Bitter Pill: A Demographic Analysis of Unpaid Medical Bills

In this paper, we explore the relationship between past-due medical bills and worker demographics. For comparative purposes, we also look at other forms of debt. We focus on adults of working age, because they experienced an increase in cost sharing in their health benefits. Data from the FINRA Foundation’s 2021 National Financial Capability Study (NFCS) are used for this study. In our analysis, we observe:

Despite the increase in cost sharing, the percentage of Americans who reported having past-due bills from a health care or medical service provider remained unchanged between 2015 and 2021.
Since 2015, the percentage of Americans who reported past-due medical bills has remained in the low 20 percent range, down from 26 percent in 2012.
Compared with other sources of debt, Americans were less likely to report that they had past-due medical bills.
Women were slightly more likely than men to report that they had past-due medical bills.
The likelihood of having past-due medical bills increased with age for younger adults but decreased with age for older adults.
Black adults were more likely than other race/ethnicity groups to report that they had past-due medical bills.
Adults with a high school degree or less were more likely than those with a college or graduate degree to report that they had past-due medical bills.
As income increased, the odds of having past-due medical bills decreased.
Health insurance and living in a Medicaid expansion state reduced the percentage of individuals reporting that they had past-due medical bills.
Past-due medical bills were highly correlated with a lower level of use of health care services.
Individuals with past-due medical bills were more likely than those without past-due medical bills to report several other financial challenges.

Although levels of medical debt are often low, there is still the potential for adverse effects as a result of that debt. Medical debt on credit reports can affect one’s ability to obtain a mortgage, get a lease for an apartment, get insurance, get a job, and obtain other forms of credit. Medical debt may also affect credit worthiness, which affects the interest rate that a consumer can get on a loan. Medical debt may also lead to delay or avoidance of health care, which can result in not just higher health care costs in the long term, but also worse health outcomes. Beginning in July 2022, the three major credit reporting bureaus began phasing in changes to the way medical debt is included in credit reports to address some of these adverse effects.

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Jake Spiegel is Bitter Pill: A Demo Pastg -Du ra e p Med hic ical A Bills, nalys Indiv is idua ols A f Un ges p18 a – id 64,Medical Bills Past-Due Medical Bills, Individuals Ages 18 –64, Past Aver -Du age e Med Copay Past ical -Du m Bills, en e Med t and In ical diCoinsu vid Bills, uals A ra Innce di ge vs id for 18 ua – ls A a P 64, hy ge by sician s A18 nx – ie 64, O ty ffice Relat Visit, ed to Past-Due Medical Bills, Individuals Ages 18 –64, by Savings for by Income Variation Over the Past Year, 2021 Figure 10 40% d a w p t w ha d e e ho aop m ult s t og r it ne le s e inf w w rv ta o a it e 2018/. p or s h rr hic e c se v p p e ea so r d r. st v y r e For t b - d d y d tiff ha ue tt he o c ic tom ul m rt e he m te p p d t ult or y a o ic rt ha is iv c a o tl b on a he d vr e ia ill p y p rt s r a ur e ha e st xpe p e a -d m na d ose ue p ns aly a ine s, w st si e m s s -d e d . a e d ue st Thi nd ic a a a ls m b s p l o la e b e cy on .d ill look a ic A s ac . ls a lleN l b o, r the nin etill a the ot r isrg ly . he b Ov fin sh one ill rs in a d a e for r ing r-e tone hir m of d s of t d e - a y ha ser p d (31 ic ult d lf (5 v a e s w e l mont p bs fur e t6 p .r it c D h ea e tnt he h ( t p ra c ) ae rst fr Fi of nt e om -gxa d )indiv ur ue of m e the ina c m 17 idua ur eFI ) tr d ion. . eic N ls They nt a RA a l b m g Founda e ill ew s 25 m s d ebre e e– rc s of a 34 rte ls ion’ ao ha sed tm s he dor 2021 pe a st- a Research Associate at EBRI. This Issue Brie by f w G as w end riter tenand with a Ass ge, ista 2021 nce from the Institute’s research and editorial Among individuals with health insurance, one-by qua Credit rter (24 Record, percent) re 2021 ported that they had past-due medical bills (Figure Among Workers in PrivPer ateson -Sector al Fin Establishm ances, 2021* ents With Copayments or by Use of Health Care Services, 2021 Fi gure 13, Past-Due Medical Bills, Individuals Ages 18–64, by Household Income, 2021 ............................................ 12 Children’s College Education, 2021 Pa ul Fronstin, Ph.D., Emplo yee Benefit Research Institute, and Jake Spiegel, Employee Benefit 40% 1 Past-Due Medical Bills, Individuals Ages 18 –64, by Education, 2021 sl d A N lik ue ra ight e m tly iona e m d ly te o Se d o l Fina ric v ere a p vrl b ic or tnc e he till s tia s, c ha rp e l C a p tom st o a crp ov td a p ee e b d acrili r a ing t et ha d d ye t w St .t he tFu it udy (NF he h ir ry t18 he m ha ont r p, d eC w rhly p c S) o a erst nt k are ee - xpe d r as r ue m us ns ong e m e pe d or e s d for ttw hos ic ed a a ts l his h eb som a ill a v g st s ing e . udy. es 55 Thi wpha a s is st – tThe 64 -d d c iff ue o ( Fi ic m foc ul g m pur a us te. rd e e Iic of n cont d 7a )w l b t. hi it Thi ill h s p rs2 a s m a l8 p st epss , e ae tr y hose fr r is cb e e e q on nt ue dw ue a a nt it m dho ly ult t ong o ut ts t ha he a p vg n o a e e c st te s 18 or t-rhe d a re ue ns rla – 64 tta y ion nd pw es ho 24 70% 14 sta)ff . . In cont Any vie ra w st s, e35 xpr peess rce ed nt in of this indiv reidua portls a rw eho those were of uni the ns aur utehor d ha s, a d nd past sh -d ould ue m not ed ic ba el a bsc illr sibe . Wde ta o lsto hefin offic d tha ers, t t indiv rusitd eua es, ls 45% Has UCoin npaid Me surance, dical Bills No 2002 Unpai – d2020 Medical Bills 36% 70% Has U Ha nps a U id np Me aid d icMe al B diic lls al BillsNo Unp No Unp aid Me aid Me dical di B cal ill B s ills Carried a Credit Card Balance in the Past Did Not Fill Prescription Because of the Cost Res Our McG int fin ea y drch I , ings th Tom 50%ns , a Me tt itut indiv lanie e idua Evals ns w , it ah he nd Aa nna lth insu Wilde ra nc Ma e ta he nd w Me s. those n20W 21 om re . si e"nMe ding thod in Me olog dy ic: aH id ow exp th ae ns W ion st SJ Aa na tely s ze wd e rH eospit less a lik l P er ly ic ing to 2 Figure 14, Past-Due Medical Bills, Individuals Ages 18–64, by Health Insurance Status, 2021 .................................... 13 33% of b p w me e e er td rd w ce e e ic e b nt of a e tl b , n inc a w su m ill or cs ong h a k om w ing e s r er t hose e a a e g nd m veolv or , a b w e ing g e ho e t cha a ac us ha n r nd e e d t d , , w it tne a he ic s not ce v a r e r e a d rfor s lik se e dd e er , b e v ata ly e b d or ov yt oung o in t e non r , ehe tp he - e or b rA y a tp r nk e m teha xpe r e s lo d on t a rit Se ie ns ’ sw nc r .a v aSt b e ic s ili d e ill not ts a , yn inc t (t he Fi o at ga ur fa a ff rll d e or c ea t se 12 d iff t ha he ic ). in c tult a tlt he ost h ca to p c sh rov r ee a v. e r aing rW le tnc he he in t e n g ir of m he eont p nde ira st h hly e r- a d a lt ue nd eh b xpe m ae g ns ene e d e ic a fit s. r ae s. l b ill s or other sponsors of EBRI, EBRI-ERF, or their staff. Neither EBRI nor EBRI-ERF lobbies or takes positions on specific residing in Me 70% dicaid-expansion states were less likely (20 percent) than those residing in states that did 41% not expand 35% Year $35 Average Copayment Average Coinsurance 30% September 1, 2022 • No. 568 Has Unpaid Medical Bills No Unpaid Medical Bills report tha Dt 35 a tt% a he ."y W ha all St d pa rst ee-td ue Jour m na ed l, icJauly l b ill 6. Ac s we creess re ed inf A or pc ril 29, 202 ed by the2. reht grte pss s:/ ion a /wwna w.w lysi sjs.c . om The /afin rtic dle ings r s/me etla hod tedolog to y-how- 3 c ha om s not bine c dha , 35 w nge %e fin d d d etspit hat,e a rm isiong ng out all a -of g- ep g oc roup ket s 34% c, os wtom s, eespe n wce ia re lly m dor ure ing like the ly tC ha OVI n me D-19 n to r pande epor m t ic p,a st is -not due a m jus edtic ifiacl e ation xpe ns fore s p Me olic dic y apid rop (40 27 osa % pls e. rcE eB nt RI ) tinv o rit ee ps c ortom tha m t etn he t y on ha this d p r ae st sea -due rch. m edical bills. 44% 45% Figure 15, 60 P% ast-Due Me 58% dical Bills, Individuals Ages 18–Figure 64, bSy k iUse pp 12 ed M of edH ical e a Tlt esh C t, Tra ea re tm Se ent o rv r Fol icels, 202 ow-Up Re 1 c.............................. ommended by 14 32% 58% The hous d ea hold tat he p r spe e -w sent sj nding -a ena d in t ly reze la his d tiv - hospit e p a tp o einc ra a l- om rp er it e cim ing and e- ly d inc a gtiv aom - e116255835 n th e ceha re ng ceent s w 71. a nnounc ere also em ree inf ntor tha ced t tb he y tthe hr ere e gm re ass jor ion a cred nit aly bsi ur s, w eaus hil a er e those 60% 56% a Doctor Because of the Cost ( cFi om gur pla e c8 e)nc . y on the part of policymakers or employers. Inflation increases will, in all likelihood, eventually cause health $3 Us 0 ed Non-Bank Borrowing in the Past Five Past-Due Med 54% ical Bills, Individuals Ages 18 –64, by $28.19 U.S. $28.15 Armed $27.90 Introduction 58% $27.62 31% 32% 30 60 % % $27.34 $27.23$27.34 $27.34 25% $27.17 $27.05 30% $26.92 Fi ov reg la eur rtha eed ul 1t6 o ing , inc P a how om st-D e m ue st e a d Me Yb ic ea ili a d rt sl d y ic a we el bB tr ill e is s, I not rendivi flect . How e dd ua e on vls er A , crg te he eds 18 it b riv e– a p64 ror ia,tt s e b : y fin Sp dings r ending ela Re teld a ttiv o einc to om Inc eom staeb, ili 20 ty21 w e ............................. re not as strong as 14 40% Past-due medical bills were highly correlated w$26.30 ith a lower level of use of health care services. Among individuals who care costs to increase as well. It may just be a matter of time before the prevalence of past-due medical bills increases. Suggested 35% citation: Fronstin, Paul, and Jake Spiegel, “BitHa ter d a P Me ill: dA ical D Pe rob mlog em b ra ut pDi hic d N A ot na Go ly to sias of Doctor o Unp r Cl aid inicMedical Bills,” 30 30% % Services Status, 2021 $25.38 $25.09 $25.15 $25.09 29% Ortaliza, Jared, Matthew Rae, Krutika Amin, Matthew McGough, and Cynthia Cox. 2021. Most Private Insurers are no 50% 28% Over the past two decades, cost sharing in employment-based Becau he se o alt f th h p e Co lasns t has been increasing. Hence, workers with ot Rahe cer/E fin thni dings. city — Black adults were more likely than those of other race/ethnicity groups to report that they had past- 60% reported that they had past-due medical bills, 58 perceFigure nt repor17 ted that they had not filled a prescription because of the Bit ter Pill: A D 49%emographic Analysis of Unpaid Medical Bills $25 $23.44 EBRI Issue Brief, no. 568 (September 1, 2022). 50% Figure 17, Past-Due Medical Bills, Individuals Ages 18–64, 26% by Difficulty Covering Expenses, 2021 .............................. 15 56% 50% 35 $22.40 % 25% • B Long eginn ering Wain July iving C ost 2022 -sh , a Erq ing uifa for x, Tr COVI ansD Union -19 Tr , a end atm Ee xpe nt. rW ian a sh stingt oppon, ed inc DC luding : Kais e m r e Fa dic maily l d Founda ebts tha tion. t weA re c cessed health coverage through their job often pay more out of pocket for health care services than they did in the past. For 20% due medical bills. Thirty percent of Black adults reported past-due medical bills, compared with 26 percent among 25% Past-Due Medical Bills, Individuals Ages 18 –64, cost; 56 percent reported 25% that they skipped a medical test, treatment, or follow24% -up recommended by a doctor; and 54 H 30 50 a% % ve a Mortgage or Home Equity Loan 31% 20.5% 20.5% 28% 20.2% 25% 20.1% 20.1% 20.0% 19.8% Paul Fro A pr pns erv il 29, 202 ious tin, P ly in c h.D., 2. ht olle E tcpts:/ ions mplo /ww . ye w.he e Ben althsyesftit emRes trace kearrch I .org/br ns iet f/itut mose t-, pa riv nd ate Ja -ins ke ur Spiege ers-are-no l, -long Emp erloye -waive ing Ben -cost e-fit Fi exa gur me p le 18 , , aP g arst ea -D teue r num Med bic ea r l oB f w ills, I orkndivi ers ha dua ve ls a 45% A d ge ed s 18 uctible –64 ,a 27% b s p y I anc rt om of tehe Va ir rhe iata ion O lth pv la en r . th Ae nd P a ast m ong Yea rindiv , 2021 idua .................. ls with a 16 W hite adult 25s, 24 p % erce22% nt among Hispby anic Diff adult icult s, ay nd Cov 12 p ering ercentExpenses, am 19.2% ong Asian a 2021 dults (Figure 9). CopT yr hig ish Iss t In uform e Brief ati w on a:s su This p p reo pror ted t is by cop ay gra right ne t fr d bo ym the th E em FINR 19.0% ployeA e B In ev ne es fitto Re r E sea du rc ch I atins on tit Fou ute n (E dB aRI ti) o. nY .ou Thm e ay copy, percent re40 por %ted tha 23% t they did not go to the 18.9% doctor for 18.8% a m 18.9% edical problem because of the cost (Figure 15). $20 18.6% 18.6% 50 30 70% % % 18.5% 18.3% 22% 18.0% Res •e arch I sh Mead ric ing ns al d -tfor itut eb -c ts w ov e id ill- 19 not -t rb ee a trm efl ee nt c/. te d on credit reports until they have been past due for one year. Limitat4ions 17.4% 0% of the Analysis deductible, the average deductible has been increasing. Between 2002 and 2020, the average deductible increased study was conducted through the EBRI Center for Research on Health Benefits Innovation (EBRI print, or download this report solely for personal and noncommercial use, provided that all hard copies retain a 15 ny % and 25% 23% Figure 19, 20P % ast-Due Medical Bills, Individuals Ages 18–64, by Changes in Household Income, 2021 .......................... 20% 16 40% 38% Has Unpaid Medical Bills No Unpaid Medical Bills E duc •a tion In 2023 — Adul , tm s w edit ich a aHa l d vhigh e e an bt s b Asc uto L ehool lo ow an $5 diploma 00 will or no lelong ss weerr e b em ror epeor lik teedly on tha cn retdhose it repw or itth a s. college or graduate degree to 20 25% % 29% fr Ther ome $ a 650 re at o num $1,9 be 45 r of am lim ong ita ttions hose w w itit h us h em ing ploy the ee N -only FCS tco ov ee xa ram ge ine , a nd med itic inc al d ree ab sed t. Fi fr rst om , m $e 1,39 dica5 l d to eb $3 t a ,722 nd p aam stong -due t hose all cop CR $1 yH r 5ight BI), a nd whot iche h r r ec apeiv plices ab f leu not ndin ice gs c su ont pp ao ine rt fr d to he m r th ein, a e fnd ollo you win m ga organ y cite or iz a qti uot on es s :m Aon all p , B orlu tions e Cros of the s B rlu epe ort 32% 30% 4 20 0% % Rae, Matthew, Gary Claxton, Krutika Amin, Emma Wager, Jared Ortaliza, and Cynthia Cox. 2022. The Burden of Medical report that they had past-due medical bills. Nearly one-third (32 percent) of those who did not complete high school Figure 20, Past-Due Medical Bills, Individuals Ages 18–64, by Credit Record, 2021 ................................................... 20% 17 with family 60 c % overage (Figure 1). Copayments have been increasing as well. The average copayme18% nt 58% for an office visit medical bills are not necessarily the same thing. The NCFS does not include inf 20% ormation on the length of time the Shield Association, FINRA Investor Education Foundation, ICUBA, JP Morgan Chase, Pfizer, and provided t20 ha % t you do so verbatim and with proper citation. Any us 19% e beyond the scope of the foregoing requires EBRI’s 30% 10% 20% 15% A contribut Deib ng t in t fache tor Unit to te his d St cha ate nge s. W waash s r ingt eseon, arch DC tha : K t afound iser Fa pm ast ily 18% - dFounda ue med tion. ical b Aill cc s etss o e bd e A ap n un ril 29, 202 reliable2. indicator of a A T A G L A N C E 26% 17% 17% 18% 15% Figure 25 and 29 percent of those with only a high school diploma reported past-due medical bills, compared with 17 percent inc merdeic aa $1 sed l b 0 ill frs ha om v $e 22 b.e 40 en in 200 past d 2 t ueo . $2 And 6.92 it d in 2 oes not 020 (F prigur ovide e 2) inf . or Coins mation o urancn th e raet eas for mount offic of ep v ais stit-s inc due r m ee ad sed ica l b mor ills e. 30% priorPh express RM 15 A. An % pery m vi issi ews ex on. Forp p re es rm sed issi in ons, p this le r aep se o cont rt a arce th t EBo RI s e of th at perm e a issi u ons@e thors a brn i.or d sh g. ould not be ascribed to 16% 20% 20% Figure 21, Past-Due Me Ha dic vea a l S Btud ills, I ent Lo ndivi an duals Ages 18–64, by Emergency Fund, 2021 ................................ 16% .............. 17 23% 19% 19% person’s ht ab tp ilis:/ ty /ww to pw ay.he ota he lths r dye sb te ts m (tC E ra onsu sctk im er a m .or te ed g r /br C Fio na ie e 28% fnc f/ fic tia he iel P n -tb s rur ot fo d ere c P tnion B - ro of b-im tur R ee d ea g icu 2014 ra els -d se io bn t)- .o in n- tP he ro-b uni abtie lid ty - st oa f t H ea s/ v.in g Past-Due Medical Bills 18% 30 20% % 28% a mong those with a college degree and 18 percent among those with a 17% graduate degree (Figure 10). modestly, 15 but % since coinsurance requires plan participants to pay a percentage of the charge, out-of-pocket payments In this pap 15 15 e% % r, we explore the relationship between past-due medical bills and worker demographics. For comparative the officers, trustees, or other sponsors of EBRI, EBRI-ERF, or their staffs. 14% Estimated Statistical Estimated Statistical 48% 50% 12% 24% 5% 20% The FigurN eFC 22 S , d Poe ast s not -Due inc Me lude dica l inf Bill ors, mI andivi tion o dua n b lsa nk Agreuptc s 18y– a 64 nd , b how y Sa it vings for relates t C o hil m de rd eic n’a s C l dolle ebt 17% g a end Edp uc ast at-ion, due 20 me 21 dic ............. al bills. 18 $5 Report availability: This report is available on the internet at www.ebri.org for coinsur 10 a% nce increase with office visit costs. Coefficient Significance Coefficient Significance purposes, we also look at other forms of debt. We focus on adults of working age, because they experienced an 11% 9% 10% 20% 9% Marital Status and Children — Family structure affects the odds of having past-due medical bills. Married and never- 10% We know from prior research that past-due medical bills often play a role in bankruptcy. 8% FINR Have Unp 20 A % In aidv Me es dito calr B E illsd Tha uct A ati reo Pn as Fou t Due ndation 8% 13% 10 10% % 22% increase in cost sharing in their health benefits. Data from the FINRA Foundation’s 2021 National Financial Capability Figure 23, Past-Due Medical Bills, Individuals A 8% ges 18–64, by Savings, 2021 ............................................................ 18 Endnotes 10% Work Sm taa tursried adults were least likely to report that they had past-due medical bills. About Ma rone ital S-tq aua tusrter of married and never- Self-employed -0.04 Never married -0.18 *** $0 0% Tabl e of Contents 10% 4% St udy (NFC 40S) % are used for this study. In our analysis, we observe: About the National Financial Capability Study 5% 3% 5% 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Part time -0.06 Separated -0.25 *** Finally, whil 5% e we are interested in t 2% he working population because they are most likely to have health insurance from marrThe ied a FI dN ult RA s rIenv por est teor d p Ea dst uc -d aue tio n Found medical b ation, ills, ceom stap ba lis re he d d w it in 200 h 29 3 b pery c etnt he aFi m na ong nc ia wl I ido ndust ws/wid ry Re owgeula rs, tor 32y pA eut rchor entit a ym , ong Figure 24, Past-Due Medical Bills, Individuals Ages 18–64, by Anxiety Related to Personal Finances, 2021 ................. 19 10% 0% 5% 10% 15% 20% 25% 30% 35% Introduction 5% .......................................................................................................................................................... 4 10% 1 0% Homemaker Figure 14 0.01 Divorced -0.38 *** Source: Medical Expend3% iture Panel Survey Insurance Component (MEPS-IC). a n e Them qpue loy stion er, to he n rp ea s ist -no dueinf un or pm aid a tme ion in dicatl he bil ls N FC waS s on word the ed v a asr ious follo w tysp : e"Do s of yins ou ur curre ancntly e tha ha t vindiv e any idua unp lsa ha id b ve ill. s The from NaFC he S alth d ivorcees, and 41 percent among separated adults (Figure 11). Similarly, larger families were more likely to report that Inc., empowers underserved Americans with the knowledge, sk 32% ills, and tools to make sound financial decisions • De0% spite the increase in cost sharing, the percentage of Americans who reported having past-due bills from a Note: Data not collected in 20 Y0es 7. Copayments shown in 2020 dollars. No Don't Know, Prefer Not To Say The Na 5% tional Financial Capability Study (NFCS) has been conducted every three years since 2009 by the FINRA SoS urc tu ed : e Em ntployee Benefit Research Institute (EBRI) estimates from the 2021 Nati -o 0n .3 a5 l F*** inancial Capability Survey (NFCS). Widowed -0.26 *** Figure 25, Estimated Coefficients for Probit Regression on Probability of Having Past-Due Medical Bills ...................... 20 Worker DemograpPast hics a-nd DuP e ast Med -Due ical Med Bills, ical Bill In s di ................................ viduals Ages 18................................ –64, by Health Insu ................................ rance .... 7 0% Strongly Disagree 2 3 Neither Agree Nor 5 6 Strongly Agree care or medical service provider (e.g., a hospital, a doctor’s office, or a testing lab) that are past due?" only asked one question as to whether the individual had any form of health insurance. We do not know the source of theyt ha hroug d p0% a hout st-d ue life m . For edic d ae l b taiils lls, . v Ais m itong ww a wd.FI ultN s w RAit Founda h four tor ion.o mor rg e. children, 39 percent had past-due medical bills, 30% 0% he0% alth care or medical service provider remained unchanged between 2015 and 2021. Investor Ed Duc isaa blteion Found d ation to benchmark key indicators of 0fin .31a*** ncial capability and to evaluate how Marrie d the (rese ference) Income Is Roughly the Same Amount Income O Di cc sas agree ionally Varies Income Varies Quite Often Source: Employee Benefit Research Institute (EBRI) estiStatu mates fros, m th2021 e 2021 National Financial Capability Survey (NFCS). Adults, Ages 18 and Figure 1 65+ 0% 0% Workers, 18–64 Non-Workers, Disabled, Other Non-Workers, Ages Very 1825% –B 24 ad 25 Bad –34 Abou35 t A– v44 erage G 45 oo –54 d Very 55 G –64 ood that insurance, or the generosity of the plan. Thus, we are unable to separate workers with health benefits through H com ealt ph I arens d ur wit anc h 31 e, Use perc of ent H E a eac m alt h M ong h C ont aa hrd eult , as w nd it Ph o ast- ne Due chil Me d Fd a rom nd ica Mo l B 21 nill th p ste o M ................................ rco enth nt among those wit F ................................ h no rom Moc nhil th td o M reo n. nth ........... 13 2 24% Unemployed 0.05 • Since Sourc 20e: 15 Emp , tlhe oy Olee d er p Bene ercfie t R nt esa ea grc eh of InstiA tum te e (EB ric RI) e anss ti mw atho es frorm e p A thor ge e 20 st e 21 18 d – N 64 p ata ion st al- d Fina ue nc m ial C eap dic ab 18a i– lil b ty 64 Surv ills ha ey (Ns r FCS). emained in the low 20 The full NFCS sample conta Saviin ngs fo 27, r Chi 118 ldreno 'sb C sol erv lega e E tions ducati . Our on analysis, which liNo mit t S s athe ving fo sa r Ch mp ille dren's to Co adults llege E ad guc es ati 18 on–64, contains indicators vCu arry re n w tly it a h d Mee mm beog r of rth ap e U. hic S, . b Pe reha viou vsior ly aa M l, ea mtbteit r o udina f the Ul, .S a . nd Nefin vera anc Me ia ml lit ber o er f a thc ey U c .Sha . racteris Prt eic fes. r No Mor t to S ea y than 27,100 Average Annual Employee-Only and Family Deductible, M edical debt is different from other forms of debt. Some forms of debt, such as a mortgage, automobile loan, or * Respondents were asked "How strongly do you agree or disagree with the following statement? Thinking about my personal finances can make 0% Number of Children D the espit ir job e t he from inc w R re e or a tirse k ee drA in c s w rmed ost ho Se d rsh vo ica es not ring, hatv he e he pea rc ltA e h b rnt med a eg ne Se e rfit of vics es Atm hre oug rica h th ns -w e 0.ir ho 05 A jrob m re ed , p a S oe s t rrtved ihis ces ha lev vin el o g p f d ast et-a dil w ue b as not ills from ad dar e he ssa elt dh in -0.22 21,617 ob pseerrv ceant tions rang . e, down from 26 percent in 2012. Financ U.ia S.l I a40 ss dult % ue me s a s a feeg lnd ae ns 18 a xio P ua s. st (Pl -nd e D au s ee old g ivMe ee yr od uw ic r ae a nr sl B e we r o ill su s nr ................................ av se cy ale e d of 1 for to 7 t , he whe re 20 1 = 21 “Stro stnudy. ................................ gly Disa The gree,” d 7a =t “Stro a an rg e ly w Age reight e................................ ,” ane dd 4 = to “Ne bith e er r e Ag p re re e sent Nor a ............ tive of 14 Sourc Di ed No : Emp t Co loyemp e Be lete ne Hi fit Res gh S ea crc ho h o In l stitute (EBRI) e High stim S ac te ho s o fro l m the 2021 National FinaCo ncia llleg Cap e ability Survey (NFCS).Graduate Degree Amo ng Workers in Private-Sector Establishments student loa 20 n, % So aurrc ee : tEm akpe lon o yee n v Beneolunt fit Resea a r rcily h In . sC titu onsu te (EBRI) e mer ss c timaa ten sh s fromop the 2for 021 Nat the io nb ale Fist na nint ciale Cap rest ab ilr itya Su terv a eynd (NFCS). have time to consider the cost Full time (reference) Dis Sou arc gre e: e Em ”. Y plo ou y c ee a n Be us ne e fi at nRes y nu em arc be hr In fro sm titu 1 te t o (EBRI) e 7. " stimates from the 2021 National Financial Capability Survey (NFCS). c R ae refe orr m enc edice So as ul se rc e: r Em vic plo ey ep er Be ov neid fit e Res r r ee arc m ha Inin stied tute (EBRI) e unchasnge timated s.fro Si mnc thee 2 020 21 15 Nat, ionta he l Fi np an e cr iacl e Cap ntaa bg ility e Su of rvA eym (NFCS). ericans who reported past-due the NFCS. Financial Issues and Past-Due Medical Bills • Compared with other sources of debt, Americans were less likely to report that they had past-due medical bills. Sou So rcu erc : Em e: Em ploy pe lo ey Be ee n Be efin t e Res fit Res earc ea hrc Inh s ti In tu ste titu (EBRI) e te (EBRI) e stim sa tim tea ste fro sm fro th m e th 20 e2 21 0 Nat 21 Nat iona iol n Fi an l Fi an nca ia nlc Cap ial Cap abila ity bi lSu ity rv Su ey rv (NFCS). ey (NFCS). the national population in terms of agW e, ith gend a Dedu er, ethni ctib city,le, educ 2002 ation –,2020 and census division. State-level estimates 3 Veteran Status Current member of U.S. Armed Forces 0.37 *** Re of Th g the r ee re ss ho ma ion An mye , be aa ut c ly oom si nfso ob ................................ unile ding , or fa tc uit toion rs a . t Ip n con lay in ................................ trthe ast , inte consu raction merb s of etwhe e................................ en altMe h ca dicra eid us eua xplly ans d ion o not ................................ and p p la an to ta st-due kme e on dica m l e b............. d ills ic a tha l dte b a re t19 , 35% medical bills remained in the low 20 percent range, down from 26 percent in 2012 (Figure 3). Furthermore, compared 35% We found • Wtom hate n indiv weidua re slls ight wly ith m por ast e -lik due ely m tha edn me ical bn to ills wre erp eor m t or tha e tlik the elyy tha had n th paose st-d w ue it ho me ut d ic pa al b st-id lls ue . medical bills to Gender can also be derived using weights that accompany the NFCS data, and when weighted, state figures are Male -0.13 *** Veteran 0.07 * Source: Employee Benefit Research Institute (EBRI) estimates from the 2021 National Financial Capability Survey (NFCS). Employee-Only Coverage Family Coverage beyond the scope of the paper. a s it is often the result of a one-time or short-term medical expense arising from an acute medical need (Hamel et al. with other sources of debt, Americans were less likely to report that they had past-due medical bills (Figure 4). For Limitations of the Analysis ................................................................ Figure 7 .................................................................... 21 Household Income — Some of the differences found above may be explained by differences in income. We found that • $4 ,000 The 10%likFe elih maood le (re fof eren ha cev )ing past-due medical bills increased with age for younger adults but decre Na ev sed er s ew rveit dh a (refe gre en ce) report several other financial challenges. representative of each state in terms of age, gende Figure r, ethnic 21 ity and education. Fielding was conducted from June 7% $3,746 $3,722 2016). Because of the way health care expenses are often incurred, most people are not in a position to shop for health C Consu onc m lus er Fi ion nanc ial Protection Bureau. 2014. Consumer Credit Reports: A Study of Medical and Non-Medical 4 Past-Due Medical Bills, Indi Figure Figure viduals A 9 6 ges 18 –64, by Age, 2021 example, 22 percent of adults had past-due medical bill Figure Figure s, comp23 19 ared with 33 percent who carried a credit card balance. More specifically, a probit model was estimated to better understand the relationship between de$3,608 mographics and other 30% a R s inc egr om es es inc ion A reases, naly the s od is d s of having past-due medical bills decreases. For example, one-third of adults with a for older adults. Past-Due Medical Bills, Individuals Ages 18 –64, Conctlu o si Oc on tob ................................ er 2021. ................................................................................................$3,530 .......................... 21 care services like they can for a home, automobile, or education. Furthermore, recent public policy e27% fforts to address Age Collections. Past W Pa ash st -ing Du -Du ton, e e Med Med DC:ical Cical onsu Bills, Bills, mer Fi In na In di nc di via id vid l P ua ua rot ls A e ls A ctige on ge s Bs ur 18 18 ea –u. – 64, 64, Acby ce by H ss eG a e Race ld en th Ma Inde su rc r, r ah 21, , 202 nc2021 e 12022. Many workers st Agre ugg (inPast yle ea w rs)it -Du h pe ast Med -dueical medBills, ical bills In . Tw div eid ntua y-fiv ls A e pe ge r0c .e 0 s 4nt18 *** of –w 64, orkby ers b Sav etwin eegs n th , e 2021 ages of Ha18 s h ea alnd th i n64 sur ance -0.25 *** Medical debt was the most com Past mon -c Du rede it Med accou ical nt lisBills, ted on In crdi edv itid reua corls A ds (Fu ge re s y18 and –64, Kelly 2019). It is important to v Aa m ria ong ble st ho tha se t ma wityh ap ffaest ct -d the ue lim ke elidho ica ol b d oill f s, 35 having p epra cs etnt -d ue spe m nt e dm icor al e b iltls ha . n their household’s $3,342 income over the past year, and $3,500 household income of $15,000 to $35,000 reported having past-due medical bills (Figure 13). In contrast, 14 to 15 • Black adults were more likely than o by the Emergency r race/ethnicit yFu grnd oup, s t 2021 o report that they had past-due medical bills. Figure 11 There is a strong degree of correlation among the various factors examined above and how they interact to impact Status p Re ric fe ing renc tre as ns ................................ par Ae gnc e-sy qu found ared that 34 ................................ percent of hospitals ................................ do not post -0.0 0us 04a *** ble pric ................................ ing d $3,166 ata, and anothe.......................... r 12 D op ee s rnc oe t nt ha ve p ost heal t h 22 in surance (reference) https://files.consumerfinance.gov/f/201412_cfpb_reports_consumer-credit-medical-and-non-medical- 0% 24% by Changes in Household Income, 2021 reported having past-due medical bills. These past-due medical bills can have a cascading effect on both health and recognize 25 tha %t some types of debt in Figure 4 were not necessarily past due, such as mortgages and auto loans. 26 percent spent less than their household’s 18 inc –24 ome 25 (Fi –34 gure 35 16 –) 44 . In com 45–54 paris 55 on, –64among those without past-due medical p 5 ercent of adults with $150,000 or more in household income reported they had past-due medical bills. • Adults wPast ith a high -Due scMed hool d ical egreBills, e or less In di we vrid e m ua or Me ls A e n likge e Wly om s teha n18 n th –64, oseby wit h a Marital collegStat e or us gra d an uad te degree to whether an individual has past-due medical bills. For instance, education and income were highly correlated. To isolate The Wald chi-squared tests Very of Di sff ta ictis ulttical significance are w Sha omt ewha is et Di xaffi mine cult d to determine that No the t at mo All Di dffi el cufits lt the data well. 90% 80% Has Unpaid Medical Bills No Unpaid Medical$2,914 Bills data, but those data fall well short of the requirements (McGinty, Evans, and Mathews 2021). But medical debt also colle 35%ctions.pdf. personal fina 50%nces. Fifty-eight percent of workers with past-due medical bills reported skipping prescription drug fills; 56 $3,000 80% b Eill ndno s, 16 te s p e ................................ rcent spent more tha................................ n their hous Ha ehold s Unp’as inc id Me ................................ om dicale B , ila lsnd No46 Un p pai edr Me cent dic al ................................ spe Billnt s less. ............................ 23 $2,791 Number of Children, 2021 Race/Ethnicity report that they had past-due medical bills. Medicaid Expa 75% nsion Black -0.08 ** 20% Resides in Medicaid expansion state -0.18 *** the unique effect of each of the various factors that may affect the odds of having past-due medical bills, regression Figure 13 tends to b70 e % low, especially relative to other forms of Has U de npb atid . Me A r de icc ale B nt i$2,643 lls report that looked at consumer credit reports in 80% $2,601 p ercent sk20 ipp %ed a test, treatment, or a recommended follow 73% -up appointment; and S54 tate percent skipped seeing a doctor 45% Figure 3 Hispa 4nic -0.16 *** Resides in non-expansion state (reference) • As income increased, the odds of having past-due medical bills decre65% ased. analysis w80 45 as us % % ed. The estimaPast ted coe -Du ffic e ieMed nts frical om the Bills, modIn el di arv eid sh ua owls A n in ge Figs ur18 e 25 –64, . In large part, the model fit the Consumer Fina Sounc rceia : Em l P plr oot yee e Be ctn ion B efit Resur eae rca h u. Insti20 tute22 (EBRI) e . "Me stid mic ate a sl D from e b tht e 2B 0ur 21 d Nat ein in onal Fit nhe anc iaUnit l Cape abd ili ty St Su arv te eys." (NFCS). Accessed March 8, 2022. 45% 2020 found that the median medical debt 30% collection lev$2,351 el was $310, the average was $773, and 62 percent of medical 70% Figure 16 altog $2 et ,50 he 0r, which can have a deleterious impact on managing health conditions. Furthermore, workers may struggle to AsianPast-Due Medical Bills, Individuals Age -0.s 32 18 an *** d Older, 2012 –2021 Worker Demographics and Past-Du No e Unp M aie d Me dica dicall BiB llsills 70% 5 68% 41% • H30 ea % lth insurance and living in a Medicaid expansion state reduced the percentage of individuals reporting that by Household Income, 2021 data well with strong explanatory power. And for the most part, the findings from the model confirmed our bivariate ht30 40 tp % % s://files.consumerfinance.gov/f/docum $2,152 ents/cfpb_medic 71% al-debt-burden-in-the-united-states_re 39% port_2022- Figur d ebt was es unde r $490 (ConsumPast er Fina -Du ncia e l P Med roteical ction B Bills, ureau 2022 Individ ). ua In cont ls Arge asts , a18 O not th – ehe r64, Fr o rrm es p o or f t D efound bt that nearly 10 15% Other -0.02 Credit card debt 0.20 *** obtain app 6 4r0 0ov % % al for housing, mortgages, and other types of credit if past-due medical bills are sent to collections $2,026 68% Overall, one-quarter of workers ages 18–64 reported that the68% y had past-due medical bills (Figure 5). Over one-third (36 70% 27% they had past-due medical bills. findings ab 40 ov %e — the sign effects of most of the coefficients were consistent and conformed to our expectations. 03.pdf. 55% White (reference) Mortgage or home equity loan -0.03 by Spending Relative to Income, 2021 perce $2 nt ,00 of 0 adults had a26% t least $250 in past-due medical bills as of December 2019, 6 percent owed over $1,000, and 1 64% agencies and their credit is adversely affected. $1,758 60% Figure 1, Average Annual Em 26% ployee-Only and Family Deductible, Among Workers in Private-Sector Establishments With percent) of adults unable to work because they were permanently sick or disabled reported that they had past-due • Pa 60 st %-due medical bills were highly correlated with a lower level of use of health care services. 50 35% % $1,667 33% 34% However, there were a few notable differences between the bivariate findings above and the findings fr Au om tom o the bile 0.30 *** 35% 24% $1,979 $1,592 33% $1,945 percent ow 10 25 e% % d more than $10,000 (Rae et al. 2022). Recent estimates suggest that 43 million A $1,921 mer$1,921 icans accounted for $1,532 32% 32% $1,847 60 35% % 46% Househm ole d d In ic ca ol b meill a 25 sD % . e One duc-tq ible ua, rt20 er 02 (24 –20 pe 20 rc e ................................ nt) of other non-work................................ ers ages 18–64 report................................ ed that they had past......................... -due medical bills . 4 50% $15,000–$24,999 -0.12 *** 31% Non-bank debt 0.59 *** Fr onst • in, P Indivi aul, a dua nd ls A w . it Ma h p rk a st Fe -d ndr ueic m k. ed 20 ic21 al b . " ill Es mw pe loy ree m r or Up et a Ha lik ks e e U ly of np taha P id re Me n th -D die cose al d B uc i lltw sible ithout Cov p ea ra stg-e d ue for m Pe re dv ic ea nt l b ivill e s t Seo rvric ep eo s in rt r egression a $1 na ,39ly 5sis that are worth pointing out. 32% $1,500 $1,699 Analysis of the NFCS reveals seve 50% ral demographic and 29% economic patterns 23% in people who reported having past-due $88 billion in medical debt on credit reports (Consu 29% mer Financial Protection Bureau 2022). 45% 3 30 0% % $25,000–$34,999 0.17 ** Student loan 0.41 *** I In cont ndividua rast ls 50 ,w % only ith p 9 p aste -d rcue ent m of eda icdault l bs (whe ills wer the e arls w o or m kor ing e lik ore not ly t o wror ep kor ing) a t tha gte : s 65 and older reported 22% having past-due seve HSA-rE aligib l othe le rH fin eaa ltnc h P iala l c nha s." lle Enge BRIs I . ss ue Brief, no. 542 (Employee Benefit Research Institute). $1,493 47% 50% No Unpaid Medical Bills Figure 2, Av 5% erage 27% Copayment and Coinsurance for a Physician Office Visi $1,426 t, Among Workers in Private-Sector medical debt. First, women were slightly more likely than men to report having past-due medical bills. Age, too, 21% 30% $35,000–$49,999 0.07 * 50% $1,328 40% $1,315 Fi mrest d, ictahe l b ill e 20 st s% . im Da etspit e 25% d e c oe usff ing iciem ntor for e m Be la dcic ka indiv l serv idua ices t ls ha wan younge s negativre a a dnd ults, o statlde istic r a ally dult sis m gnifa ic ya b nt e. ne Thi fits fr m om ea ns the t ha uni t v Bela rsa ckl 40% $1,220 Although le 40v % els of medical debt are often low, there is still the potential for adverse effects as a result of that debt. $1,000 24% 24% E 25 st % ablishments With Copayments or Coinsurance, 2002–2020 ................................ Household Spe ................................ nding .... 5 seemed to 20 ha %ve $5 a 0,n 00int 0–$e 7r 4a ,9c 9t9ion with past-due medical bills: More 25 0– .034 5 -year-olds had past-due medicaS l b peill nds t ingha lesn s 18 tha– n income -0.25 *** 25% $1,120 • Their income varied month to month, either occasionally or quite often (Figure 18). $1,062 36% Fu Altrhoug ey, Mic h le ha ve els l, a of nd mRy eda icn K al d ee lly bt . 20 are 19 oft . "eMa n low rke, 25% t tSna herp esh isot st: illThi the rd p -P ot ae rtnt y ia Dl for ebt Caolle dvecrtse ions ef fe Trcatd s a elin s a e r Reesu por lt tof ing." tha C t onsu debtm . er individuals were less likely than White individuals to report having past-due medical bills. This finding is in contrast to nature of Medicare. And even though the traditional Me 24% dicare program has a high deductible, a recent study found that Relative to Income 35% 40% 21% Medical de 40 25 b 0% % % t on $7c 5r ,0 e 0d 0it –$ 9 re 9,p 99 o9rts can $929 affect one’s ability to obtain a m0or .06 tg *** age, get a lease for an apart 34% meS nt pe , ng die nt g more than income 0.16 *** 24-year-olds, but the prevale $882 nce of past-due medical bills decreased for older age groups. Finally, household income 35% 21% 40% 32% • They experienc $798 ed a large, unexpected drop in income in the past year (Figure 19). Fi Me gd ur ic ea l d 3, Fi e Pna b atst nc on -D iaue c l P re r Me d ot ite drc ic etp ion B ao l rBtill s c ur s, I aen a a ndivi u.ff A ed c cua c t e one ss ls e A’d s a g e Ma s 18 a bili rc ty h 8, tnd o ob 20 Old t22 ae in a . r, 20 m12 or– tg 2021 age, ................................ get a lease for an apa.............................. rtment, get 5 Has Health Insurance Uninsured Resides in Medicaid Does Not Reside in 9 the 0 p fin erd ce ing nt 2 0of t% haMe t w d $735 eic raerp eo b re t n in efic Fig iaur rie es 9ha ab dov su ep . p The leme ent stim al c atov ed e rcaoe ge ff , ic w ie hic nth w for ould Blac k he indiv lp reid dua uce ls cw ost as sh nea gra ing tivea nd becta he us e the $100,000–$149,999 -0.31 *** Spending about equal to income (reference) $500 insurance, get a job, and obtain other forms of credit. Medical debt may also affect credit worthiness, which affects the 20$650 % a ppeared 15 to %have a strong correlation with the propensity to report tha 20% t they E xha pan ds ip on S ast tat -d eue m Me edi dcic aa id l b Expa ills ns , ion wit Sh th tate e 30% 20% • They had a very bad, bad, or about average credit record (Figure 20). 31% insurance ht , tg pe s:/ t a /f jile ob s. , caons nd u ob mte arin finot anc heer.g for ovm /fs of /docc urm ed eit nt . sMe /201 dic90 al d 7_ ecbftp b m_t ay hir ad ls-o pa arff ty e-cdte cbrte-d colle it wc or tio thin ns_r ess ep , or whic t.pd h a f. ffects the model controls $for 150 ,ot 00he 0–$r1 9fa 9,c 9t 9or 9 s that affect whether an individual ha -0.s 31p*** ast-due medical bills. In other words, there may potential for 30% past-due medical bills (Koma, Cubanski, and Neuman 2021). The 17% remainder of this paper focuses mainly 20 15% % Health Insurance Status int Fi ge ur reest 4 , raPtree v tha ale t nc a e c onsu of Va m rio erus 28% ca Ty n g pe ets of on D a elo ba t n for . Me Am dic er aic l d an Adult ebt mas, 20 y also 21 le ................................ ad to delay or avoidanc ................................ e of health care, whic ..h 6 30% 15% percentage 30 30 p % %eaking for households e 28% arning between $25,000 and $34,999 and generally decreasing as hous 15%ehold 15% 26% 26% 12% Income Stability $200,000–$299,999 0.11 ** Medicaid Expansion State Occasionally varies from month to month -0.004 interest rate that a consumer can get on a loan. Medical debt may also lead to delay or avoidance of health care, which be a high correlation between race and other factors, such as income, education, and 14% other forms of debt. on adult $0 s a 1g 5% es 18– 24% 64, because employment-based health benefits are the most common source of health coverage for 15% can result in not just higher health care costs in the long term, but also worse health outcomes. They incomw e einc re25 rle e %a ss se lik d.e ly to:23% H amel, Liz, Mira $3 0 N 0or ,00t0 on, or m K oa reren Pollitz, Larry Levitt, Gary Claxton, and 0.12Molly *** ann Brodie. 2016. "The Burd Ve arn o ies q f uMe ite od ftie cna fl rom month to month 0.01 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Figure 5, Americans Ages 18 and Older, by Pa 22% st-Due Medical Bills, 2021 ................................................................... 8 15% can result 20 in not % just higher health care costs in the long term, but also worse health outcomes. Beginning in July 2022, 10% this group. 10% 18% 20% Sou Lrc es e: sEm tha pln o y$ e1 e5 Be ,00 ne 0fi ( t rRes efere ean rc ch e ) Institute (EBRI) estimates from the 2021 National Financial Capability Survey (NFCS). Roughly the same amount each month (reference) D20 20 eb % % t: Results from the Kaiser Family Foundation/New York Times Me11% dical Bills Survey." Kaiser Family A number 10 of %the socioeconomic findings are also notable. Individuals with incomes of at least $200,000 were more the three m 10a %jor credit reporting bureaus began phasing in changes to the way medical debt is included in credit reports 20% The recent COVID-19 pandemic highlighted issues related to medical debt. When the Families First Coronavirus Figure 6, Past-Due Medical Bills, Individuals Ages 18–64, by Gender, 2021 ................................................................ 8 Impor • tant Re ly, pwe ort tfind hat k the eyy lin ha ks b d ae n e twm eeen r gseve encyr afun l ind d ic (Fi atgor urs eof 21 d)is . t ressed personal finances and a higher propensity to 10 So % urce: Medical Expenditure Panel Survey Insurance Component (MEPS-IC). Foundation. Accessed March 8, 2022. https://www.kff.org/wp 16%-content/uploads/2016/01/8806-the-burden-of- 5% G likeende ly tr ha an th nd A og se e — wit W h th om ee low n we est re inc slight omly es m to orre e p lik oretly ha tha ving n me pan to r st-due e p m or etd ic tha al tb till he s. y C ha olle d g pe a st gr -a dd ue ua m tees dw ice arl eb ill eq s. ua Tw llye lnt ike yly - to address some of these adverse effects. Education Income Change Response A Not cte : (Dat C FF olaC le n g RA oe t c) o llw ecte ad s e in 2na 007c. tDed edu on ctibleMa s shr oc wh 18, n in 202020 dol20 lars, . it required0 t .0 ha 1 t health plans 8% provide benefits rIe nla cot m eed e t xo pet rihe enc ed a large drop in past 12 months 0.46 *** 10% 10% repor •t the Re pp re or senc t sae v ing of pfor ast t-he due ir c m hil ed dic reanl b ’s c illolle s. W gor e e ke druc s w atho ion (Fi carrgie ur de c 22 red ). it card debt or resorted to non-bank loans were 15 5% % 5% 5% Figure 7, m Pe ad st ic -a Dlue -de Me bt-d re ic su al ltB sill -fr s, I om ndivi -thed -k ua ais lse A r-g fa em s 18 ily-– founda 64, byt ion Age -, ne 20 w21 -yor ................................ k-times-medical-bills-................................ survey.pdf. ..... 9 as those without a college education to report having past-due medical debt, whereas our biva 4% riate analysis indicated eight perce 10nt % of women and 23 percent of men reported that they had past-due medical bills (Figure 6). Research 10% Graduate degree -0.06 No large change in income in past 12 months (reference) 3% detection of SARS-CoV-2 without imposing any cost sharing. In addition, many employers were not subjecting plan 2% 5% 0% 5% more • lik ely Re tp o or re t p bor eing t tha ab t le the to y cha om d ep up ast-w dit ue h $2,00 medic0 al w bit ill hin s t ha a n th mont eh ir if a peen une rs witxpe hout ct e the d ne see td y pae rs of ose ( dFi eg bur t. e Sim 23ila ). rly, 5% 4% Less than college (reference) Intercept -1.39 *** su tha gtg c eolle sts t gha e g t rm ad eu n a ate re s le less ss fr lik ee qly ue tnt haly n w reom pore te n to use d having he pa alt st h ca -due re m , a end dica wl d om eb en a t. Thi re s m mor ae y lik bee a ly rte ha sun me lt of n to e the close xperience Married Never Separated Divorced Widowed None 1 2 3 4 or More 10% participants 0% to cost sharing related to the treatment of COVID-19, although by late 2020, these cost sharing waivers Figure 8, Past-Due Medical Bills, Individuals Ages 18–64, by Gender and Age, 2021 ................................................. 10 w orkers who 0%reported being unlikely to come up with $2,000 for an unexpected need were more likely to report that Kaiser Family Foundation. 2015. Gender Differences in Health Care, Status, and Use: Spotlight on Men’s Health. 0% Married Yes No Don't Know/Prefer Not to Say relationship between educational attainment and income in the United States; when income was added to a barriers to health care due to cost (Kaiser Family Foundation 2015). 0% 0% All of this a0% 0% dds up to a m Set uc Ah si de highe Emerge r le ncv ye ol o r Rai f ny anxi Day e Fun ty w dshen it comes to persona No Em l fina ergennc cy o ers Rai . Thos ny Day e Fun witds h past-due medical were being phased out (Ortaliza et al. 2021). And the Coronavirus Aid, Relief, and Economic Security (CARES) Act of ***p<0.0 t1 he , **yp < ha 0.d 05 p , *a 5% pst <0-.d 10 ue . medical bills. While this analysis does not establish the direction of the causal arrow linking these Washington, DC: Kaiser Family Foundation. Accessed April 29, 2022. https://www.kff.org/womens-health- Marital Status Figure 9, Past-Due Med Wic hia tel Bill Ys, I es ndividuaB ls lac A kges 18–64, by Hi Ra sNo pc an ei, c 2021 ................................ AN sian umbe Don't K r of no C w hil /P ................................ dren refer Not Othe to S r ay .. 10 I Am Certain I E Coul xperie d C nc om ed e L up arge I C Dr ou op ld P in I rob nca om bly e Come up With I Could Prob Di ad No bly No t E t Co xperie menc up e La I A rgm e Dro Cerp i tain I n In Coul come d Not Come multivariate analysis, the association between medical debt and education was washed out. Similarly, the effects by 0% bills were more than twice as likely as those without them to report that thinking about their personal finances made 2020 provided economic relief related to the COVID-19 pandemic. It included a provision that allowed health savings Source: Employee Benefit Research Institute (EBRI) estimates from the 2021 National Financial Capability Survey (NFCS). With the Full $2,000 $2,000 With $2,000 up With $2,000 phenomena, targeted interventions that help workers avoid resorting to payday loans, avoid carrying a credit card policy/fact-sheet/gender-differences-in-health-care-status-and-use-spotlight-on-mens-health/. 2012 2015 2018 2021 Source: Employee Benefit Research Institute (EBRI) estimates from the 2021 National Financial Capability Survey (NFCS). marital status and number of children disappeared in the regression analysis, also suggesting that other factors are 0% Sourc EBRI Is e: Emp su loy e ee Bri Bene ef is re fit Rg es ist ea erc re h dIn in sti ttu hte e U (EB .SR . I) e Pat se tin mtat aes ndfro Tr m a d the e m 20 ar 21 k O Nat ffii on ce al . I Fi Sna SN nc:i al 0 8 C8 ap 7 – ab 1i3 lity 7X Surv /90ey 0 (N 88FC 7 –S). 137X/90 $ .50+.50 t Fi he gur me fe 10 el a , P nxi a So st ous (F u-rc D eue : Em igur Me ployed ee ic Be 24 anl eB ). fit ill Res s, I earc ndivi h Instid tuua te (EBRI) e ls Age stis 18 mates– fro 64 m, th b e y 20 2 E 1d Nat uc ioa nt aion, l Finan20 cial21 Cap ................................ ability Survey (NFCS). ......................... 11 account (HSA)-eligible health plans to provide pre-deductible coverage for telehealth services. Nearly all employers balance, or establish a rainy day fund may help reduce the incidence of past-due medical bills. Spending Less Than Income Spending More Than Income Spending About Equal to Income So Sou urc rce e: : Em Emp pllo oy ye ee e Be Ben ne efi fit t Res Rese ea arc rch h In Ins sti titu tute te (EBRI) e (EBRI) es sti tim ma ate tes s fro from m th the e 2 20 02 21 1 Nat Natiio on na all Fi Fin na an nc ciia all Cap Capa ab biilliity ty Su Surv rve ey y (NFCS). (NFCS). Sou So rcu erc : Em e: Em plop ye loe y e Be e n Be efi nt eRes fit Res earc ea hrc In hs In titu sti te tu (EBRI) e te (EBRI) e stim sti am tea ste fro s m fro th me th 2e 0 2 21 0 1 Nat 2-2 io 0n 2a 1l Nat Fina ion nca ia l Fi l Cap nana cb ia illi ty Cap Suarv be iliy ty (NFCS). Survey (NFCS). Source: Employee Benefit Research Institute (EBRI) estimates from the 2021 National Financial Capability Survey (NFCS). correlated with those demographics. adopted pre-deductible coverage for telehealth services (Fronstin and Fendrick 2021). And many employers (76 Koma, Wyatt, Juliette Cubanski, and Tricia Neuman. 2021. A Snapshot of Sources of Coverage Among Medicare © 2022, Employee Benefit Research Institute –Education and Research Fund. All rights reserved. Figure 11, Past-Due Medical Bills, Individuals Ages 18–64, by Marital Status and Number of Children, 2021 ............... 11 Source: Employee Benefit Research Institute (EBRI) estimates from the 2021 National Financial Capability Survey (NFCS). percent) B pe rne eSo fefic urrc ria e e: d r Em ie to ps in 201 lom yeea Be ke n et8. fihe t Res W now ea ash rch -ingt In e sxpi tituon, ter e (EBRI) e dD p Cr: ov sK tim is a ais ion p tee s r fro Fa me th rm m e ily 2a 0ne 2 1Fou Nat nti. onda nal Fitnion. ancialA Cap ccae bs ilised ty Su rvA ep y (NFCS). ril 29, 2022. e e e e e e e e e e e e e e e e e e e e e eb b b b b b b b b b b b b b b b b b b b b br r r r r r r r r r r r r r r r r r r r r ri. i. i. i. i. i. i. i. i. i. i. i. i. i. i. i. i. i. i. i. i. i.o o o o o o o o o o o o o o o o o o o o o or r r r r r r r r r r r r r r r r r r r r rg g g g g g g g g g g g g g g g g g g g g g IIIIIIIIIIIIIIIIIIIIIIs s s s s s s s s s s s s s s s s s s s s ss s s s s s s s s s s s s s s s s s s s s su u u u u u u u u u u u u u u u u u u u u ue e e e e e e e e e e e e e e e e e e e e e B B B B B B B B B B B B B B B B B B B B B Br r r r r r r r r r r r r r r r r r r r r rief ief ief ief ief ief ief ief ief ief ief ief ief ief ief ief ief ief ief ief ief ief A re • • • • • • • • • • • • • • • • • • • • • • s e S S S S S S S S S S S S S S S S S S S S S Sa e e e e e e e e e e e e e e e e e e e e e erp p p p p p p p p p p p p p p p p p p p p p ctttttttttttttttttttttth e e e e e e e e e e e e e e e e e e e e e e mbe mbe mbe mbe mbe mbe mbe mbe mbe mbe mbe mbe mbe mbe mbe mbe mbe mbe mbe mbe mbe mbe repor r r r r r r r r r r r r r r r r r r r r rr t1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 f, , , , , , , , , , ,, , , ,, , , , , , , r o 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2m 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 02 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 t2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 h e • • • • • • • • • • • • • • • • • • • • • • E N N N N N N N N N N N N N N N N N N N N N NB o o o o o o o o o o o o o o o o o o o o o oR ...................... 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 568 568 I 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 E8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 d ucation and R esearch Fund © 2022 Employee Benefit Research Institute 20 15 10 16 12 14 11 17 18 19 21 22 13 23 2 9 4 5 7 6 3 8