People who live in the South owe doctors and hospitals more than three times as much as those who live in the Northeast. The finding comes from a study published this month in the Journal of the American Medical Association.
The authors of this study looked at unpaid medical debts in collections for the last decade and found that medical debt started shrinking after the implementation of Obamacare, as more people were covered by insurance. But the decline was relatively small in the South where most states haven’t expanded Medicaid to people who are working but can’t afford a health plan.
At this point, the average medical debt in the South is still $550 a person — more than three times the amount of debt in the Northeast. And low-income communities are hit hardest, according to their zip code-level research. In non-expansion states, the gap between medical debt racked up in low-income communities and high-income grew by more than $200 per person. The gap shrank by nearly as much in expansion states.
Separate from the JAMA study, the Sycamore Institute has been conducting state-level research on medical debt in Tennessee and found massive disparities depending on the community.
“Lake County, for example — 47% of people have medical debt in collections,” says policy director Mandy Pellegrin. “Then you have to zoom out and think about what that means. It doesn’t include medical bills that people tried to pay with a credit card or a payday loan. So, it’s just really surprising how common it is.”
By comparison, the state’s wealthiest county, Williamson, has just 10% of residents with medical debt in collections. Statewide, the rate is 24%. Nationally, 18% have medical debt on their credit report.
Even hospitals have blamed some of their aggressive collection tactics on the lack of Medicaid expansion. Franklin-based Community Health Systems has said the higher rate of uninsured people in the states where it has hospitals results in more people being unable to pay.