A new study published in the Journal of the American Medical Association chronicles the prevalence and risk factors that contribute to medical debt in the United States. The authors, who surveyed a representative population between 2017 and 2019, found medical debt among 18 percent of householders; a higher risk of acquiring medical debt fell to those without insurance as well as those with high deductible private insurance or Medicare Advantage. The survey also found that medical debt worsened social determinants of health––causing more food insecurity, inability to pay for housing and utilities, and eviction or foreclosure. 

DAVID HIMMELSTEIN and STEFFIE WOOLHANDLER; himmelhandler@comcast.net 
    Himmelstein and Woolhandler are professors in the CUNY School of Public Health at Hunter College.

Himmelstein and Woolhandler comment on Health Justice Monitor: “A raft of previous studies have established that each year millions of Americans suffer catastrophic financial harm from medical debt, and it’s no surprise that people needing hospitalization, the uninsured, and those with disabilities are at highest risk.” But two findings from the study stand out, the authors say. First, “individuals with Medicare Advantage coverage are, like the uninsured, at high risk of running up medical debts.” Second, “incurring medical debts causes housing and food insecurity––key social determinants of health.” 

Himmelstein and Woolhandler argue that the “health care system itself is a big contributor to housing problems and food insecurity. As we note in this article, ‘Unaffordable medical bills… contribute to a downward spiral of ill-health and financial precarity.’”