Black Americans have nearly twice the amount of medical debt as white borrowers, according to a new study by UC Berkeley researchers that analyzed credit reports from 2016 to 2022.
The researchers found that Black Americans consistently accrued the highest medical debt in collections within the past year and had the highest total outstanding medical debt.
Impacting nearly one in five U.S. households, medical debt can increase the risk of food or housing insecurity and contribute to personal bankruptcy, according to the study.
“Having medical debt may lead people to skip necessary health care, and unfortunately providers sometimes refuse to treat patients with medical debt,” said co-author Charleen Hsuan, an associate professor at Pennsylvania State University, in an email. “This can have enormous impact on patients with emergency conditions or who are struggling with chronic conditions including cancer.”
The UC Berkeley researchers found that in 2016, Black borrowers had the highest rate of new medical debt in collections at 15.6%, compared to Hispanic borrowers at 8.7% and white borrowers at 8.6%. Asian and Pacific Islander borrowers had the lowest debt rate at 1.8%.
Although the amount that any given borrower owed was relatively equal, Black borrowers were far more likely to have debt compared to other regional ethnic groups.
“That just shows again a lot of the sort of ugliness of structural racism,” said Alexander Adia, first author of the study and a UC Berkeley doctoral candidate in health policy. “Black Americans in the United States really face uphill battles in terms of getting adequate healthcare, having built environments and social settings that are conducive to health, and then being able to accumulate wealth and income that prevent you from suffering medical debt in this way.”
Medical debt fell nationwide from 2021 to 2022, largely due to a growth in Medicaid enrollment and pandemic-era relief measures, according to an Urban Institute study. Still, the racial gap in debt persisted: In 2022, 11.2% of Black borrowers were in debt compared to 6.5% of Hispanic borrowers.
According to the study, healthcare coverage expansions through Medicaid helped alleviate medical debt, but not all states have expanded Medicaid programs.
In states without Medicaid expansion — 10 states that include Texas, Georgia and Florida — Black adults face the highest probability of medical debt. But the study found that in states with expanded Medicaid, the probability of medical debt was lower across all demographics and the racial gap was narrower.
“You can address some general issues and think that you’ve solved the problem, but even if on the population level folks are generally doing better, if those severe differences still remain among specific groups — and then in this case, racial and ethnic minoritized groups is one,” Adia said. “I think that that’s not a solution at all. That’s a Band-Aid.”