think of as good insurance, you could well be liable for huge bills," Himmelstein said.
Among 136,000 adults surveyed from 2017 through 2019, about 10.8% carried medical debt, including 10.5% of adults with private insurance, according to the report.
Women (about 1 in 8) were more likely than men (about 1 in 11) to carry medical debt, the report found.
Nearly 1 in 5 households carry medical debt, according to the study. People considered middle class or low income bore the brunt of the burden. On average, an American household owes about $4,600 in medical debts.
What’s more, the researchers found that the debt was associated with a higher risk of being unable to pay one’s rent or mortgage, being evicted and being food insecure, even among those with private insurance.
The research has limitations: The U.S. Census Bureau survey data is self-reported and subject to bias. People with Medicare Advantage plans also appear to be underreported in the data.
Still, Lunna Lopes, a senior survey analyst for the Kaiser Family Foundation, said the study’s findings appear to be in line with other studies linking medical debt to poorer health and financial outcomes.
She published a report in June that found that uninsured adults, women, Black and Hispanic people, parents and those with lower incomes are especially likely to say they have a health care-related debt.
Most people are often on the hook for medical debt because of a rare life event, she said, like a hospital stay due to a car accident. They often have to make sacrifices, including getting a second job or cutting everyday expenses.
"Food was one that really came up quite frequently when we asked people about being selective in how much and what they buy," she said.
Himmelstein said there’s not much people can do from an individual standpoint to address their medical debt.
People could "ask the price before they get the care, but in many cases, you still have to get the care even if you can’t really afford it," he said.
Experts agree that there's no simple fix for the medical debt crisis in the U.S.
"Medical debt is complex and requires myriad health and economic policy approaches," said Allison Sesso, the president of RIP Medical Debt, a nonprofit group that uses donations to pay medical bills.
Sesso advocates for federal policies that would address the high cost of premiums as well as high deductibles and copays that often leave people in debt.
Arthur Caplan, the head of the Division of Medical Ethics at NYU Langone Medical Center, recommended that states form a "catastrophic health fund" that would help bail out families with massive amounts of medical debt.
To those outside the U.S., the answer seems straightforward.
The most "obvious" policy that the U.S. could implement is universal health coverage with no copayments, similar to what is seen in the majority of European countries, said Robert Yates, a political health economist and executive director of the Centre For Universal Health at Chatham House in the United Kingdom.