Covering medical debt? You’ll need these resources

One of the lesser known aspects of medical debt collection is its impact on low-income, uninsured and people of color. Also less known is how common medical debt collection is among consumers with chronic conditions.

Healthcare journalists provide a wealth of data on these and other issues related to medical debt. Urban Research Institute It has been published since spring 2022. In this series, researchers document the biggest factors that lead to rising medical debt and the multiple reasons consumers end up in medical debt.

The Urban Institute report is important because medical debt, rather than combating illness, has become a feature of the U.S. health care system. KFF Health News Investigation “More than 100 million Americans — a staggering 41% of adults — have medical bills they can’t afford,” an NPR/CBS News investigation revealed.

The Urban Institute, a nonprofit research institute in Washington, D.C., published the latest report in its series,The changing US medical debt landscapeFor journalists, this report may be the most useful starting point for covering America’s medical debt crisis.

“This is not a report. By itself” Researcher Fredric Brabin “This is like a user-friendly data tool that any county or state can use to look at medical debt,” Brabin said of the July 10 report, who is a senior fellow at the institute’s Center for Health Policy.

For the 100 million Americans with medical debt, any financial challenge is more pressing than it would be otherwise, potentially affecting their access to care and contributing to poorer health outcomes, Bravin added in an email. Other researchers have shown links between medical debt and poorer health and mortality. In March, JAMA Network Open published article As we reported in May, 2,943 U.S. counties have shown that a higher percentage of the population with medical debt is associated with poorer health, more premature deaths and higher mortality rates.

State and county health care debt trends

Although the Urban Institute researchers did not study the relationship between medical debt and mortality risk, the study is a detailed and nuanced collection of data that health reporters can use to assess trends in medical debt in specific regions, states and counties, Bravin said. Using data from a region allows reporters to compare those numbers with data from other counties or states, he added.

Reporters can also use the data to identify factors driving medical debt, such as changes in a population’s median income, the percentage of the population that is uninsured or disabled, or the percentage of people of color in a particular area, he explained.

The latest report also helps identify factors in each community that lead to increased health care debt, such as hospital concentration, recent hospital closures or mergers with other hospitals. Other factors include median household income and the number of uninsured and disabled people within a state, county or zip code.

How hospital treatment can increase your debt

For example, in March 2023, the institute released a report stating that 72.9% of U.S. adults with past-due medical bills owe at least some of that money to hospitals. The report stated:Many people who are behind on their medical bills owe money to hospitals.The researchers noted that of adults with medical debt, 27.9% owed money only to hospitals, and 45.1% owed money to both hospitals and other health care providers.

In the report, researchers also uncovered how journalists report on whether their local hospitals offer charity care to patients in need. Just over one-third (35.7%) of adults who are behind on their hospital bills say they have a payment plan, and only about one-fifth (21.7%) of adults receive discounted care, the report found.

In addition, adults who earn less than 250% of the annual income Federal Poverty Level The report found that low-income earners ($31,200 for a family of four) were just as likely as higher-income earners to have had debt collectors inquire about their hospital bills or to have received discounts on medical care.

Here’s a story worth pursuing: The concentration of past-due medical debt among low-income households, most of which they owe to hospitals, suggests that hospitals could provide more charity care to consumers in need, the researchers wrote.

Colorado is a great example

In a recent article on medical debt collection in Colorado, Ray Ellen Bishell and Lindsay Toomer Using data from the Urban Institute, the paper reported on how low-income consumers are struggling to pay their hospital bills. In April, KFF Health News and several Colorado news sites published a report titled “Medical debt affects many parts of the US, but immigrants in Colorado are hit especially hard.We reported on their work here: “Colorado journalists unleash the power of collaboration in exposing UCHealth debt collection.”

“The state’s overall medical debt burden is lower than other states, but racial and ethnic disparities are large,” Beshell and Toomer write. Data from the Urban Institute found that Denver’s low-income, predominantly Hispanic Westwood neighborhood (ZIP code 80219) has one of the highest medical debt rates in the state.

County-level debt data

Using credit bureau data on more than 10 million consumers, Urban Institute researchers showed where medical debt is more likely to be collected and where county-level socioeconomic and health characteristics predict medical debt. “We find that 79 of the 100 counties with the highest rates of collected medical debt are in states that did not expand Medicaid under the Affordable Care Act,” the researchers wrote in the report.Which county characteristics predict medical debt?“

Those counties were primarily concentrated in Georgia, North Carolina and Texas, the researchers added. None of those states had expanded Medicaid at the time the report was released in June 2022. Since then, only North Carolina has expanded it, effective December 1, 2023. Two months later, more than 346,400 residents have enrolled, the researchers said. Reporting by Jamie Baxley From North Carolina Health News.

Another story worth covering is the impact of changes made by the three major credit reporting agencies, which two years ago began removing outstanding medical bills from consumers’ credit reports, and in 2023 will no longer include outstanding balances under $500. CNBC reported in July.In June, the federal government Proposed by the Consumer Financial Protection Bureau Ban medical expenses from appearing on credit reports.

Recording changes over time

One strength of the Urban Institute report is that it shows the impact of changes the credit bureaus have made over time. Removing paid debts from credit reports cut the number of Americans facing medical debt in half, Bravin wrote in an email. Still, 15 million Americans face medical debt in collections, and most of the outstanding debt remains on credit reports, he added.

The changes in medical debt reporting are concentrated in the South, he added, with the states that saw the largest declines in the percentage of consumers involved in medical debt collection from 2021 to 2023 being West Virginia (down from 25.8% to 6.7%), South Carolina (24.4% to 9.1%), Oklahoma (23.7% to 10.1%), Louisiana (21.3% to 8.1%) and Mississippi (18.5% to 6.1%).

Blevins added that the states with the lowest medical debt collection rates in 2023 were Colorado (0%), Minnesota (0.7%), Hawaii (1.2%), Vermont (1.2%) and Washington (1.4%). As of August 2023, Colorado prohibits credit reporting bureaus from including medical debt on consumers’ credit reports.

resource

• Medical debt has declined during the pandemic. How can we make this decline sustainable?May 11, 2022.
• Which county characteristics predict medical debt?June 15, 2022.
• What hospital financial characteristics are associated with medical debt?September 27, 2022.
• Medical debt in New York State: Significant variations across regions and communitiesMarch 1, 2023.
• Many people who are behind on their medical bills owe money to hospitals.March 13, 2023.
• New York State’s Health Care Debt and Regional Unequal BurdensJuly 12, 2023.
• America’s Debt: Interactive MapUpdated February 2022 and October 10, 2023.
• Most consumers’ medical debt could be wiped from their credit records, potentially improving the lives of many Americans.November 2, 2023.
• How to address the health care costs for immigrant communitiesApril 3, 2024.
• The impact of hospital closures on medical debt collection: An analysis using data from consumer credit reporting agenciesSeptember 2023.
• How many adults are behind on medical bills on their credit cards?September 5, 2023.
• The changing US medical debt landscapeJuly 10, 2024.