Special Report

How Many People in Your State Are Burdened With Medical Debt?

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41. South Dakota
> Adults with unpaid med. bills: 164,003 (24.5% of adult pop. — 22nd highest)
> Median medical debt in collections: $542 (17th lowest)
> Uninsured rate: 9.8% (15th highest)
> Adults in fair or poor health: 11.8% (the lowest)

In South Dakota, 25.7% of adults have not sought necessary medical treatment in the last year because of concerns related to cost — well above the 20.6% of American adults. Indeed, the percentage of South Dakota residents with unpaid medical bills is higher than average.

Concerns over medical costs in South Dakota are likely exacerbated for the state’s relatively large uninsured population. South Dakota is one of 14 states not to have adopted Medicaid expansion under the Affordable Care Act, and currently, 9.8% of residents are uninsured, compared to 8.9% of Americans nationwide.

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42. Tennessee
> Adults with unpaid med. bills: 1.3 million (25.6% of adult pop. — 19th highest)
> Median medical debt in collections: $855 (8th highest)
> Uninsured rate: 10.1% (13th highest)
> Adults in fair or poor health: 19.1% (10th highest)

In Tennessee, 25.6% of the 18 and older population has unpaid medical bills, slightly more than the 22.7% national share. That figure would likely be reduced by greater health insurance coverage. As one of the 14 states not to adopt Medicaid expansion, Tennessee currently has a 10.1% uninsured rate, which is higher than the uninsured rate in the vast majority of states.

Over the last 12 months, the high cost of medical care has discouraged 21.8% of adults in Tennessee from seeking treatment for a health problem — higher the comparable national figure of 20.6%.

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43. Texas
> Adults with unpaid med. bills: 6.2 million (29.0% of adult pop. — 5th highest)
> Median medical debt in collections: $829 (9th highest)
> Uninsured rate: 17.7% (the highest)
> Adults in fair or poor health: 18.2% (15th highest)

In Texas, 17.7% of the population does not have health insurance, the highest uninsured rate of any state. Partially as a result, a staggering 6.2 million adults in the state have unpaid medical bills — or 29.0% of Texas residents age 18 and up. Nationwide, 22.7% of adults are saddled with medical debt.

The state’s high uninsured rate is a threat to overall public health. Over the last year, the high cost of medical care has discouraged 26.1% of adults in Texas from seeking treatment for a health problem — well above the comparable 20.6% national figure.

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44. Utah
> Adults with unpaid med. bills: 448,181 (20.1% of adult pop. — 15th lowest)
> Median medical debt in collections: $997 (4th highest)
> Uninsured rate: 9.4% (17th highest)
> Adults in fair or poor health: 12.1% (3rd lowest)

The share of adults in Utah with unpaid medical bills, at 20.1%, is slightly below the comparable share nationwide of 22.7%. However, those unpaid bills are likely higher than average for many in the state. The median unpaid hospital, clinic, or doctor bill that has been turned over to a collections agency in Utah is $997, about $300 more than the national average.

Having health insurance coverage can greatly reduce out-of-pocket medical expenses, and in Utah, 9.4% of the population is uninsured, slightly higher than the 8.9% national rate.

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45. Vermont
> Adults with unpaid med. bills: 119,842 (23.4% of adult pop. — 25th highest)
> Median medical debt in collections: $469 (9th lowest)
> Uninsured rate: 4.0% (2nd lowest)
> Adults in fair or poor health: 12.5% (4th lowest)

As is the case across much of New England and the broader Northeastern United States, Vermont has an exceptionally low uninsured rate. Just 4.0% of Vermonters do not have health insurance, less than half the 8.9% national uninsured rate.

However, even with insurance, health care can have high out-of-pocket costs that many Americans struggle to afford. Despite the high insurance coverage in Vermont, 23.4% of adults in the state have unpaid medical bills, higher than the 22.7% national share.

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