The Changing Medical Debt Landscape in the United States
July 10, 2024
Millions of Americans have medical debt in collections.
Medical debt can intensify
financial challenges, affect
health care access, and potentially
worsen health
outcomes. Starting in 2022, the three nationwide credit reporting companies made significant
changes to medical debt reporting. Paid medical collections were removed from credit reports,
debt in collections would no longer be used in calculating Vantage credit scores, the grace
period for medical debt was extended to one year, and collections under $500 were excluded
from consumer credit reports.
These changes helped
cut the number of Americans with medical debt in collections in half and improve
credit scores. But
15 million Americans still have medical debt in collections, and most debt balances remain on credit reports. The Biden-Harris Administration has
called on states and localities to reduce the burden of medical debt and has
announced new actions
to remove medical debt from credit reports altogether.
2023 Share with Medical Debt in Collections
0%
10.1%
Explore Medical Debt in Collections by Geography over Time
Notes:
July 2022: Stopped reporting collections less than a year old. April 2023: Stopped reporting
collections less than $500. Data are collected annually in August.
Nationwide
Share with medical debt in collections
n/a
Median medical debt in collections
n/a
Hospital market concentration (HHI)
n/a
Hospital closures and mergers
n/a
Average household income
n/a
Uninsured
n/a
Disabled adults
n/a
Share with medical debt
Change charts by selecting and deselecting toggles below.
Potential Debt Drivers
Hospital Market Concentration
Hospital Closures and Mergers
How Local Policies Impact Medical Debt
0%
with medical debt in 2023
Colorado
In August 2023, Colorado enacted a consumer protection law that excluded all medical debt information from credit reports, dropping the share of people with debt in collections to zero.
About the Data
Below we list definitions of the indicators included in this tool.
Share with medical debt in collections is the share of adults with a credit bureau record who have medical debt in collections in their records. Median amount of medical debt is the median amount of medical debt in collections among those with medical debt in collections in their records. White communities are zip code tabulation areas where at least 50 percent of the population is white. Communities of color are zip code tabulation areas where at least 50 percent of the population is people of color. Hospital market concentration uses the Herfindahl–Hirschman index (HHI), based on adjusted admissions of nonfederal general medical/surgical hospitals within a health system. Measured on a 0 to 10,000 scale, where 0 indicates a perfectly competitive market while 10,000 indicates a monopoly. Hospital closures and mergers refer to the number of short-term and critical access hospitals that have closed or merged. The uninsured is defined as the share of the total population that does not have health insurance. Disabled adults are the share of the nonelderly adult population (ages 18 to 64) that reports having any one of six disability types. Average household income is the average household income measured in 2023 dollars. Our medical debt estimates are derived from the Urban Institute Credit Bureau Panel. This dashboard is based on annual data collected from August 2011 through August 2023, which consists of a 2 percent random sample of consumers in each year from 2011 through 2019 (i.e., more than 5 million consumers in each year) and a 4 percent random sample from 2020 through 2023 (i.e., more than 10 million consumers). The consumer panel is refreshed at each data pull to keep the sample representative at the national level. Hospital market concentration estimates are derived from the American Hospital Association Annual Survey Database. Closures and mergers data are derived from the Provider of Services File provided by the Centers for Medicare & Medicaid Services.The estimates of uninsured, disabled adults, average household income, and racial composition are from the US Census Bureau’s American Community Survey (ACS) summary tables. We use ACS one-year estimates for state—and national-level statistics, but we use the ACS five-year estimates for counties and zip code tabulation area-level information.
Additional Resources
Debt in America: An Interactive Map
Which County Characteristics Predict Medical Debt? Medical Debt Was Erased from Credit Records for Most Consumers, Potentially Improving Many Americans' Lives How to Address Medical Debt Burdens in Immigrant Communities The Impact of Hospital Closures on Medical Debt in Collections: Analysis Using Consumer Credit Bureau Data (PDF) Which Hospital Financial Characteristics Are Associated with Medical Debt? How Many Adults Have Past-Due Medical Bills on Credit Cards? Medical Debt in New York State and Its Unequal Burden across Communities Medical Debt in New York State: Estimates for Large Cities and Towns, State Legislative Districts, Congressional Districts, and Other Geographic Areas Most Adults with Past-Due Medical Debt Owe Money to Hospitals Medical Debt Fell during the Pandemic. How Can the Decline Be Sustained?Project credits
This data tool was supported by Arnold Ventures. We are grateful to them and to all our funders, who make it possible for Urban to advance its mission. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders. Funders do not determine research findings or the insights and recommendations of our experts. More information on our funding principles is available here. Read our terms of service here.
- Research Fredric Blavin, Breno Braga, Noah Johnson, and Apueela Wekulom
- Design Brittney Spinner
- Data visualization and development Rachel Marconi
- Writing Wesley Jenkins
View the project on Github.