Urban Wire How to Address Medical Debt Burdens in Immigrant Communities
Fredric Blavin, Breno Braga
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photo of doctor and patient in medical setting

Despite recent improvements in health insurance coverage access, a substantial share of Americans continues to grapple with the burden of unpaid medical bills. This widespread problem not only affects households’ financial stability but also hampers a person’s ability to access necessary medical care, raising the risk of poor health outcomes.

The impact of medical debt can be especially acute in immigrant communities. Often arriving in the US in pursuit of better opportunities, immigrants frequently face barriers to stable employment and financial security that are compounded by language barriers and restrictive eligibility for safety net programs. As a result, many immigrants find themselves in disadvantaged economic situations, making the burden of medical expenses heavy.

Immigrants are also disproportionately less likely than US-born residents to have health insurance because of gaps in eligibility for Medicaid and Marketplace coverage and immigrants’ underrepresentation in jobs that provide employer-sponsored health insurance coverage. Lacking coverage further complicates immigrants’ abilities to access affordable health care services and, when combined with the fear of discrimination and potential deportation, can lead to delays in medical treatment until conditions worsen and treatment becomes more expensive.

We partnered with KFF Health News to explore an example of medical debt among immigrant communities. We chose to conduct our in-depth analysis in Colorado because of the state’s large foreign-born population—about 1 in 10 residents in the state is an immigrant—and substantial disparities in medical debt. Our investigation revealed that medical debt in collections is concentrated in areas in the state with large immigrant populations.

Immigrant-dense communities have higher debt than other communities in Colorado

Within Colorado’s immigrant-dense communities—defined as zip codes where noncitizens make up more than 15 percent of the population—19 percent of adults have medical debt in collections on their credit reports. That’s 8 percentage points higher than the rate in other communities in the state (11 percent).

These immigrant-dense communities, predominantly in the Denver metropolitan area, differ from other Colorado communities in other ways too. They have higher uninsurance rates (19 percent versus 7 percent), lower average incomes ($80,450 versus $119,593), and a higher share of renters who spend more than 30 percent of their income on rent (60 percent versus 52 percent), according to our analysis of the 2018–22 American Community Survey. These disparities underscore the need for targeted interventions to alleviate the burden of medical debt and promote equitable access to health care services within immigrant communities.

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How can policymakers alleviate immigrants’ medical debt burdens in Colorado and elsewhere?

Addressing medical debt among immigrant communities requires policies that tackle both immediate challenges and underlying systemic issues. One step is to expand state-funded health insurance coverage (e.g., state-funded Medicaid-like coverage) to all income-eligible immigrants regardless of citizenship status. With evidence showing that expanding state-funded insurance coverage reduces medical debt in collections, this could allow immigrants to access essential health care services without fear of financial hardship.

State governments could also promote patient advocacy and community health programs tailored to immigrants. Such programs can help immigrants better navigate the complex health care system, including the resolution of billing disputes and the identification of financial assistance programs that consider language barriers and cultural differences. Federal and state policymakers could prioritize implementing programs that ensure access to better health care for immigrants, such as those that reimburse health care providers that provide language services.

Researchers have an important role in quantifying how these policies could reduce medical debt among immigrant communities and improve their access to health care. By evaluating how well policies reduce medical debt, researchers can help policymakers advance policies that meaningfully and continuously decrease the number of people struggling to pay their medical bills.

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Research Areas Health and health care Immigration
Tags Asset and debts Financial stability Health care delivery and payment Health care spending and costs Health insurance Immigrant access to the safety net Immigrant children, families, and communities
Policy Centers Health Policy Center Center on Labor, Human Services, and Population
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