Amount of Medical Debt Highest Among U.S. Middle Class

Medical Debt

Medical debt continues to be a pressing issue in the United States, with about a quarter of middle-class American families struggling to fully pay their medical bills in 2020. This challenging situation is particularly acute for Black and Hispanic families, who face the highest levels of medical debt, according to comprehensive reports from the reputable think tank Third Way and the U.S. Census Bureau.

Main Points

  • Nearly a quarter of middle-class Americans (23.5%) with incomes between $50,000 and $100,000 faced unpaid medical bills in 2020, revealing significant financial challenges within this group.
  • Black and Hispanic middle-class individuals are hit hardest by medical debt, with 37.5% of Black and 25.2% of Hispanic individuals facing unpaid medical bills, underscoring disparities in healthcare costs.
  • Geographic location impacts medical debt, with the South (28.1%) and Midwest (24.6%) having higher rates.
  • Education also matters, as middle-class individuals with a Bachelor's degree experience slightly lower debt (16.5%) compared to those with less education.

The Disturbing Reality

A recent in-depth study conducted by Third Way, utilizing comprehensive data from the U.S. Census Bureau, sheds light on the concerning state of medical debt among various segments of the American population. This research highlights that middle-class families, irrespective of their specific categories, experience the highest levels of medical debt in the nation.

Middle-Class Struggles

The study, based on data from the year 2020, reveals that nearly a quarter of middle-class individuals with household incomes ranging between $50,000 and $100,000 were unable to fully cover their medical expenses. This substantial financial burden is especially pronounced among Black and Hispanic middle-class individuals, who grapple with disproportionately high rates of medical debt.

Alarming Statistics

Approximately 17 million middle-class individuals, accounting for about 23.5% of this demographic, were burdened by unpaid medical bills during 2020. Surprisingly, among those impacted, a significant 22% belong to the lower-income bracket, while 9% fall into the higher-income category. This scenario persists despite the common assumption that middle-class families often benefit from better insurance coverage and the fact that lower-income households might be more inclined to avoid medical care due to its prohibitive costs.

Factors Influencing Debt

According to the Third Way study, even after accounting for various variables such as education levels, parental statuses, health insurance coverage, and geographic location within the U.S., middle-class individuals continue to face disproportionately high rates of medical debt. While medical debt affects middle-class people of all races and ethnicities, it's particularly severe for Black and Hispanic individuals within this economic stratum.

Disproportionate Impact

The report indicates that Black middle-class individuals bear a significant burden, with around 37.5% grappling with medical debt. This is in contrast to 29% among low-income individuals and 21.5% among those in the high-income bracket. Similarly, among Hispanic middle-class members, around 25.2% faced unpaid medical bills, compared to 20.3% among low-income individuals and 18.3% among their high-income counterparts.

Education and Debt

Interestingly, the level of education also appears to play a role in medical debt. Middle-class individuals with a Bachelor's degree experience slightly lower levels of medical debt at 16.5%, compared to those with some college (25.5%), a high school diploma (26%), or no high school diploma (27.1%). Despite these variations, it's important to note that middle-class individuals across education categories still carry higher debt loads than their low- or high-income counterparts.

Age and Debt

When analyzing medical debt by age, middle-class Americans consistently carry higher medical debt burdens across all age groups except those aged 65 and older. Among individuals over 65, only 14.4% of middle-class individuals have this type of debt, compared to 15.9% of people with lower incomes within the same age group.

Geographic Variation

Geographic location also plays a role in the prevalence of medical debt among the middle class. In the South, a staggering 28.1% of middle-class individuals are burdened by medical debt, with the Midwest closely following at 24.6%. In the Northeast, around 18.8% of middle-class individuals face medical debt, while in the West, the figure is 17.8%.

A Complex Picture

It's important to highlight that Third Way's report is based on the Census Survey of Income and Program Participation, which considers individuals as having medical debt if anyone in their household carries such debt. Additionally, the renowned health policy research organization KFF estimates that approximately 100 million Americans currently struggle with some form of medical debt.

Uncharted Territories

As the ongoing pandemic and its associated financial crisis continue to impact households across the country, the exact influence on medical debt remains unclear. The Axios report, referencing the same Census dataset, underscores the uncertainty surrounding how the pandemic has compounded the issue of medical debt among middle-class Americans.


The burden of medical debt is a pressing concern for the U.S. middle class, with Black and Hispanic families being disproportionately affected. Despite various factors such as education, age, and location, this critical issue underscores the urgent need for comprehensive healthcare reform to ensure equitable access to medical services for all segments of society.

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