Rural residents, especially in South, likelier to have medical debt; most Americans have had some in the last five years

More than 100 million Americans, representing 41% of adults in the nation, have medical debt, and they are more likely to live in rural areas, according to a new data analysis by the Urban Institute. The issue is a "critical challenge to Americans’ financial stability and well-being," says the report, since "people with medical debt are likely to forgo needed medical care, have difficulty meeting other basic needs, and face an increased risk of bankruptcy."

A Kaiser Health News and NPR investigation found that the problem of medical debt is "far more pervasive than previously reported," Noam Levey reports, "because much of the debt that patients accrue is hidden as credit-card balances, loans from family, or payment plans to hospitals and other medical providers." According to a recent Kaiser Family Foundation poll that informed the reporters' investigation, more than half of U.S. adults said they've gone into debt in the past five years because of medical or dental bills. About one in four with medical debt owe more than $5,000 and about one in five said they'll probably never pay it off.

Medical debt "is forcing families to cut spending on food and other essentials. Millions are being driven from their homes or into bankruptcy, the poll found," Levey reports. The issue is also deepening racial disparities, and is preventing many from saving for retirement, buying a home, affording college, and more. It's also making life harder for people already facing cancer and other chronic illnesses. 

The Urban Institute analysis found that people with medical debt in collections are more likely to live in the South; of the 100 counties with the highest levels of medical debt, 79 are in states that didn't expand Medicaid under the Patient Protection and Affordable Care Act. One-off medical emergencies aren't driving medical debt: The prevalence of chronic medical conditions among a county's residents was the strongest predictor of medical debt. Counties with higher shares of uninsured, low-income, younger, or Black or Hispanic residents also have higher rates of medical debt. 

The No Surprises Act, which took effect Jan. 1, aims to protect patients from out-of-network medical bills, but it has some limitations; ground ambulances, for example, can cost thousands of dollars but are not covered under the bill. About half of emergency ground ambulance rides result in out-of-network charges for people with private insurance, according to a recent KFF study.