This report examines the geographic variation of medical debt in collections in New York State, providing a detailed picture of its unequal distribution across local communities. We estimate the share of consumers with medical debt on their credit reports and the amounts owed, how medical debt varies across and within the state’s 10 economic regions, and disparities in medical debt based on the demographic and socioeconomic characteristics of consumers’ communities.
Why this matters
The burden of medical debt can intensify a person’s financial challenges; affect their access to health care, credit, employment, housing, and food; and worsen their health. Because this burden falls disproportionately on marginalized groups, medical debt can exacerbate health disparities and economic inequality. The findings in this report can inform state initiatives to protect consumers in New York State from medical debt by demonstrating where such reforms are likely to have the greatest impact.
What we found
Approximately 6 percent of New York State consumers had medical debt in collections on their credit reports in February 2022. However, the relatively low statewide average conceals significant local variation.
- The share of New York State consumers with medical debt varied widely across regions and communities.
- Communities with high rates of medical debt were concentrated in the Central New York, Mohawk Valley, North Country, and Southern Tier regions, whereas communities in Long Island and New York City tended to have low rates of medical debt.
- The share of New York State consumers with medical debt ranged from 3.2 percent or less in communities with the lowest levels of medical debt to between 9.7 percent and 37.6 percent in communities with the highest levels of medical debt.
- Within each region, the burden of medical debt generally fell most heavily on communities of color and communities with greater economic challenges.
- In most regions, communities with a majority of residents who are people of color had higher rates of medical debt than communities with residents who are predominantly white.
- In all regions, communities with lower median household incomes had higher rates of medical debt than communities with higher incomes. The prevalence of medical debt was also higher in communities where more residents were uninsured.
- Nearly half of consumers with medical debt owed $500 or more and therefore may still have medical debt on their credit reports following a change in credit reporting practices that took effect in April 2023.
- Of consumers with medical debt, 48 percent owed $500 or more, including nearly one in three (30 percent) consumers who owed $1,000 or more and about one in eight (13 percent) who owed $2,000 or more.
- In communities with the lowest incomes, more than half of consumers with medical debt owed $500 or more.
- Communities with the highest prevalence of medical debt faced additional challenges in confronting greater health care needs with fewer resources. High-debt communities were more rural, had higher rates of disability, and had lower rates of educational attainment and employment than communities with the lowest prevalence of medical debt.
- Even after accounting for differences in local demographic and health characteristics observed in the data, living in certain regions was associated with a greater risk of having medical debt. Further research is needed to understand additional individual, community, and health system factors that may explain differences in medical debt across regions.
How we did it
Our analysis draws on February 2022 data from a representative random sample of deidentified credit records for more than 600,000 consumers ages 18 and older in New York State from one of the national credit reporting agencies. We assessed variation in medical debt at the region, county, and community levels. Because the credit bureau data does not contain demographic information for consumers except for their ages, we use information on the demographic and socioeconomic characteristics of consumers’ communities—defined based on zip codes of residence—as a proxy for examining the disproportionate burden of medical debt on marginalized groups.