Americans owe $140 billion in medical debt that has been sold to collections agencies, according to research published in the Journal of the American Medical Association (JAMA). This figure is nearly double the $81 billion previously estimated by a 2016 study published in Health Affairs, and does not include debts owed to health care providers that have not yet gone to collections, those tied up in lawsuits against patients, or balances on long-term payment plans.
Between 2009 and 2020, medical bills became the largest source of debt owed to collections agencies in the U.S. Additionally, the study found, U.S. medical debt has become increasingly concentrated in the 12 states that opted not to expand Medicaid under the Affordable Care Act. In 2020, Americans living in states that did not expand Medicaid owed an average of $375 more than residents of states that did not participate in Medicaid expansion. This disparity has increased 30% since 2013, the year before the Medicaid expansion rule was passed.
The new JAMA paper does not include data on debt incurred during the coronavirus pandemic, which is not yet available.