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States With the Most Past-Due Medical Debt

Thomas C. Frohlich

Each year, there are 487 premature deaths for every 100K people in MS, the highest such rate.
The vast majority of people have experienced, are dealing with, or will someday likely endure any number of medical problems. Serious diseases, chronic conditions, and grave injuries or accidents often mean a trip to the nearest hospital. In the United States -- even for those with health insurance -- such events are often extremely costly.

24/7 Wall St. reviewed data from Urban Institute's report, Past- Due Medical Debt among Nonelderly Adults, published in March 2017. In 2015, 23.8% of nonelderly adults across the country reported past-due medical debt, down from 29.6% in 2012.

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The prevalence of delinquent medical bills varies substantially by state. Mississippi leads the nation with 37.4% of nonelderly adults with past-due medical debts, while just 5.9% of nonelderly adults in Hawaii reported such debts, the lowest share.

The physical decline that comes with age means medical problems are far more common among elderly individuals than other adults. This is not the case for past-due medical debt, however. Of Americans 25 to 34 years old, 27.8% report past-due medical debt, the highest share of all age cohorts. By contrast, among people 55 to 64, 19.2% report past-due medical bills, and among 65 and older individuals, the share is even lower.

The relatively low prevalence of medical debt among older Americans is likely due to high Medicare coverage rates. Older Americans often have higher incomes and typically have accumulated more savings, which could also explain the debt burden differences between age cohorts.

“A fundamental function of health insurance is to protect people against the risk of unexpected medical bills,” wrote Urban Institute researchers. And while health insurance does not fully offset the costs of medical problems, nor does it eliminate the risk of debt, it is not especially surprising that states reporting low health insurance coverage rates tend to have the highest levels of residents with past-due medical debt.

The percentage of people without health insurance is greater than the national uninsured rate of 9.4% in just four of the 25 states with lower shares of nonelderly adults reporting past-due medical bills. Meanwhile, residents of 18 of the 25 states with high levels of residents reporting of medical debt are more likely than the average adult nationwide to not have health insurance.

Income is also a major factor in the likelihood of incurring unwieldy medical bills. Medical debt is most common among households earning between $25,000 and $34,999 annually, with 30.8% of such households reporting past-due medical bills. In 16 of the 25 states with lower past-due medical bills, the typical household earns more than $55,775 a year -- the national household median income. This is the case in only four of the 25 states with higher delinquent medical debt.

Citing 2016 research by the Kaiser Family Foundation, Urban Institute researchers wrote, “Families with medical debt report that it reduces their ability to save and to afford basic household needs, increases their reliance on credit cards and other forms of debt, damages their credit, and induces them to forgo needed health care.”

People in states with the most past-due medical debt also tend to be less healthy and report higher incidence of premature death. The number of deaths before age 75 per 100,000 Americans is 473 in a year. Converted to years, that figure amounts to 7,054 years for every 100,000 people nationwide annually. The premature death rate is lower than the national average in 22 of the 25 states with lower medical debt burden. It exceeds the national average in 22 of the 25 states with higher prevalence of past-due medical debt.

To identify the states with the most past-due medical debt, 24/7 Wall St. reviewed the percentage of nonelderly adults who reported in 2015 having past-due medical debt in each state from the Urban Institute March 2017 report, Past-Due Medical Debt among Nonelderly Adults, 2012-2015. Adults reporting that they do not know if they have past-due medical debt or who refuse to report whether they have past-due medical debt were excluded.

The percentage of adults without health insurance in each state (the uninsured rate), and the median annual household income came from the U.S. Census Bureau’s 2015 American Community Survey. The premature death rate, measured in lives and years lost before age 75 per 100,000 people in each state annually were aggregated from the county level using 2016 data from County Health Rankings & Roadmaps, a joint program of the Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute.

These are the states with the most past-due medical debt.

1. Hawaii
> Nonelderly adults with past-due medical debt: 5.9%
> Uninsured rate: 4.0% (3rd lowest)
> Median household income: $73,486 (2nd highest)
> Premature deaths per 100K: 279 (5th lowest)

2. Minnesota
> Nonelderly adults with past-due medical debt: 13.3%
> Uninsured rate: 4.5% (4th lowest)
> Median household income: $63,488 (12th highest)
> Premature deaths per 100K: 262 (the lowest)

3. California
> Nonelderly adults with past-due medical debt: 16.0%
> Uninsured rate: 8.6% (25th lowest)
> Median household income: $64,500 (9th highest)
> Premature deaths per 100K: 273 (4th lowest)

4. Massachusetts
> Nonelderly adults with past-due medical debt: 16.1%
> Uninsured rate: 2.8% (the lowest)
> Median household income: $70,628 (6th highest)
> Premature deaths per 100K: 269 (3rd lowest)

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5. Connecticut
> Nonelderly adults with past-due medical debt: 16.3%
> Uninsured rate: 6.0% (11th lowest)
> Median household income: $71,346 (5th highest)
> Premature deaths per 100K: 266 (2nd lowest)

6. Utah
> Nonelderly adults with past-due medical debt: 18.2%
> Uninsured rate: 10.5% (16th highest)
> Median household income: $62,912 (13th highest)
> Premature deaths per 100K: 288 (11th lowest)

7. Maryland
> Nonelderly adults with past-due medical debt: 18.6%
> Uninsured rate: 6.6% (17th lowest)
> Median household income: $75,847 (the highest)
> Premature deaths per 100K: 317 (22nd lowest)

8. New York
> Nonelderly adults with past-due medical debt: 18.8%
> Uninsured rate: 7.1% (20th lowest)
> Median household income: $60,850 (15th highest)
> Premature deaths per 100K: 283 (8th lowest)

9. Nevada
> Nonelderly adults with past-due medical debt: 19.4%
> Uninsured rate: 12.3% (7th highest)
> Median household income: $52,431 (22nd lowest)
> Premature deaths per 100K: 361 (16th highest)

10. North Dakota
> Nonelderly adults with past-due medical debt: 19.5%
> Uninsured rate: 7.8% (21st lowest)
> Median household income: $60,557 (16th highest)
> Premature deaths per 100K: 314 (20th lowest)

11. Rhode Island
> Nonelderly adults with past-due medical debt: 19.5%
> Uninsured rate: 5.7% (7th lowest)
> Median household income: $58,073 (19th highest)
> Premature deaths per 100K: 299 (13th lowest)

12. Michigan
> Nonelderly adults with past-due medical debt: 19.7%
> Uninsured rate: 6.1% (12th lowest)
> Median household income: $51,084 (18th lowest)
> Premature deaths per 100K: 357 (17th highest)

13. Illinois
> Nonelderly adults with past-due medical debt: 19.9%
> Uninsured rate: 7.1% (20th lowest)
> Median household income: $59,588 (18th highest)
> Premature deaths per 100K: 321 (25th lowest)

14. Vermont
> Nonelderly adults with past-due medical debt: 19.9%
> Uninsured rate: 3.8% (2nd lowest)
> Median household income: $56,990 (20th highest)
> Premature deaths per 100K: 289 (12th lowest)

15. New Jersey
> Nonelderly adults with past-due medical debt: 20.1%
> Uninsured rate: 8.7% (25th highest)
> Median household income: $72,222 (4th highest)
> Premature deaths per 100K: 286 (10th lowest)

16. Ohio
> Nonelderly adults with past-due medical debt: 21.3%
> Uninsured rate: 6.5% (15th lowest)
> Median household income: $51,075 (17th lowest)
> Premature deaths per 100K: 377 (12th highest)

17. Pennsylvania
> Nonelderly adults with past-due medical debt: 21.8%
> Uninsured rate: 6.4% (14th lowest)
> Median household income: $55,702 (21st highest)
> Premature deaths per 100K: 343 (20th highest)

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18. Oregon
> Nonelderly adults with past-due medical debt: 22.1%
> Uninsured rate: 7.0% (18th lowest)
> Median household income: $54,148 (25th lowest)
> Premature deaths per 100K: 309 (17th lowest)

19. Colorado
> Nonelderly adults with past-due medical debt: 22.2%
> Uninsured rate: 8.1% (22nd lowest)
> Median household income: $63,909 (11th highest)
> Premature deaths per 100K: 279 (6th lowest)

20. South Dakota
> Nonelderly adults with past-due medical debt: 22.2%
> Uninsured rate: 10.2% (18th highest)
> Median household income: $53,017 (23rd lowest)
> Premature deaths per 100K: 320 (23rd lowest)

21. Iowa
> Nonelderly adults with past-due medical debt: 22.3%
> Uninsured rate: 5.0% (5th lowest)
> Median household income: $54,736 (25th highest)
> Premature deaths per 100K: 309 (18th lowest)

22. Idaho
> Nonelderly adults with past-due medical debt: 22.7%
> Uninsured rate: 11.0% (12th highest)
> Median household income: $48,275 (11th lowest)
> Premature deaths per 100K: 309 (17th lowest)

23. Wisconsin
> Nonelderly adults with past-due medical debt: 23.0%
> Uninsured rate: 5.7% (7th lowest)
> Median household income: $55,638 (23rd highest)
> Premature deaths per 100K: 302 (15th lowest)

24. Washington
> Nonelderly adults with past-due medical debt: 23.7%
> Uninsured rate: 6.6% (17th lowest)
> Median household income: $64,129 (10th highest)
> Premature deaths per 100K: 285 (9th lowest)

25. New Hampshire
> Nonelderly adults with past-due medical debt: 23.8%
> Uninsured rate: 6.3% (13th lowest)
> Median household income: $70,303 (7th highest)
> Premature deaths per 100K: 280 (7th lowest)

 26. Arizona
> Nonelderly adults with past-due medical debt: 24.3%
> Uninsured rate: 10.8% (15th highest)
> Median household income: $51,492 (20th lowest)
> Premature deaths per 100K: 321 (25th lowest)

27. Wyoming
> Nonelderly adults with past-due medical debt: 24.3%
> Uninsured rate: 11.5% (10th highest)
> Median household income: $60,214 (17th highest)
> Premature deaths per 100K: 341 (22nd highest)

28. Nebraska
> Nonelderly adults with past-due medical debt: 25.2%
> Uninsured rate: 8.2% (23rd lowest)
> Median household income: $54,996 (24th highest)
> Premature deaths per 100K: 302 (14th lowest)

29. Texas
> Nonelderly adults with past-due medical debt: 25.4%
> Uninsured rate: 17.1% (the highest)
> Median household income: $55,653 (22nd highest)
> Premature deaths per 100K: 340 (23rd highest)

30. Delaware
> Nonelderly adults with past-due medical debt: 25.5%
> Uninsured rate: 5.9% (8th lowest)
> Median household income: $61,255 (14th highest)
> Premature deaths per 100K: 343 (19th highest)

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31. Virginia
> Nonelderly adults with past-due medical debt: 25.8%
> Uninsured rate: 9.1% (23rd highest)
> Median household income: $66,262 (8th highest)
> Premature deaths per 100K: 315 (21st lowest)

32. Alaska
> Nonelderly adults with past-due medical debt: 26.2%
> Uninsured rate: 14.9% (2nd highest)
> Median household income: $73,355 (3rd highest)
> Premature deaths per 100K: 345 (18th highest)

33. New Mexico
> Nonelderly adults with past-due medical debt: 26.7%
> Uninsured rate: 10.9% (13th highest)
> Median household income: $45,382 (6th lowest)
> Premature deaths per 100K: 363 (14th highest)

34. Louisiana
> Nonelderly adults with past-due medical debt: 26.9%
> Uninsured rate: 11.9% (8th highest)
> Median household income: $45,727 (7th lowest)
> Premature deaths per 100K: 446 (6th highest)

35. Kansas
> Nonelderly adults with past-due medical debt: 27.0%
> Uninsured rate: 9.1% (23rd highest)
> Median household income: $53,906 (24th lowest)
> Premature deaths per 100K: 342 (21st highest)

36. Montana
> Nonelderly adults with past-due medical debt: 27.3%
> Uninsured rate: 11.6% (9th highest)
> Median household income: $49,509 (14th lowest)
> Premature deaths per 100K: 339 (24th highest)

37. Tennessee
> Nonelderly adults with past-due medical debt: 27.3%
> Uninsured rate: 10.3% (17th highest)
> Median household income: $47,275 (9th lowest)
> Premature deaths per 100K: 430 (8th highest)

38. Maine
> Nonelderly adults with past-due medical debt: 27.7%
> Uninsured rate: 8.4% (24th lowest)
> Median household income: $51,494 (21st lowest)
> Premature deaths per 100K: 314 (20th lowest)

39. Florida
> Nonelderly adults with past-due medical debt: 28.1%
> Uninsured rate: 13.3% (5th highest)
> Median household income: $49,426 (13th lowest)
> Premature deaths per 100K: 325 (25th highest)

40. North Carolina
> Nonelderly adults with past-due medical debt: 28.9%
> Uninsured rate: 11.2% (11th highest)
> Median household income: $47,830 (10th lowest)
> Premature deaths per 100K: 362 (15th highest)

41. Georgia
> Nonelderly adults with past-due medical debt: 29.2%
> Uninsured rate: 13.9% (3rd highest)
> Median household income: $51,244 (19th lowest)
> Premature deaths per 100K: 372 (13th highest)

42. Alabama
> Nonelderly adults with past-due medical debt: 30.0%
> Uninsured rate: 10.1% (19th highest)
> Median household income: $44,765 (4th lowest)
> Premature deaths per 100K: 461 (3rd highest)

43. Oklahoma
> Nonelderly adults with past-due medical debt: 30.0%
> Uninsured rate: 13.9% (3rd highest)
> Median household income: $48,568 (12th lowest)
> Premature deaths per 100K: 453 (4th highest)

44. Missouri
> Nonelderly adults with past-due medical debt: 30.6%
> Uninsured rate: 9.8% (20th highest)
> Median household income: $50,238 (15th lowest)
> Premature deaths per 100K: 381 (11th highest)

45. Kentucky
> Nonelderly adults with past-due medical debt: 30.9%
> Uninsured rate: 6.0% (11th lowest)
> Median household income: $45,215 (5th lowest)
> Premature deaths per 100K: 443 (7th highest)

46. South Carolina
> Nonelderly adults with past-due medical debt: 32.4%
> Uninsured rate: 10.9% (13th highest)
> Median household income: $47,238 (8th lowest)
> Premature deaths per 100K: 400 (9th highest)

47. Indiana
> Nonelderly adults with past-due medical debt: 32.5%
> Uninsured rate: 9.6% (21st highest)
> Median household income: $50,532 (16th lowest)
> Premature deaths per 100K: 382 (10th highest)

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48. West Virginia
> Nonelderly adults with past-due medical debt: 33.0%
> Uninsured rate: 6.0% (11th lowest)
> Median household income: $42,019 (3rd lowest)
> Premature deaths per 100K: 466 (2nd highest)

49. Arkansas
> Nonelderly adults with past-due medical debt: 36.3%
> Uninsured rate: 9.5% (22nd highest)
> Median household income: $41,995 (2nd lowest)
> Premature deaths per 100K: 446 (5th highest)

50. Mississippi
> Nonelderly adults with past-due medical debt: 37.4%
> Uninsured rate: 12.7% (6th highest)
> Median household income: $40,593 (the lowest)
> Premature deaths per 100K: 487 (the highest)

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