More Americans are facing an increased risk of food insecurity, eviction or foreclosure, and poor health outcomes amid rising medical debt, according to a study published Friday in JAMA Network Open.

Study details and key findings

For the study, researchers analyzed data from the U.S. Census Bureau's Surveys of Income and Program Participation, which provides data on American households' incomes.

In 2017, 51,872 adults were surveyed, 40,784 were surveyed in 2018, and 43,220 were surveyed in 2019. Overall, 51.6% of respondents were women, 16.8% were Hispanic, 6% were non-Hispanic Asian, 11.9% were non-Hispanic Black, and 62.6% were non-Hispanic white.

In total, 10.8% of Americans—roughly 18.1% of households—carried medical debt, with the average American household owing around $4,600 in medical debts.

In addition, the study found that around 1 in 8 women carried medical debt, while just 1 in 11 men carried medical debt.

While uninsured Americans faced the highest risk of incurring medical debt, 10.5% of individuals with private insurance also collected medical debt. In particular, Americans insured through high deductible health plans or Medicare Advantage were at risk of collecting medical debt.

"Even if you have what most of us think of as good insurance, you could well be liable for huge bills," said the study's lead author David Himmelstein, a professor at the CUNY School of Public Health at Hunter College.

According to Himmelstein, individuals 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."

During the three-year study period, declines in health and insurance coverage were associated with acquiring medical debt, which was then associated with a 1.7- to 3.1-fold increase in the risk of worse housing and food security.

Commentary

According to Lunna Lopes, a senior survey analyst for the Kaiser Family Foundation, the study's findings appear to echo other studies that have linked medical debt to worse health and financial outcomes.

Notably, the Biden administration in April announced an initiative to decrease the medical debt burden facing Americans. However, Wes Yin, an economics professor at the University of California, Los Angeles, noted that the administration's plan does not create national health insurance, expand Medicaid, or change the way coverage is determined.

"Private insurance is a defective product. You pay for it and then when you get sick, there's co-payments, there's deductibles, there's out-of-network fees, there's things that aren't covered at all," said Steffie Woolhandler, a physician and public health professor at Hunter College, who co-authored the new study.

"The price of health care keeps on rising at dramatic rates and that has to do with provider consolidation and mergers and acquisition. That really hasn't been shown to benefit health outcomes," Yin said.

"Shining the light on hospitals to solve this deeper issue of household financial vulnerability is like patching the holes on a roof. The root causes here are much deeper than that," he added. (Moreno, Axios, 9/19; Lovelace, NBC News, 9/16; Himmelstein et al., JAMA Network Open, 9/16)