医院和健康医疗保险是美国最大的产业The 10 Biggest Industries by Revenue in the UShttps://www.ibisworld.com/united-states/industry-trends/biggest-industries-by-revenue/ Industry Revenue for 2024 1. Hospitals in the US $1.426.9B 2. Health & Medical Insurance in the US $1.397.9B 3. Commercial Banking in the US $1.389.9B 4. Drug, Cosmetic & Toiletry Wholesaling $1.331.6B 5. Pharmaceuticals Wholesaling in the US $1.296.9B 6. New Car Dealers in the US $1.217.1B 7. Life Insurance & Annuities in the US $1.084.5B 8. Public Schools in the US $982.5B 9. Property, Casualty and Direct Insurance $975.7B 10. Retirement & Pension Plans in the US $965.3B
April 12, 2024, Drug shortages hit record high, pharmacists warn There are at least 323 active shortages, according to a pharmacy trade group. https://abcnews.go.com/Health/drug-shortages-hit-record-high-hundreds-short-supply/story?id=109160863#:~:text= 医疗债务颠覆了他们的生活。这就是他们所遭受的损失 Medical debt upended their lives. Here's what it took from them
https://www.npr.org/sections/health-shots/2022/06/16/1104969627/medical-debt-upended-their-lives-heres-what-it-took-from-them
一些人失去了家园。一些人掏空了退休账户。一些人挣扎着养家糊口。医疗债务现在影响了美国 1 亿多人，因为美国医疗保健系统大规模地将患者推入债务。各行各业、全国各地的人们都背负着医疗债务。美国有 1 亿人因病和挣扎支付医疗费用而背负医疗债务, 以下是他们的故事——他们如何负债累累，他们为此放弃了什么，以及他们如何承受这种负担。
Some lost their homes. Some emptied their retirement accounts. Some struggled to feed and clothe their families. Medical debt now touches more than 100 million people in America, as the U.S. health care system pushes patients into debt on a mass scale. People from all walks of life and all corners of the country are living with health care debt. 美国有 1 亿人因病和支付不起医疗费而背负医疗债务
Sick and struggling to pay, 100 million people in the U.S. live with medical debt By Noam Levey (Kaiser Health News) June 16, 2022 https://www.opb.org/article/2022/06/16/sick-and-struggling-to-pay-100-million-people-in-the-u-s-live-with-medical-debt/ 纽约州宾厄姆顿的伊丽莎白和尼克·伍德拉夫被尼克感染的腿被截肢的医院起诉索赔近 10,000 美元。 Heather Ainsworth 为 KHN 和 NPR 撰稿 伊丽莎白·伍德拉夫耗尽了退休账户，并从事了三份工作，此前她和丈夫被纽约一家医院起诉索赔近 10,000 美元，尼克感染的腿被截肢。 亚利桑那州一位年轻的父亲阿丽亚娜·巴克是一名健康保险销售员，他无法预约医生治疗危险的肠道感染，因为医生说他还有未付的账单。 艾莉森·沃德和她的丈夫用信用卡刷卡，向亲戚借钱，并推迟偿还学生贷款，因为他们的双胞胎早产，欠下了 8 万美元的债务。沃德是一名执业护士，她加班加点，日夜工作。 “我想成为一名母亲，”她说。“但我们必须有钱。” KHN 和 NPR 的一项调查显示，他们三人是美国 1 亿多人（包括 41% 的成年人）中的一员，他们受到医疗保健系统的困扰，该系统正在大规模地将患者推入债务之中。 调查揭示了一个问题，尽管白宫和国会对此进行了新的关注，但这个问题比之前报道的要普遍得多。这是因为患者所欠债务中的大部分都隐藏在信用卡余额、家庭贷款或医院和其他医疗机构的付款计划中。 为了计算这些债务的真实程度和负担，KHN-NPR 调查借鉴了凯撒家庭基金会 (KFF) 为该项目进行的一项全国性民意调查。这项民意调查的目的不仅在于捕捉患者无法负担的账单，还在于捕捉用于支付医疗费用的其他借款。城市研究所和其他研究合作伙伴对信用局、医院账单和信用卡数据的新分析也为该项目提供了信息。KHN 和 NPR 记者对患者、医生、医疗行业领袖、消费者权益倡导者和研究人员进行了数百次采访。
情况不容乐观。
KFF 民意调查发现，在过去五年中，超过一半的美国成年人报告称他们因医疗或牙科账单而负债累累。
四分之一的背负医疗债务的成年人欠款超过 5,000 美元。大约五分之一的负债者表示，他们预计永远无法还清债务。
“债务不再只是我们系统中的一个缺陷。它是主要产品之一，”Rishi Manchanda 博士说，他为加州的低收入患者服务了十多年，并担任非营利性 RIP 医疗债务委员会的董事。“我们的医疗保健系统几乎完美地设计为产生债务。”
这种负担迫使家庭削减食品和其他必需品的支出。调查发现，数百万人被迫离开家园或破产。
医疗债务给癌症和其他慢性病患者带来了额外的困难。根据城市研究所的分析，美国发病率最高的县的债务水平可能是最健康县的三到四倍。
债务也加剧了种族差异。
而且，它阻碍了美国人为退休储蓄、为子女教育投资，或为安全的未来奠定传统基础，例如借钱上大学或买房。KFF 民意调查发现，30 岁以下成年人的医疗债务几乎是 65 岁及以上成年人的两倍。
芝加哥的 Allyson 和 Marcus Ward 在他们的双胞胎 Milo 和 Theo 早产后背负了约 80,000 美元的医疗债务，因此搬到了美国另一边，以便更靠近家人。
芝加哥的 Allyson 和 Marcus Ward 在他们的双胞胎 Milo 和 Theo 早产后背负了约 80,000 美元的医疗债务，因此搬到了美国另一边，以便更靠近家人。
Taylor Glascock 为 KHN 和 NPR 撰稿
也许最反常的是，医疗债务阻碍了患者接受治疗。
调查显示，大约七分之一的负债者表示，由于未付账单，他们被拒绝进入医院、看医生或其他医疗服务机构。更大比例的人——约三分之二——因为费用问题推迟了他们或家人需要的治疗。
“这太野蛮了，”佐治亚州肿瘤学家米里亚姆·阿特金斯博士说，她和许多医生一样，都曾遇到过患者因害怕债务而放弃治疗的情况。
尽管具有里程碑意义的 2010 年《平价医疗法案》出台，但患者的债务仍在不断增加。
该法案将保险覆盖范围扩大到数千万美国人。然而，它也为医疗行业带来了多年的强劲利润，该行业在过去十年中稳步提高价格。
据《纽约时报》报道，2019 年是医院有史以来利润最高的一年，总利润率为 7.6%。
提交给联邦医疗保险支付咨询委员会。即使在疫情期间，许多医院也蓬勃发展。
但对许多美国人来说，该法律未能兑现其提供更实惠医疗服务的承诺。相反，他们面临着数千美元的账单，因为医疗保险公司通过提高免赔额将成本转嫁给患者。
现在，一个利润丰厚的行业正在利用患者无力支付的特点。医院和其他医疗服务提供者正在将数百万美元投入信用卡和其他贷款。根据研究公司 IBISWorld 的数据，这些贷款让患者背负高额利息，同时为贷方带来高达 29% 的利润。
患者债务还维持着一项暗中催收业务，由医院（包括公立大学系统和获得税收减免以服务社区的非营利组织）提供资金，这些医院将债务私下出售给催收公司，而催收公司又会追讨患者。
“人们一天到晚都在受到骚扰。许多人来找我们，却不知道债务从何而来，”克利夫兰法律援助协会的监督律师 Eric Zell 说。 “这似乎是一种流行病。”
欠医院、信用卡和亲戚的债务
美国的债务危机是由一个简单的现实驱动的：根据 KFF 民意调查，一半的美国成年人没有现金来支付意外的 500 美元医疗费用。
因此，许多人根本就不付钱。大量未付账单使医疗债务成为消费者信用记录中最常见的债务形式。
根据消费者金融保护局的数据，截至去年，收款记录中的债务中有 58% 是医疗账单。这几乎是电信账单债务的四倍，电信账单是信用记录中第二常见的债务形式。
但 KHN-NPR 调查显示，信用报告中的医疗债务仅占美国人欠医疗费用的一小部分。
KFF 民意调查发现，约有 5000 万成年人（约占五分之一）通过分期付款计划向医院或其他医疗服务提供者支付自己或家人的医疗费用。除非患者停止付款，否则此类债务安排不会出现在信用报告中。 十分之一的人欠朋友或家人的钱，这些朋友或家人支付了他们的医疗或牙科费用，这是另一种通常不衡量的借贷形式。
随着患者支付账单并累积余额，更多的债务最终以信用卡的形式出现，在他们欠下的医疗费用之上又累积了高额利息。大约六分之一的成年人正在偿还他们用卡支付的医疗或牙科费用。
美国人总共有多少医疗债务很难知道，因为没有记录太多。但 KFF 早些时候对联邦数据的分析估计，2019 年集体医疗债务总额至少为 1950 亿美元，超过了希腊的经济规模。
根据摩根大通研究所对信用卡记录的分析，信用卡余额可能相当可观，但这些余额并未被记录为医疗债务。该金融研究小组发现，在发生重大医疗费用后，典型持卡人的月度余额会上涨 34%。
随着人们偿还账单，月度余额随后下降。但一年来，它们仍比医疗费用发生前高出约 10%。没有重大医疗费用的可比持卡人的余额保持相对平稳。
目前尚不清楚高额余额中有多少最终变成了债务，因为该研究所的数据没有区分每月还清余额的持卡人和不还清余额的持卡人。但全国约有一半的持卡人卡上有余额，这通常会增加利息和费用。
承担大大小小的债务负担
对于许多美国人来说，医疗或牙科护理的债务可能相对较低。KFF 民意调查发现，约三分之一的人欠款不到 1,000 美元。
即使是小额债务也会造成损失。
31 岁的埃迪·亚当斯是德克萨斯州的一名医学生，在遭到性侵犯后，她接受了一次体检，但被债务催收员追债多年。
亚当斯刚从大学毕业，住在芝加哥。
警方一直没有找到肇事者。但在袭击发生两年后，亚当斯开始接到催收员的电话，说她欠了 130.58 美元。
德克萨斯州奥斯汀的埃迪·亚当斯在芝加哥遭到性侵犯后，因一次体检欠款 130.68 美元，被债务催收员追债多年。
Julia Robinson 为 KHN 和 NPR 撰稿
伊利诺伊州法律禁止向受害者收取此类检查的费用。但无论亚当斯解释多少次错误，电话还是不断打来，她说，每一次都让她重温一生中最糟糕的一天。
有时，当催收员打来电话时，亚当斯会在电话里泪流满面。“我当时很疯狂，”她回忆道。 “我被这张僵尸账单困扰着。我无法停止它。”
医疗债务也可能是灾难性的。
63 岁的谢丽·福伊和她的丈夫迈克尔看到他们精心计划的退休生活被打乱了，因为福伊的结肠必须切除。
迈克尔去世后
从纽约联合爱迪生公司退休后，这对夫妇搬到了弗吉尼亚州西南部农村。谢丽有足够的空间来照顾获救的马匹。
这对夫妇努力存钱。他们通过联合爱迪生公司购买了退休健康保险。但谢丽的手术导致了许多并发症，住院数月，医疗费用超过了这对夫妇健康计划的 100 万美元上限。
当福伊无法支付她欠弗吉尼亚大学健康系统的 775,000 多美元时，该医疗中心提起诉讼，这曾经是一种常见的做法，但大学表示已经控制了这种做法。这对夫妇宣布破产。
弗吉尼亚州莫内塔的谢丽·福伊的退休计划被打乱了，因为结肠切除手术让她背负了近 800,000 美元的账单，迫使她和她的丈夫迈克尔破产。
弗吉尼亚州莫内塔的谢丽·福伊 (Sherrie Foy) 的退休计划被打乱了，因为结肠切除手术让她背负了近 80 万美元的债务，迫使她和丈夫迈克尔破产。
Carlos Bernate 为 KHN 和 NPR 撰稿
福伊夫妇兑现了一份人寿保险单来支付破产律师的费用，并清算了他们为孙辈设立的储蓄账户。
“他们拿走了我们所有的一切，”福伊说。“现在我们一无所有。”
根据 KFF 民意调查，大约八分之一的医疗负债美国人欠款 10,000 美元或更多。
虽然大多数人预计会偿还债务，但 23% 的人表示至少需要三年时间；18% 的人表示他们预计永远也还不清债务。
医疗债务影响广泛
债务长期以来一直潜伏在美国医疗保健的阴影下。
根据查尔斯·罗森伯格 (Charles Rosenberg) 撰写的美国医院历史，19 世纪时，纽约贝尔维尤医院的男性患者必须在东河上运送乘客，新妈妈必须擦洗地板以偿还债务。
然而，这些安排大多是非正式的。历史学家乔纳森·恩格尔 (Jonathan Engel) 表示，医生更经常只是免除患者无法负担的账单。“没有医疗欠款的概念。”
如今，医疗和牙科账单的债务几乎触及美国社会的每个角落，甚至让那些通过工作或医疗保险等政府计划获得保险覆盖的人负担沉重。
KFF 民意调查发现，近一半家庭年收入超过 9 万美元的美国人在过去五年中承担了医疗债务。
女性比男性更容易负债。父母比没有孩子的人更容易有医疗债务。
但这场危机对最贫穷和没有保险的人打击最大。
城市研究所对信用记录的分析显示，债务在南部最为普遍。那里的保险保障较弱，许多州尚未扩大医疗补助，慢性病更为普遍。
根据民意调查，在全国范围内，黑人成年人欠医疗费的可能性比白人高出 50%，西班牙裔成年人欠医疗费的可能性比白人高出 35%。（西班牙裔可以是任何种族或种族组合。）
城市研究所的数据显示，在某些地方，例如首都，差距甚至更大：华盛顿特区以少数族裔为主的社区的医疗债务几乎是白人社区的四倍。
为低收入华盛顿居民提供财务咨询的非营利组织 Capital Area Asset Builders 的首席执行官 Joseph Leitmann-Santa Cruz 表示，在已经因教育和经济机会较少而苦苦挣扎的少数族裔社区，债务可能会让他们陷入困境。“这就像在他们身后绑了另一只手臂，”他说。
医疗债务还会阻碍年轻人积累储蓄、完成学业或找到工作。一项信用数据分析发现，普通美国人的医疗债务在 20 多岁和 30 岁出头时达到顶峰，然后随着年龄的增长而下降。
夏安·丹托纳 (Cheyenne Dantona) 的医疗债务在她开始职业生涯之前就毁了她的职业生涯。
31 岁的丹托纳在大学期间被诊断出患有血癌。癌症进入缓解期，但当丹托纳更换健康计划时，她收到了数千美元的医疗账单，因为她的主要医疗服务提供者之一不在网络范围内。
她办理了一张医疗信用卡，结果却不得不支付更多的利息。其他账单被催收，拖累了她的信用评分。丹托纳仍然梦想着与受伤和孤儿野生动物一起工作，但她被迫搬回明尼阿波利斯郊外与母亲同住。
“她被困住了，”丹托纳的妹妹德西蕾说。“她的生活暂停了。”
医疗债务的最强预测因素 Desiree Dantona 说，债务也使她的妹妹不愿寻求治疗以确保她的癌症保持缓解状态。
医疗服务提供者表示，这是美国债务危机最有害的影响之一，使病人无法得到治疗，并在患者最脆弱的时候给他们带来有毒的压力。
癌症研究人员发现，经济压力会减缓患者的康复，甚至增加他们的死亡几率。
然而，疾病与癌症之间的联系
城市研究所分析了信用记录和其他有关贫困、种族和健康状况的人口统计数据，发现债务是美国医疗保健的一个决定性特征。
美国患有多种慢性病（如糖尿病和心脏病）的居民比例最高的县往往也拥有最多的医疗债务。这使得疾病成为比贫困或保险更能预测医疗债务的指标。
在美国慢性病水平最高的 100 个县中，近四分之一的成年人的信用记录中有医疗债务，而最健康的县中这一比例不到十分之一。
这个问题如此普遍，甚至许多医生和商界领袖都承认债务已成为美国医疗保健的污点。
“在这个国家，人们不应该背负毁掉他们的医疗债务，”美国最大的综合医疗系统和健康计划 Kaiser Permanente 的前首席执行官乔治·哈尔沃森 (George Halvorson) 说。KP 的财务援助政策相对慷慨，但有时会起诉患者。 （该医疗系统与 KHN 无关。）
Halvorson 指出，高免赔额医疗保险的增长是债务危机的主要驱动因素。“人们在接受治疗时会破产，”他说，“即使他们有保险。”
联邦政府可以做什么 《平价医疗法案》加强了对数百万美国人的财务保护，不仅增加了医疗保险，还制定了保险标准，旨在限制患者必须自掏腰包支付多少费用。
研究表明，从某些方面来看，这项法律是有效的。在加利福尼亚州，该州通过该法律扩大了覆盖范围后，每月使用发薪日贷款的人数下降了 11%。
但事实证明，该法律对自付费用的限制对大多数美国人来说太高了。联邦法规允许个人计划的自付费用最高限额为 8,700 美元。
此外，该法律并没有阻止高免赔额计划的增长，在过去十年中，高免赔额计划已成为标准。这迫使越来越多的美国人在获得保险之前自掏腰包支付数千美元。
根据 KFF 的年度雇主调查，去年，拥有工作保险的单身工人的平均年度免赔额超过 1,400 美元，几乎是 2006 年的四倍。家庭免赔额最高可达 10,000 美元。
虽然健康计划要求患者支付更多费用，但医院、制药商和其他医疗服务提供者正在提高价格。
非营利性医疗成本研究所的一份报告发现，从 2012 年到 2016 年，医疗费用飙升了 16%，几乎是整体通胀率的四倍。
对于许多美国人来说，高价格和高自付费用几乎不可避免地意味着债务。KFF 民意调查发现，在过去五年中，有 60% 的有保险的工作年龄成年人因接受医疗服务而负债，这一比例仅略低于无保险人群。
研究表明，即使是医疗保险，患者也需要为药物和治疗支付数千美元的费用。
亚利桑那州皮奥里亚的萨曼莎和阿丽亚娜·巴克表示，他们因欠款而被医生办公室拒之门外，迫使他们寻求紧急护理。他们估计，现在他们有大约 50,000 美元的医疗债务。
亚利桑那州皮奥里亚的萨曼莎和阿丽亚娜·巴克表示，他们因欠款而被医生办公室拒之门外，迫使他们寻求紧急护理。他们估计，现在他们有大约 50,000 美元的医疗债务。
KHN 和 NPR 的 Ash Ponders
民意调查发现，大约三分之一的老年人欠有医疗费用。其中 37% 的人表示，他们或他们家中的某个人因欠款而被迫削减食品、衣服或其他必需品的支出；12% 的人表示，他们已经承担了额外的工作。
债务负担不断增加，引发了民选官员、监管机构和行业领袖的新兴趣。
3 月，在消费者金融保护局发出警告后，各大信用报告公司表示，将从消费者信用报告中删除 500 美元以下和已偿还的医疗债务。
4 月，拜登政府宣布 CFPB 将对债务催收者进行新的打击，卫生与公众服务部也将采取一项举措，收集更多有关医院如何提供经济援助的信息。
这些行动受到了患者倡导者的赞扬。然而，这些变化可能不会解决这场国家危机的根本原因。
“人们陷入医疗债务的首要原因，以及第二、三、四号原因，是他们没有钱，”保险公司 Centivo 的联合创始人、在健康福利领域工作了 30 多年的艾伦·科恩 (Alan Cohen) 说。“这并不复杂。”
亚利桑那州被拒绝治疗的父亲巴克在向老年人推销医疗保险计划时亲眼目睹了这种情况。 “我曾听到老人在电话里哭泣，”他说。“这太可怕了。”
现年 30 岁的巴克
巴克也面临着自己的困境。他从肠道感染中恢复过来，但在被迫去医院急诊室后，他收到了数千美元的医疗账单。
当巴克的妻子因卵巢囊肿被送进急诊室时，他的医疗账单又增加了不少。
如今，巴克夫妇有三个孩子，他们估计欠款超过 5 万美元，包括他们用信用卡支付的无法偿还的医疗费用。
“我们不得不削减一切开支，”巴克说。孩子们穿的是旧衣服。他们节省学习用品，依靠家人送圣诞礼物。出去吃一顿辣椒大餐是一种奢侈。
“当我的孩子要求去某个地方而我不能去的时候，我很痛苦，”巴克说。“我觉得我作为一个父母失败了。”
这对夫妇正准备申请破产。
关于这个项目
《诊断：债务》是 KHN 和 NPR 之间的报道合作伙伴关系，旨在探索美国医疗债务的规模、影响和原因。
该系列借鉴了“KFF 医疗保健债务调查”，这是一项由 KFF 的民意调查研究人员与 KHN 记者和编辑合作设计和分析的民意调查。该调查于 2022 年 2 月 25 日至 3 月 20 日以英语和西班牙语在线和电话方式进行，调查对象为 2,375 名美国成年人，具有全国代表性，其中包括 1,292 名目前有医疗保健债务的成年人和 382 名在过去五年内有医疗保健债务的成年人。全样本的抽样误差幅度为正负 3 个百分点，目前有债务的样本为 3 个百分点。对于基于子组的结果，抽样误差幅度可能更高。
城市研究所进行了额外的研究，分析了信贷局和其他人口统计数据，包括贫困、种族和健康状况，以探索美国医疗债务集中在哪里以及哪些因素与高债务水平有关。
摩根大通研究所分析了大通信用卡持有人的样本记录，以了解客户的余额如何受到重大医疗费用的影响。
KHN 和 NPR 的记者还对全国各地的患者进行了数百次采访；与医生、健康行业领袖、消费者权益倡导者、债务律师和研究人员进行了交谈；并审查了数十项有关医疗债务的研究和调查。
KHN（凯撒健康新闻）是一个全国性的新闻编辑室，制作有关健康问题的深入新闻。与政策分析和民意调查一起，KHN 是 KFF（凯撒家庭基金会）的三大运营项目之一。KFF 是一个捐赠的非营利组织，向全国提供有关健康问题的信息。
Sick and struggling to pay, 100 million people in the U.S. live with medical debt
By Noam Levey (Kaiser Health News) June 16, 2022 https://www.opb.org/article/2022/06/16/sick-and-struggling-to-pay-100-million-people-in-the-u-s-live-with-medical-debt/
Elizabeth and Nick Woodruff of Binghamton, New York, were sued for nearly $10,000 by the hospital where Nick's infected leg was amputated.
Heather Ainsworth for KHN and NPR
Elizabeth Woodruff drained her retirement account and took on three jobs after she and her husband were sued for nearly $10,000 by the New York hospital where his infected leg was amputated.
Ariane Buck, a young father in Arizona who sells health insurance, couldn't make an appointment with his doctor for a dangerous intestinal infection because the office said he had outstanding bills.
Allyson Ward and her husband loaded up credit cards, borrowed from relatives, and delayed repaying student loans after the premature birth of their twins left them with $80,000 in debt. Ward, a nurse practitioner, took on extra nursing shifts, working days and nights.
"I wanted to be a mom," she said. "But we had to have the money."
The three are among more than 100 million people in America ― including 41% of adults ― beset by a health care system that is systematically pushing patients into debt on a mass scale, an investigation by KHN and NPR shows.
The investigation reveals a problem that, despite new attention from the White House and Congress, is far more pervasive than previously reported. That is because much of the debt that patients accrue is hidden as credit card balances, loans from family, or payment plans to hospitals and other medical providers.
To calculate the true extent and burden of this debt, the KHN-NPR investigation draws on a nationwide poll conducted by KFF (Kaiser Family Foundation) for this project. The poll was designed to capture not just bills patients couldn't afford, but other borrowing used to pay for health care as well. New analyses of credit bureau, hospital billing, and credit card data by the Urban Institute and other research partners also inform the project. And KHN and NPR reporters conducted hundreds of interviews with patients, physicians, health industry leaders, consumer advocates, and researchers.
The picture is bleak.
In the past five years, more than half of U.S. adults report they've gone into debt because of medical or dental bills, the KFF poll found.
A quarter of adults with health care debt owe more than $5,000. And about 1 in 5 with any amount of debt said they don't expect to ever pay it off.
"Debt is no longer just a bug in our system. It is one of the main products," said Dr. Rishi Manchanda, who has worked with low-income patients in California for more than a decade and served on the board of the nonprofit RIP Medical Debt. "We have a health care system almost perfectly designed to create debt."
The burden is forcing families to cut spending on food and other essentials. Millions are being driven from their homes or into bankruptcy, the poll found.
Medical debt is piling additional hardships on people with cancer and other chronic illnesses. Debt levels in U.S. counties with the highest rates of disease can be three or four times what they are in the healthiest counties, according to an Urban Institute analysis.
The debt is also deepening racial disparities.
And it is preventing Americans from saving for retirement, investing in their children's educations, or laying the traditional building blocks for a secure future, such as borrowing for college or buying a home. Debt from health care is nearly twice as common for adults under 30 as for those 65 and older, the KFF poll found.
Allyson and Marcus Ward of Chicago moved across the country to be closer to family after the premature birth of their twins, Milo and Theo, left them with about $80,000 in medical debt. Allyson and Marcus Ward of Chicago moved across the country to be closer to family after the premature birth of their twins, Milo and Theo, left them with about $80,000 in medical debt.
Taylor Glascock for KHN and NPR
Perhaps most perversely, medical debt is blocking patients from care.
About 1 in 7 people with debt said they've been denied access to a hospital, doctor, or other provider because of unpaid bills, according to the poll. An even greater share ― about two-thirds ― have put off care they or a family member need because of cost.
"It's barbaric," said Dr. Miriam Atkins, a Georgia oncologist who, like many physicians, said she's had patients give up treatment for fear of debt.
Patient debt is piling up despite the landmark 2010 Affordable Care Act.
The law expanded insurance coverage to tens of millions of Americans. Yet it also ushered in years of robust profits for the medical industry, which has steadily raised prices over the past decade.
Hospitals recorded their most profitable year on record in 2019, notching an aggregate profit margin of 7.6%, according to the federal Medicare Payment Advisory Committee. Many hospitals thrived even through the pandemic.
But for many Americans, the law failed to live up to its promise of more affordable care. Instead, they've faced thousands of dollars in bills as health insurers shifted costs onto patients through higher deductibles.
Now, a highly lucrative industry is capitalizing on patients' inability to pay. Hospitals and other medical providers are pushing millions into credit cards and other loans. These stick patients with high interest rates while generating profits for the lenders that top 29%, according to research firm IBISWorld.
Patient debt is also sustaining a shadowy collections business fed by hospitals ― including public university systems and nonprofits granted tax breaks to serve their communities ― that sell debt in private deals to collections companies that, in turn, pursue patients.
"People are getting harassed at all hours of the day. Many come to us with no idea where the debt came from," said Eric Zell, a supervising attorney at the Legal Aid Society of Cleveland. "It seems to be an epidemic."
In debt to hospitals, credit cards, and relatives America's debt crisis is driven by a simple reality: Half of U.S. adults don't have the cash to cover an unexpected $500 health care bill, according to the KFF poll.
As a result, many simply don't pay. The flood of unpaid bills has made medical debt the most common form of debt on consumer credit records.
As of last year, 58% of debts recorded in collections were for a medical bill, according to the Consumer Financial Protection Bureau. That's nearly four times as many debts attributable to telecom bills, the next most common form of debt on credit records.
But the medical debt on credit reports represents only a fraction of the money that Americans owe for health care, the KHN-NPR investigation shows.
About 50 million adults ― roughly 1 in 5 ― are paying off bills for their own care or a family member's through an installment plan with a hospital or other provider, the KFF poll found. Such debt arrangements don't appear on credit reports unless a patient stops paying. One in 10 owe money to a friend or family member who covered their medical or dental bills, another form of borrowing not customarily measured.
Still more debt ends up on credit cards, as patients charge their bills and run up balances, piling high interest rates on top of what they owe for care. About 1 in 6 adults are paying off a medical or dental bill they put on a card.
How much medical debt Americans have in total is hard to know because so much isn't recorded. But an earlier KFF analysis of federal data estimated that collective medical debt totaled at least $195 billion in 2019, larger than the economy of Greece.
The credit card balances, which also aren't recorded as medical debt, can be substantial, according to an analysis of credit card records by the JPMorgan Chase Institute. The financial research group found that the typical cardholder's monthly balance jumped 34% after a major medical expense.
Monthly balances then declined as people paid down their bills. But for a year, they remained about 10% above where they had been before the medical expense. Balances for a comparable group of cardholders without a major medical expense stayed relatively flat.
It's unclear how much of the higher balances ended up as debt, as the institute's data doesn't distinguish between cardholders who pay off their balance every month from those who don't. But about half of cardholders nationwide carry a balance on their cards, which usually adds interest and fees.
Bearing the burden of debts large and small
For many Americans, debt from medical or dental care may be relatively low. About a third owe less than $1,000, the KFF poll found.
Even small debts can take a toll.
Edy Adams, a 31-year-old medical student in Texas, was pursued by debt collectors for years for a medical exam she received after she was sexually assaulted.
Adams had recently graduated from college and was living in Chicago.
Police never found the perpetrator. But two years after the attack, Adams started getting calls from collectors saying she owed $130.58.
Edy Adams of Austin, Texas, was pursued for years by debt collectors over a $130.68 bill for a medical exam she received after being sexually assaulted in Chicago.
Julia Robinson for KHN and NPR
Illinois law prohibits billing victims for such tests. But no matter how many times Adams explained the error, the calls kept coming, each forcing her, she said, to relive the worst day of her life.
Sometimes when the collectors called, Adams would break down in tears on the phone. "I was frantic," she recalled. "I was being haunted by this zombie bill. I couldn't make it stop."
Health care debt can also be catastrophic.
Sherrie Foy, 63, and her husband, Michael, saw their carefully planned retirement upended when Foy's colon had to be removed.
After Michael retired from Consolidated Edison in New York, the couple moved to rural southwestern Virginia. Sherrie had the space to care for rescued horses.
The couple had diligently saved. And they had retiree health insurance through Con Edison. But Sherrie's surgery led to numerous complications, months in the hospital, and medical bills that passed the $1 million cap on the couple's health plan.
When Foy couldn't pay more than $775,000 she owed the University of Virginia Health System, the medical center sued, a once common practice that the university said it has reined in. The couple declared bankruptcy.
Sherrie Foy of Moneta, Virginia, had her retirement plans upended when surgery to remove her colon left her with nearly $800,000 in bills and forced her and her husband, Michael, into bankruptcy.
Sherrie Foy of Moneta, Virginia, had her retirement plans upended when surgery to remove her colon left her with nearly $800,000 in bills and forced her and her husband, Michael, into bankruptcy.
Carlos Bernate For KHN and NPR
The Foys cashed in a life insurance policy to pay a bankruptcy lawyer and liquidated savings accounts the couple had set up for their grandchildren.
"They took everything we had," Foy said. "Now we have nothing."
About 1 in 8 medically indebted Americans owe $10,000 or more, according to the KFF poll.
Although most expect to repay their debt, 23% said it will take at least three years; 18% said they don't expect to ever pay it off.
Medical debt’s wide reach
Debt has long lurked in the shadows of American health care.
In the 19th century, male patients at New York's Bellevue Hospital had to ferry passengers on the East River and new mothers had to scrub floors to pay their debts, according to a history of American hospitals by Charles Rosenberg.
The arrangements were mostly informal, however. More often, physicians simply wrote off bills patients couldn't afford, historian Jonathan Engel said. "There was no notion of being in medical arrears."
Today debt from medical and dental bills touches nearly every corner of American society, burdening even those with insurance coverage through work or government programs such as Medicare.
Nearly half of Americans in households making more than $90,000 a year have incurred health care debt in the past five years, the KFF poll found.
Women are more likely than men to be in debt. And parents more commonly have health care debt than people without children.
But the crisis has landed hardest on the poorest and uninsured.
Debt is most widespread in the South, an analysis of credit records by the Urban Institute shows. Insurance protections there are weaker, many of the states haven't expanded Medicaid, and chronic illness is more widespread.
Nationwide, according to the poll, Black adults are 50% more likely and Hispanic adults 35% more likely than whites to owe money for care. (Hispanics can be of any race or combination of races.)
In some places, such as the nation's capital, disparities are even larger, Urban Institute data shows: Medical debt in Washington, D.C.'s predominantly minority neighborhoods is nearly four times as common as in white neighborhoods.
In minority communities already struggling with fewer educational and economic opportunities, the debt can be crippling, said Joseph Leitmann-Santa Cruz, chief executive of Capital Area Asset Builders, a nonprofit that provides financial counseling to low-income Washington residents. "It's like having another arm tied behind their backs," he said.
Medical debt can also keep young people from building savings, finishing their education, or getting a job. One analysis of credit data found that debt from health care peaks for typical Americans in their late 20s and early 30s, then declines as they get older.
Cheyenne Dantona's medical debt derailed her career before it began.
Dantona, 31, was diagnosed with blood cancer while in college. The cancer went into remission, but when Dantona changed health plans, she was hit with thousands of dollars of medical bills because one of her primary providers was out of network.
She enrolled in a medical credit card, only to get stuck paying even more in interest. Other bills went to collections, dragging down her credit score. Dantona still dreams of working with injured and orphaned wild animals, but she's been forced to move back in with her mother outside Minneapolis.
"She's been trapped," said Dantona's sister, Desiree. "Her life is on pause."
The strongest predictor of medical debt Desiree Dantona said the debt has also made her sister hesitant to seek care to ensure her cancer remains in remission.
Medical providers say this is one of the most pernicious effects of America's debt crisis, keeping the sick away from care and piling toxic stress on patients when they are most vulnerable.
The financial strain can slow patients' recovery and even increase their chances of death, cancer researchers have found.
Yet the link between sickness and debt is a defining feature of American health care, according to the Urban Institute, which analyzed credit records and other demographic data on poverty, race, and health status.
U.S. counties with the highest share of residents with multiple chronic conditions, such as diabetes and heart disease, also tend to have the most medical debt. That makes illness a stronger predictor of medical debt than either poverty or insurance.
In the 100 U.S. counties with the highest levels of chronic disease, nearly a quarter of adults have medical debt on their credit records, compared with fewer than 1 in 10 in the healthiest counties.
The problem is so pervasive that even many physicians and business leaders concede debt has become a black mark on American health care.
"There is no reason in this country that people should have medical debt that destroys them," said George Halvorson, former chief executive of Kaiser Permanente, the nation's largest integrated medical system and health plan. KP has a relatively generous financial assistance policy but does sometimes sue patients. (The health system is not affiliated with KHN.)
Halvorson cited the growth of high-deductible health insurance as a key driver of the debt crisis. "People are getting bankrupted when they get care," he said, "even if they have insurance."
What the federal government can do The Affordable Care Act bolstered financial protections for millions of Americans, not only increasing health coverage but also setting insurance standards that were supposed to limit how much patients must pay out of their own pockets.
By some measures, the law worked, research shows. In California, there was an 11% decline in the monthly use of payday loans after the state expanded coverage through the law.
But the law's caps on out-of-pocket costs have proven too high for most Americans. Federal regulations allow out-of-pocket maximums on individual plans up to $8,700.
Additionally, the law did not stop the growth of high-deductible plans, which have become standard over the past decade. That has forced growing numbers of Americans to pay thousands of dollars out of their own pockets before their coverage kicks in.
Last year the average annual deductible for a single worker with job-based coverage topped $1,400, almost four times what it was in 2006, according to an annual employer survey by KFF. Family deductibles can top $10,000.
While health plans are requiring patients to pay more, hospitals, drugmakers, and other medical providers are raising prices.
From 2012 to 2016, prices for medical care surged 16%, almost four times the rate of overall inflation, a report by the nonprofit Health Care Cost Institute found.
For many Americans, the combination of high prices and high out-of-pocket costs almost inevitably means debt. The KFF poll found that 6 in 10 working-age adults with coverage have gone into debt getting care in the past five years, a rate only slightly lower than the uninsured.
Even Medicare coverage can leave patients on the hook for thousands of dollars in charges for drugs and treatment, studies show.
Samantha and Ariane Buck of Peoria, Arizona, say they were turned away from a physician's office because of money they owed, forcing them to seek emergency care. They estimate they now have about $50,000 in medical debt. Samantha and Ariane Buck of Peoria, Arizona, say they were turned away from a physician's office because of money they owed, forcing them to seek emergency care. They estimate they now have about $50,000 in medical debt.
Ash Ponders for KHN and NPR
About a third of seniors have owed money for care, the poll found. And 37% of these said they or someone in their household have been forced to cut spending on food, clothing, or other essentials because of what they owe; 12% said they've taken on extra work.
The growing toll of the debt has sparked new interest from elected officials, regulators, and industry leaders.
In March, following warnings from the Consumer Financial Protection Bureau, the major credit reporting companies said they would remove medical debts under $500 and those that had been repaid from consumer credit reports.
In April, the Biden administration announced a new CFPB crackdown on debt collectors and an initiative by the Department of Health and Human Services to gather more information on how hospitals provide financial aid.
The actions were applauded by patient advocates. However, the changes likely won't address the root causes of this national crisis.
"The No. 1 reason, and the No. 2, 3, and 4 reasons, that people go into medical debt is they don't have the money," said Alan Cohen, a co-founder of insurer Centivo who has worked in health benefits for more than 30 years. "It's not complicated."
Buck, the father in Arizona who was denied care, has seen this firsthand while selling Medicare plans to seniors. "I've had old people crying on the phone with me," he said. "It's horrifying."
Now 30, Buck faces his own struggles. He recovered from the intestinal infection, but after being forced to go to a hospital emergency room, he was hit with thousands of dollars in medical bills.
More piled on when Buck's wife landed in an emergency room for ovarian cysts.
Today the Bucks, who have three children, estimate they owe more than $50,000, including medical bills they put on credit cards that they can't pay off.
"We've all had to cut back on everything," Buck said. The kids wear hand-me-downs. They scrimp on school supplies and rely on family for Christmas gifts. A dinner out for chili is an extravagance.
"It pains me when my kids ask to go somewhere, and I can't," Buck said. "I feel as if I've failed as a parent."
The couple is preparing to file for bankruptcy.
About This Project
Diagnosis: Debt is a reporting partnership between KHN and NPR exploring the scale, impact, and causes of medical debt in America.
The series draws on the "KFF Health Care Debt Survey," a poll designed and analyzed by public opinion researchers at KFF in collaboration with KHN journalists and editors. The survey was conducted Feb. 25 through March 20, 2022, online and via telephone, in English and Spanish, among a nationally representative sample of 2,375 U.S. adults, including 1,292 adults with current health care debt and 382 adults who had health care debt in the past five years. The margin of sampling error is plus or minus 3 percentage points for the full sample and 3 percentage points for those with current debt. For results based on subgroups, the margin of sampling error may be higher. Additional research was conducted by the Urban Institute, which analyzed credit bureau and other demographic data on poverty, race, and health status to explore where medical debt is concentrated in the U.S. and what factors are associated with high debt levels.
The JPMorgan Chase Institute analyzed records from a sampling of Chase credit card holders to look at how customers' balances may be affected by major medical expenses. Reporters from KHN and NPR also conducted hundreds of interviews with patients across the country; spoke with physicians, health industry leaders, consumer advocates, debt lawyers, and researchers; and reviewed scores of studies and surveys about medical debt. KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
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