What the states with the highest percentage of adults with medical debt have in common

On average, 8.6% of adults reported having medical debt annually between 2019 and 2021, according to a Feb. 12 study from KFF and the Peterson Center on Healthcare. 

Over that period, South Dakota (17.7%), Mississippi (15.2%), North Carolina (13.4%), West Virginia (13.3%) and Georgia (12.7%) had the highest percentage of adults reporting medical debt. 

Of those five states, only West Virginia had expanded Medicaid under the ACA. Since then, South Dakota voters approved Medicaid expansion, which took effect in July. State officials in North Carolina struck an expansion deal last year, which went into effect Dec. 1.   

Georgia's partially expanded Medicaid program, which has work requirements, went into effect in July but has been slow to gain participants. 

The study noted, however, that medical debt remains a persistent problem even among people with insurance coverage. 

"Most Americans have private health insurance, which generally requires payment of a deductible, coinsurance, and copays for medical services and prescriptions," the report said. "A serious injury or illness can cost thousands of dollars out-of-pocket to meet these deductibles and other cost-sharing requirements."

The report said, "The fact that medical debt is a struggle even among households with health insurance and middle incomes indicates that simply expanding coverage will not erase the financial burden caused by high cost-sharing amounts and high prices for medical services and prescription drugs."

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