Trends in medical debt in the United States by imputed borrower race and ethnicity, 2016-2022.

Introduction: Medical debt is a major financial consequence of healthcare in the United States, but there is limited evidence about whether medical debt in collections varies across racial and ethnic groups. Methods: We analyzed credit report data from 2016 to 2022 for 23,093,888 adults to study medical debt in collections accrued within the past year (flow) and total outstanding medical debt in collections (stock). Results: Black borrowers had the highest levels of annual flow of medical debt, with 11.2% of borrowers facing any annual flow of debt in 2022 (mean conditional on any flow: $1524). Similar trends existed for stock, with 24% of borrowers having any stock in 2022 (mean conditional on any stock: $2074). Hispanic and White borrowers had similar medical debt, and Asian and Pacific Islander borrowers had the least debt. Gaps between racial and ethnic groups were smaller in states that expanded Medicaid compared to those that did not, especially on the flow of new medical debt. Discussion: Identifying evidence-based policies and interventions to reduce medical debt differences by borrower race and ethnicity should be a high policy priority.