Special Report

Counties With the Most Medical Debt in Collections

The United States is grappling with growing income inequality, but the widening chasm between these two Americas isn’t always easy to see. Even at the state level, the wealthiest can live in posh incorporated-township bubbles with their own fire and police departments, just a few miles away from some of the poorest Americans in the same city. These are the cities hit hardest by poverty in every state.

One factor that is particularly damaging, to the middle class as well as those with marginal incomes, is the cost of health care in this country. America is the most expensive place among wealthy nations to get sick. And not only do we pay more for healthcare — our health outcomes are worse, too. 

According to “U.S. Health in International Perspective,” a paper published by the National Institutes of Health, Americans live shorter lives in poorer health than their counterparts in prosperous countries in Europe and Asia. That’s despite how much we spend on doctors, hospital stays, emergency room visits, and prescription drugs. Consider how Americans’ medical bills compare to those in other countries.

Though healthcare-related personal bankruptcies dropped by half after implementation of the Affordable Care Act in 2010, millions of Americans still suffer from medical debts they can’t afford to pay off. The situation has been made worse by the job-destroying COVID-19 pandemic, because most Americans get health insurance through their employers. 

USA Today reported last year that a sample of 20 million Americans had $45 billion in medical debt in collection, which means that a third party is trying to collect unpaid bills on behalf of creditors. A 2020 Gallup poll concluded that more than half the population fears a major health event will lead to personal bankruptcy.

Click here to see the counties with the most medical debt in collections.

People struggle with medical debt in collections across the country, with the debt unsurprisingly linked to local levels of poverty, access to decent health insurance or Medicaid, and medical costs. These are the counties that suffer the most. 

To identify the counties with the most medical debt in collections, 24/7 Wall St. reviewed the share of people with a credit report in each state who have medical debt in collections from “Debt in America 2021,” a report by the Urban Institute, based on credit bureau data from 2020. 

Each county’s adult population that self-reported fair or poor health was obtained from “County Health Rankings and Roadmaps,” a collaboration between the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation. The percentage of each county’s residents who do not have health insurance came from the U.S. Census Bureau’s 2019 1-year American Community Survey.