The Prevalence of Unpaid Medical Bills Varies Widely by State

Nearly one in four American adults under the age of 65 has medical debt, according to the results of a new study by the Urban Institute, and southerners are hit hardest by past-due doctors’ bills.

The study authors, Michael Karpman and Kyle Caswell, found that eight of the ten states with the highest rates of past-due medical debt were in the South: Mississippi, Arkansas, West Virginia, South Carolina, Kentucky, Oklahoma, Alabama, and Georgia.

The rate was lowest in Hawaii, at 6 percent of adults, and the highest was Mississippi, at 37 percent. Nationwide, African-Americans and people aged 25 to 34 were most likely to have past-due doctors’ bills.

The Atlantic looks at the reason why there’s such a geographic disparity:

Insurance coverage is clearly a big factor. The percentage of Americans who have past-due medical debt has declined by 20 percent since 2012, the authors write, tracking with the implementation of the Affordable Care Act. When the researchers controlled for demographic variables like age and education, the geographic differences didn’t go away. Many southern states did not expand Medicaid under the Affordable Care Act, which could explain the high rates of debt in states like Mississippi and Alabama. (Other studies have found Medicaid expansion did reduce unpaid bills.)

Nonetheless, it appears to be more than just access to insurance coverage. Differences in state insurance regulations — such as rules cracking down on balance billing — could also be playing a role, as could differences in how frequently people actually go to the doctor.

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