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Diagnosis: Debt
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DIAGNOSIS: DEBT

More than 100 million people in America — a startling 41% of adults — are
saddled with medical bills they cannot pay, according to a KFF Health News
investigation with NPR and CBS News. The project exposed that medical debt —
rather than fighting disease — is now a defining feature of the nation’s health
care system.


FEATURED STORIES


100 MILLION PEOPLE IN AMERICA ARE SADDLED WITH HEALTH CARE DEBT

June 16, 2022

The U.S. health system now produces debt on a mass scale, a new investigation
shows. Patients face gut-wrenching sacrifices.


IN AMERICA, CANCER PATIENTS ENDURE DEBT ON TOP OF DISEASE

July 9, 2022

Medical breakthroughs mean cancer is less likely to kill, but survival can come
at an extraordinary cost as patients drain savings, declare bankruptcy, or lose
their homes, a KHN-NPR investigation finds.


NURSING HOMES ARE SUING THE FRIENDS AND FAMILY OF RESIDENTS TO COLLECT DEBTS

July 28, 2022

Debt lawsuits — long a byproduct of America’s medical debt crisis — can ensnare
not only patients but also those who help sick and older people be admitted to
nursing homes, a KHN-NPR investigation finds.


FEW PLACES HAVE MORE MEDICAL DEBT THAN DALLAS-FORT WORTH, BUT HOSPITALS THERE
ARE THRIVING

September 28, 2022

Some hospitals notch big profits while patients are pushed into debt by
skyrocketing medical prices and high deductibles, a KHN analysis finds.


KNOXVILLE’S BLACK COMMUNITY ENDURED DEEPLY ROOTED RACISM. NOW THERE IS MEDICAL
DEBT.

October 28, 2022

Despite the end of Jim Crow segregation, its legacy lives on in medical debt
that disproportionately burdens Black communities.


HOW BANKS AND PRIVATE EQUITY CASH IN WHEN PATIENTS CAN’T PAY THEIR MEDICAL BILLS

November 17, 2022

Hospitals strike deals with financing companies, generating profits for lenders,
and more debt for patients.


WHAT GERMANY’S COAL MINERS CAN TEACH AMERICA ABOUT MEDICAL DEBT

December 14, 2022

Coal mining ended in Germany’s Saarland a decade ago, but the transition away
from coal has been smoother than in West Virginia, which has more medical debt
than any state in America.


HUNDREDS OF HOSPITALS SUE PATIENTS OR THREATEN THEIR CREDIT, A KFF HEALTH NEWS
INVESTIGATION FINDS. DOES YOURS?

December 21, 2022

An examination of billing policies and practices at more than 500 hospitals
across the country shows widespread reliance on aggressive collection tactics.


DEBT AT A GLANCE


TELL US ABOUT YOUR MEDICAL DEBT

Have you been forced into debt because of a medical or dental bill? Have you had
to make any changes in your life because of such debt? Have you been pursued by
debt collectors for a medical bill? We want to hear about it.

Share Your Story


THE CRISIS

KFF Health News’ yearlong investigation exposed a staggering failure of U.S.
health care: It systematically pushes patients into debt.

“Diagnosis: Debt” revealed the scope and severity of this crisis as no one has
before: A quarter of those with debt owe more than $5,000. And nearly as many
with any amount of debt don’t expect to pay it off in their lifetimes. Black
Americans are 50% as likely as whites to owe money for medical care. And 20% of
U.S. hospitals will deny nonemergency care to patients with an outstanding bill.

The investigation unmasked the opaque world of medical billing and collections
and a vast new industry that preys on patients. And it garnered prompt attention
and action in Washington and beyond.

In intimate, multimedia stories, “Diagnosis: Debt” documented the suffering and
sacrifices this burden forces on patients and their families. KFF Health News
and our partners at NPR and CBS News profiled people driven from their homes,
new parents who took on extra work, and retirees pushed to bankruptcy because of
debt.


UPENDED: HOW MEDICAL DEBT CHANGED THEIR LIVES

Some lost their homes. Some emptied their retirement accounts. Some struggled to
feed and clothe their families. Medical debt now touches more than 100 million
people in America, as the U.S. health care system pushes patients into debt on a
mass scale. Debtors are from all walks of life and all corners of the country.
Here are their stories ― how they got into debt, what they’ve given up for it,
and how they’re living with the burden.

Read the Profiles




MORE STORIES FROM THE PROJECT


BIDEN ADMINISTRATION URGED TO TAKE MORE AGGRESSIVE STEPS TO RELIEVE MEDICAL DEBT

March 7, 2023

Consumer and patient advocates push for new federal rules to protect Americans
from debt collectors and force hospitals to make financial assistance more
accessible.


KIDS’ MENTAL HEALTH CARE LEAVES PARENTS IN DEBT AND IN THE SHADOWS

October 19, 2022

A youth mental health crisis and a shortage of therapists and other care
providers who take insurance are pushing many families into financial ruin. But
it's rarely acknowledged as medical debt.


MEDICAL DEBT SUNK HER CREDIT. NEW CHANGES FROM THE CREDIT REPORTING AGENCIES
WON’T HELP.

October 6, 2022

New policies to prevent unpaid medical bills from harming people’s credit scores
are on the way. But the concessions made by top credit reporting companies may
fall short for those with the largest debt — especially Black Americans in the
South.


AFTER WIPING OUT $6.7 BILLION IN MEDICAL DEBT, THIS NONPROFIT IS JUST GETTING
STARTED

August 16, 2022

Nonprofit RIP Medical Debt buys up unpaid hospital bills plaguing low-income
patients and frees them from having to pay.


THE DEBT CRISIS THAT SICK AMERICANS CAN’T AVOID

August 2, 2022

The federal government is stepping in to assist student loan borrowers. But
little public attention has been focused on what is — statistically, at least —
a bigger, broader debt crisis in our country: An estimated 100 million people in
the U.S., or 41% of all adults, are saddled with pernicious health care debt.


HOW TO GET RID OF MEDICAL DEBT — OR AVOID IT IN THE FIRST PLACE

July 1, 2022

Medical bills can add stress to the already stressful experience of dealing with
a medical crisis. And if you can’t pay those bills, they can linger, wreaking
havoc on your financial goals and credit. Here’s how to protect yourself.


MEDICAL BILLS CAN SHATTER LIVES. NORTH CAROLINA MAY ACT TO ‘DE-WEAPONIZE’ THAT
DEBT.

June 21, 2022

Medical debt is most prevalent in the Southeast, where states have not expanded
Medicaid and have few consumer protection laws. Now, North Carolina is
considering two bills that could change that, making the state a leader in
protecting patients from high medical bills.




AUDIO GALLERY




“DIAGNOSIS: DEBT” FEATURED ON CBS




ABOUT THE PROJECT

“Diagnosis: Debt” is a reporting partnership between KFF Health News and NPR
exploring the scale, impact, and causes of medical debt in America.

The series draws on original polling by KFF, court records, federal data on
hospital finances, contracts obtained through public records requests, data on
international health systems, and a yearlong investigation into the financial
assistance and collection policies of more than 500 hospitals across the
country. 

Additional research was conducted by the Urban Institute, which analyzed credit
bureau and other demographic data on poverty, race, and health status for KFF
Health News to explore where medical debt is concentrated in the U.S. and what
factors are associated with high debt levels.

The JPMorgan Chase Institute analyzed records from a sampling of Chase credit
card holders to look at how customers’ balances may be affected by major medical
expenses. And the CED Project, a Denver nonprofit, worked with KFF Health News
on a survey of its clients to explore links between medical debt and housing
instability. 

KFF Health News journalists worked with KFF public opinion researchers to design
and analyze the “KFF Health Care Debt Survey.” The survey was conducted Feb. 25
through March 20, 2022, online and via telephone, in English and Spanish, among
a nationally representative sample of 2,375 U.S. adults, including 1,292 adults
with current health care debt and 382 adults who had health care debt in the
past five years. The margin of sampling error is plus or minus 3 percentage
points for the full sample and 3 percentage points for those with current debt.
For results based on subgroups, the margin of sampling error may be higher.

Reporters from KFF Health News and NPR also conducted hundreds of interviews
with patients across the country; spoke with physicians, health industry
leaders, consumer advocates, debt lawyers, and researchers; and reviewed scores
of studies and surveys about medical debt.




CREDITS


REPORTERS

Noam N. Levey
Aneri Pattani
Bram Sable-Smith
Megan Kalata
Anna Back
Margaret Ferguson
Amber Cole
Yuki Noguchi, NPR
Anna Werner, CBS News


DATA VISUALIZATION

Juweek Adolphe
Alyson Hurt, NPR
Daniel Wood, NPR


ILLUSTRATORS

Oona Tempest
Jesse Zhang


PHOTOGRAPHERS

Heather Ainsworth
Carlos Bernate
Laura Buckman
Jamar Coach
Logan Cyrus
Pasquale D’Angiolillo
Taylor Glascock
Darren Hauck
Dawnee Lebeau
Ash Ponders
Eamon Queeney
Juan Diego Reyes
Julia Robinson
Olivia Sun


EDITORS

Kelly Johnson
Taunya English
Terry Byrne
Eric Harkleroad
Kathleen Hayden
David Hicks
Lynne Shallcross
Lydia Zuraw
Paula Andalo
Mary Agnes Carey
Rebecca Adams
Ngoc Nguyen
Carmel Wroth, NPR
Jane Greenhalgh, NPR
Meredith Rizzo, NPR
Nicole Keller, CBS News


SOCIAL AND ENGAGEMENT

Chaseedaw Giles
Hannah Norman
Tarena Lofton
Krishna Sharma
Matt Adams, NPR

© 2023 KFF. All rights reserved.

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