A new Commonwealth Fund survey released on Sept. 17 reveals that nearly one-third of working-age adults with private health insurance are currently managing medical bills or medical debt. The heaviest impact fell on Black adults, with 41% reporting medical debt, followed by residents of the South (39%), Hispanic adults and individuals with lower or middle incomes (both 38%), and women (37%).
Earlier research linking higher medical debt rates in the South had typically pointed to raised uninsured populations and the decision by roughly half of Southern states to forego Medicaid expansion, according to the report. “However, in this study, we found a higher burden of medical debt in the South even among privately insured adults with continuous coverage,” the researchers noted.
Medical Debt Burden
Forty-six percent of those surveyed who were repaying medical bills owed at least $2,000, equating to an estimated 15% of all working-age adults with private insurance. About one-quarter of respondents with medical debt reported making payments directly to a collection agency, while a comparable share said their balances had been forwarded to a credit-rating agency. The primary driver of these debts was hospital care, with 64% attributing their balances to inpatient, outpatient, or emergency department visits.
Additionally, 43% linked their debt to physician office visits, and 38% to laboratory work or diagnostic testing, highlighting how routine medical services can also contribute to financial strain. These insights come from the Commonwealth Fund’s 2025 Affordability Survey, which surveyed a nationally representative group of 6,353 adults aged 19 to 64. The analysis concentrated on 4,121 participants who maintained uninterrupted employer-sponsored, Affordable Care Act marketplace, or individual-market coverage over the past year. The research team also facilitated eight virtual focus groups involving 45 privately insured adults to explore experiences with medical debt, billing inaccuracies, and insurance claim rejections.
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Causes of Medical Debt
The ripple effects of medical debt extended beyond finances, influencing emotional well-being and healthcare-seeking behavior. Of those with outstanding medical bills, 68% experienced stress or anxiety, while 37% dipped into savings—either partially or fully—to manage costs. Another 30% cut back on essentials like groceries, heating, or rent. Focus group participants described delaying treatments, turning to online symptom checkers, taking on extra work, or reconsidering family planning due to financial concerns.
Even respondents without active debt faced vulnerabilities. Over one-third of privately insured adults admitted they would struggle to cover an unexpected $1,000 medical expense within 30 days. This figure climbed above 50% among Black and Hispanic adults and those earning less than 200% of the federal poverty level. When assigning blame, 64% of those repaying debt pointed fingers at their insurance providers, while 57% criticized the healthcare system overall. More than one-third attributed responsibility to the government. The Commonwealth Fund recommended that policymakers enhance oversight of hospital financial-assistance programs and simplify access through unified application platforms. They also advocated for tighter controls on aggressive collection tactics and restrictions on reporting medical debt to credit bureaus.
Impact of Medical Debt
Among individuals whose insurance claims were rejected, 43% reported accumulating debt they were still working to repay. With healthcare premiums projected to rise by 9.5% in 2027 and medical spending driving 91% of premium increases between 2011 and 2024, affordability challenges are expected to intensify. During that period, average premiums rose 78.4%, while per-person healthcare expenditures increased 84.2%.
