Medical debt leads to higher rates of housing and food insecurity

Medical debt is prevalent in the United States and leads to higher rates of food insecurity and the inability to pay rent, mortgage or utilities, according to a new study published in the journal Open JAMA Network.

Studies have shown that people with diabetes face higher healthcare costs than the general US population – including many insured people who pay more for deductibles, co-pays and other coverage gaps. for medications, test strips and other diabetes-related equipment. People with diabetes can also face unplanned emergency room visits or hospitalization due to dangerously high or low blood sugar. Some health insurance plans have solved this problem by offering diabetes medications at no cost, but this option is not available to many Americans. And while there is political momentum to reduce the high cost of insulin in the United States, insulin is only one piece of the puzzle when it comes to high healthcare costs.

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For the latest study, researchers looked at a nationally representative survey of more than 40,000 American adults who tracked medical debt — and its causes and consequences — for one to three years between 2017 and 2020. In the Overall, 10.8% of individual participants and 18.1% of households had medical debt, with similar levels seen among low- and middle-income individuals and households. Among those without health insurance, 15.3% had medical debt and among those with private health insurance, 10.5% had medical debt. The average level of medical debt in 2018 was $21,687 per debtor.

Various factors related to the likelihood of medical debt

Researchers found that having no insurance, having a Medicare Advantage plan, having a high-deductible private insurance plan, having a disability, and being hospitalized all increased risk to have medical debt. Living in a state that had expanded Medicaid, on the other hand, was linked to a 24% lower chance of having medical debt in 2019. Losing insurance coverage between 2017 and 2019 was linked to a 63% lower chance higher of subsequently incurring medical debt, while becoming disabled was linked to a 142% higher likelihood of incurring medical debt, and being hospitalized was linked to a 195% higher likelihood of incurring medical debt.

When researchers looked at the effects of new medical debt over the course of the study, they found that participants who incurred medical debt between 2017 and 2019 were 120% more likely to report food insecurity (lack of access constant to nutritious food) thereafter, as well as 129% more likely to lose the ability to pay rent or mortgage, 137% more likely to lose the ability to pay utilities, and 195% more likely to be evicted from their homes or subject to seizure.

As two of the study’s authors wrote in a comment to MedPage today, medical debt may be even more prevalent than their study revealed. For example, a recent survey of Kaiser Family Foundation found that 41% of adults had some form of debt caused by medical or dental bills. In this survey, 24% of adults said they had overdue bills or were unable to pay, 21% said they pay a bill over time to a healthcare provider, 17% said they paid a bill at a bank or other lender (including credit cards), and 10% said they paid off a medical debt to a family member or friend who had lent money.

Want to know more about saving money on your diabetes care? Read “Save Money on Medication,” “How Your Healthcare Team Can Help You Save on Medication,” and “Dos and Don’ts of Saving Money with Diabetes.”


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John A. Bogar