A recent employer survey conducted by the Kaiser Family Foundation revealed that the average annual deductible for a single worker with job-based insurance amounted to $1,400 in 2021. That's nearly four times as much as it was in 2006. Additionally, research from the Health Care Cost Institute discovered that medical care prices had increased 16% over four years. This lethal combination of high out-of-pocket costs and high prices has led to staggering amounts of medical debt for Americans. An investigation by KHN and NPR found more than half of U.S. adults reporting they had gone into debt over the past five years because of medical or dental bills. Some have said they don't expect to ever pay it off. An extensive medical debt policy study, featuring a first-of-its-kind scorecard of states, suggests that patients don't have to go it alone if states adopt robust policies that can help prevent medical debt in the first place and aid in problem-solving for debt already incurred. Created by Innovation for Justice and an interdisciplinary research team at the University of Utah and the University of Arizona, the Medical Debt Policy Scorecard ranks states according to current policies regarding medical debt. Policy goals evaluated by the Scorecard included the reduction of medical debt; increasing out-of-court resolution of debt; improving equity, openness, and efficiency for people navigating court cases without a lawyer; and reducing post-court negative consequences. States were given full, half, or no credit, depending on the presence of these policies. In compiling their study, the researchers conducted interviews with "Lived Experience Experts," or people who had grappled with a medical debt and had a household income of less than $70K. One of the common themes that emerged from those interviews was a general confusion about billing and collections, combined with difficulty getting answers to their questions. Many also reported "misleading, harmful or predatory practices" on the part of hospitals, insurance companies, and debt collectors. One talked about seeking help from allegedly "free" organizations who ultimately intended to charge for their services. "And then that's what killed me because these programs are designed to help you, but they don't help you. So then why design programs if they're not going to help you? That makes no sense to me," the interviewee said. "Although many states have already implemented some consumer protection policies for medical debt, states have a long way to go in eliminating medical debt and the harmful impacts experienced by those who incur it," the study concluded. "By ensuring policies are informed by the experiences of those most impacted by this issue and the perspectives of people already experiencing medical debt, states have the opportunity to implement consumer protections that effectively eliminate the burden of medical debt on Americans." See our slideshow above for which states are the best at helping residents resolve medical debt and which states have a long way to go.

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Richard Binder

Richard Binder, based in New York, is part of the social media team at ALM. He is also a 2014 recipient of the ASPBE Award for Excellence in the Humorous/Fun Department.