Medical debt affected 1 in 4 Americans and 1 in 5 Ohioans last year, study finds

A new study found that medical debt affected 1 in 4 Americans and 1 in 5 Ohioans last year, including people with health insurance.

Researchers at the Urban Institute, with support from the Robert Wood Johnson Foundation, reported that more than a quarter of U.S. adults said they had medical debt for themselves or a family member in 2025. More than half of those respondents said they owed at least $1,000.

Among those with medical debt, 26% had current health insurance.

“Health insurance does not shield people from rising healthcare costs and the crushing burden of medical debt,” Katherine Hempstead, senior policy officer for the Robert Wood Johnson Foundation, said in a statement announcing the findings.

“Historic cost increases and coverage losses are forcing impossible tradeoffs between healthcare and other basic needs.”

The study also found that 1 in 7 Americans with medical debt had bills that were past due or unpaid altogether. Adults ages 45 to 54 made up the largest share of people with medical debt, and 17.6% of respondents on Medicare also said they owed medical debt.

In Ohio, researchers at the Health Policy Institute of Ohio have been examining how medical debt affects families and broader health outcomes.

“As expected, being uninsured is a major risk for experiencing medical debt,” HPIO researcher Brian O’Rourke told the Capital Journal. “However, recent data in Ohio suggests that this is not just a problem for our uninsured population.”

Using the Ohio Medicaid Assessment Survey, O’Rourke said more than 1 in 5 Ohio adults had trouble paying medical bills over the past year.

Although uninsured residents were most likely to struggle with medical debt, about a quarter of Ohioans with private insurance were also having difficulty paying.

In the Urban Institute research, hospital care was the most common source of debt, with 52% of adults with medical debt citing hospital costs.

Debt also came from specialists, dental care and general physician visits, according to the study.

O’Rourke said out-of-pocket medical spending remains “a significant burden in Ohio,” with the average family paying more than the national average.

The Ohio institute has also released multiple studies on the possible effects of Medicaid cuts in the federal budget spending bill, also known as the One Big Beautiful Bill Act, as well as lower Affordable Care Act subsidies, on the state’s uninsured population.

Ohio’s ACA Marketplace enrollment has already dropped by 100,000, and HPIO projects that as many as 300,000 Medicaid participants could lose coverage because of newly imposed work requirements. O’Rourke said that would likely leave “many uninsured and with limited resources to pay off medical bills.”

The Urban Institute study also warned that medical debt could worsen as health insurance costs rise and Medicaid and ACA changes take effect.

“This analysis shows medical debt is pervasive, affecting adults across age groups and income levels, and people with and without health insurance,” said Urban Institute researcher Michael Karpman in a statement.

“It will be important to monitor how the burden of medical debt shifts as policies restricting access to Medicaid and (the ACA) Marketplace coverage take effect.”

More uninsured Ohioans and higher medical debt could put added pressure on households, but O’Rourke said state providers, especially those in rural and underserved communities, would also feel the strain.

“More uncompensated care can lead to closures and possibly even raise healthcare prices even further in the state,” O’Rourke told the Capital Journal.

The Ohio legislature is on recess until after the election, but one bipartisan bill dealing with medical debt could still move when lawmakers return.

Ohio House Bill 257 was introduced in May 2025 by Rep. Michele Grim, D-Toledo, and Rep. Jean Schmidt, R-Loveland.

The proposal would cap interest on medical debt at 3% a year and prohibit methods such as wage collection to recover payment.

It would also block healthcare providers and collection agencies from reporting unpaid medical debt to consumer reporting agencies.

The bill has received multiple hearings in the Ohio House Health Committee and has drawn support from groups including the American Lung Association, the American Cancer Society Cancer Action Network and the American Diabetes Association. Gary Dougherty, director of state government affairs for the ADA, said limiting interest on medical debt would help patients with diabetes.

“People with medical debt have reported it as a driving factor for delaying care or not filling their prescriptions,” Dougherty wrote in June testimony to the House Health Committee.

“For people with diabetes, it is critical that we eliminate financial barriers that may result in them forgoing the care they need to manage the disease.”

Opponents of the bill include the Consumer Data Industry Association and the Association of Credit and Collection Professionals, which argued the measure would “take an overly broad approach to limiting medical billing and collection practices that … would lead to unintended negative consequences for Ohio consumers and providers of medical services in the state.”

The legislation has until the end of the year to pass the General Assembly. If it does not, it will need to be reintroduced in the next two-year legislative session.