Executive Summary
Fifteen percent of adults in the United States have unpaid medical bills, and as many as 41% have used credit cards or personal loans or borrowed from family and friends to pay for healthcare.Lunna Lopes, Audrey Kearney, Alex Montero, Liz Hamel, and Mollyann Brodie, “Health Care Debt in the US: The Broad Consequences of Medical and Dental Bills,” kff.org, June 16, 2022, https://www.kff.org/report-section/kff-health-care-debt-survey-main-findings/ With a lack of pricing transparency, high medical costs, and the prevalence of high deductible health insurance plans, U.S. patients often find themselves taking on debt to pay for medical care.Shameek Rakshit, Matthew Rae, Gary Claxton, Krutika Amin, and Cynthia Cox, “The Burden of Medical Debt in the United States,” healthsystemtracker.org, February 12, 2024, https://www.healthsystemtracker.org/brief/the-burden-of-medical-debt-in-the-united-states/ Altogether, U.S. adults owe at least $220 billion in medical debt.Shameek Rakshit, Matthew Rae, Gary Claxton, Krutika Amin, and Cynthia Cox, “The Burden of Medical Debt in the United States,” healthsystemtracker.org, February 12, 2024, https://www.healthsystemtracker.org/brief/the-burden-of-medical-debt-in-the-united-states/
Although anyone can find themselves facing unaffordable medical bills, lower income households and individuals with chronic illnesses are at the highest risk.Noam Levey, “Sick and Struggling To Pay, 100 Million People in the US Live with Medical Debt,” npr.org, June 16, 2022, https://www.npr.org/sections/health-shots/2022/06/16/1104679219/medical-bills-debt-investigation Post Acute Sequelae of COVID-19 (PASC), commonly known as long COVID, sometimes arises following an initial COVID-19 infection. An estimated 43 million American adults have experienced it, including 17 million who currently had long COVID in March 2024. The extra care associated with long COVID symptoms has exacerbated the medical debt crisis.Berkeley Lovelace Jr., “Long Covid Patients Face Medical Debt After Insurance Denies Claims,” nbcnews.com, March 9, 2023, https://www.nbcnews.com/health/health-news/long-covid-symptoms-treatment-insurance-coverage-rcna72012
Long COVID is still poorly understood, and research into effective treatments is ongoing. Patients face a slew of doctor visits, tests, and treatments, some of which insurance companies refuse to cover.Greg Iacurci, “Millions Suffer From Long COVID – And It Costs Them $9,000 a Year in Health-Care Expenses, on Average,” cnbc.com, December 1, 2022, https://www.cnbc.com/2022/12/01/long-covid-costs-patients-an-average-9000-a-year-in-medical-expenses.html Researchers at the Centers for Disease Control and Prevention (CDC) found that, over a six-month period following a COVID-19 infection, privately insured adults aged 18-64 who developed long COVID faced medical bills $1,562 more than those who were never diagnosed with COVID-19.Jamison Pike, et al., “Direct Medical Costs Associated with Post-COVID-19 Conditions Among Privately Insured Children and Adults,” Preventing Chronic Disease, Vol. 20, 2023, https://doi.org/10.5888/pcd20.220292 Long COVID patients who were previously hospitalized with COVID-19 faced more dramatic cost disparities, with medical bills 3.2 times higher ($8,412 more) than those who had COVID-19 but were never hospitalized.Jamison Pike, et al., “Direct Medical Costs Associated with Post-COVID-19 Conditions Among Privately Insured Children and Adults,” Preventing Chronic Disease, Vol. 20, 2023, https://doi.org/10.5888/pcd20.220292
Diagnosing long COVID is complicated, and more than 200 symptoms have been associated with the condition.Hannah Davis, et al., “Characterizing Long COVID in an International Cohort: 7 Months of Symptoms and Their Impact,” eClinicalMedicine, Vol. 38, 2021, https://doi.org/10.1016/j.eclinm.2021.101019 Given the complex diagnostic process and uncertainty over effective treatments, insurance companies may deny claims, leaving patients on the hook for thousands of dollars of medical bills.Lauren Schatzman, “Characterizing Long COVID in an International Cohort: 7 Months of Symptoms and Their Impact,” nbcnews.com, March 9, 2023, https://www.nbcnews.com/health/health-news/long-covid-symptoms-treatment-insurance-coverage-rcna72012 One promising treatment for some long COVID symptoms costs as much as $51,000 but has not been FDA-approved for this purpose and so health insurance will not cover it.Annika Kim Constantino, “A New Long COVID Treatment Shows Promise, but Insurance Won’t Cover It and Some Doctors Are Skeptical: Here’s Why,” cnbc.com, April 20, 2023, https://www.cnbc.com/2023/04/20/treating-long-covid-hyperbaric-oxygen-therapy-shows-promise-concerns.html
The excess out-of-pocket costs associated with long COVID are difficult to calculate, but long COVID is responsible for an estimated $528 billion in increased medical expenses, and a $3.7 trillion overall economic impact on the U.S.David Cutler, “The Economic Cost of Long COVID: An Update,” scholar.harvard.edu, 2022, https://www.hks.harvard.edu/centers/mrcbg/programs/growthpolicy/economic-cost-long-covid-update-david-cutler Half of Americans say they cannot afford an unexpected medical bill of only $500 without taking on debt, suggesting that much of the extra expenses associated with long COVID will result in greater medical debt among U.S. adults.Lunna Lopes, Audrey Kearney, Alex Montero, Liz Hamel, and Mollyann Brodie, “Health Care Debt in the US: The Broad Consequences of Medical and Dental Bills,” kff.org, June 16, 2022, https://www.kff.org/report-section/kff-health-care-debt-survey-main-findings/
Healthcare Spending and Debt in the United States
According to the Centers for Medicare & Medicaid Services, U.S. healthcare spending reached $4.5 trillion in 2022.Healthcare spending includes all spending on goods and services, public health activities, government administration, the net cost of health insurance, and investment. See, U.S. Centers for Medicare & Medicaid Services, “National health expenditure data – Historical,” cms.gov, December 13, 2023, https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/historical As a share of gross domestic product and on a per capita basis, the United States outspends other developed countries due to higher prices.Johns Hopkins Bloomberg School of Public Health, “US Health Care Spending Highest Among Developed Countries,” publichealth.jhu.edu, January 7, 2019, https://publichealth.jhu.edu/2019/us-health-care-spending-highest-among-developed-countries In 2022, for example, the U.S. spent twice as much or more per capita on healthcare as Australia, Canada, the United Kingdom, and France.Emma Wager, Matthew McGough, Shameek Rakshit, Krutika Amin, Cynthia Cox, “How Does Health Spending in the US Compare To Other Countries?” healthsystemtracker.org, January 23, 2024, https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/
Although the COVID-19 pandemic contributed to ballooning healthcare spending in 2020 and 2021, the United States has spent far more on healthcare than other countries since the 1980s, and U.S. spending has grown at a faster rate.Emma Wager, Matthew McGough, Shameek Rakshit, Krutika Amin, Cynthia Cox, “How Does Health Spending in the US Compare To Other Countries?” healthsystemtracker.org, January 23, 2024, https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/
Unlike the United States, most wealthy countries strictly regulate health insurance costs, out-of-pocket payments, and even the amount of money that doctors, medical facilities, and drug companies can charge patients.Noam N. Levey, “Americans’ Struggles With Medical Bills Are a Foreign Concept in Other Countries,” latimes.com, September 12, 2019, https://www.latimes.com/politics/story/2019-09-11/american-struggle-insurance-deductibles-unique Absent these price controls, the same treatments and services cost significantly more in the U.S. than other high-income countries, and these costs get passed on to patients.Noam N. Levey, “Americans’ Struggles With Medical Bills Are a Foreign Concept in Other Countries,” latimes.com, September 12, 2019, https://www.latimes.com/politics/story/2019-09-11/american-struggle-insurance-deductibles-unique
Compounding the high costs of care in the United States, there is very little transparency for medical care pricing, meaning that patients will not know the final total for their health services until they receive a bill. Moreover, private healthcare insurance companies are allowed to set their own fees as well as accept or deny claims for a wide range of reasons.Patrick Rucker, The Capitol Forum, Maya Miller, David Armstrong, “How Cigna Saves Millions by Having Its Doctors Reject Claims Without Reading Them,” propublica.org, March 25, 2023, https://www.propublica.org/article/cigna-pxdx-medical-health-insurance-rejection-claims
Hospitals, drug companies, and other medical care providers have raised prices over recent years, and simultaneously, health plan deductibles have grown, too. Between 2012 and 2016, for example, healthcare prices grew nearly four times faster than the overall rate of inflation.Noam Levey, “Sick and Struggling To Pay, 100 Million People in the US Live with Medical Debt,” npr.org, June 16, 2022, https://www.npr.org/sections/health-shots/2022/06/16/1104679219/medical-bills-debt-investigation Similarly, the average health plan deductible for a single worker with employer-based insurance has almost quadrupled since 2006.Noam Levey, “Sick and Struggling To Pay, 100 Million People in the US Live with Medical Debt,” npr.org, June 16, 2022, https://www.npr.org/sections/health-shots/2022/06/16/1104679219/medical-bills-debt-investigation
High deductible health plans have accounted for approximately 30% of the private employer insurance market since 2012, nine years after George W. Bush signed a 2003 law allowing them.Jessica Glenza, “Majority of Debtors to US Hospitals Now People With Health Insurance,” theguardian.com, January 11, 2024, https://www.theguardian.com/us-news/2024/jan/11/hospital-debt-increase-people-with-insurance The average deductible for a single person enrolled in a private employer health plan is around $1,400.Noam Levey, “Sick and Struggling To Pay, 100 Million People in the US Live with Medical Debt,” npr.org, June 16, 2022, https://www.npr.org/sections/health-shots/2022/06/16/1104679219/medical-bills-debt-investigation Health plans administered through the Affordable Care Act (ACA) are “notorious” for high deductibles, according to The Guardian, averaging around $3,000.Jessica Glenza, “Majority of Debtors to US Hospitals Now People With Health Insurance,” theguardian.com, January 11, 2024, https://www.theguardian.com/us-news/2024/jan/11/hospital-debt-increase-people-with-insurance KFF, “Deductibles in ACA Marketplace Plans, 2014-2024,” kff.org, December 22, 2023, https://www.kff.org/private-insurance/issue-brief/deductibles-in-aca-marketplace-plans/
State exchanges have an out-of-pocket maximum of $9,450 in 2024, not including premiums, out-of-network services, additional provider charges and other services not covered by the plan;HealthCare.gov, “Out-of-Pocket Maximum/Limit,” healthcare.gov (accessed April 15, 2024), https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/ that number is expected to grow to $14,100 by the year 2030, outpacing projected wage increases.Matthew Rae, Krutika Amin and Cynthia Cox, “ACA’s Maximum Out-of-Pocket Limit Is Growing Faster Than Wages,” healthsystemtracker.org, July 20, 2022, https://www.healthsystemtracker.org/brief/aca-maximum-out-of-pocket-limit-is-growing-faster-than-wages/
Given the variability and high costs of care, many Americans struggle to budget for healthcare and find themselves unprepared for sudden medical bills.Lunna Lopes, Audrey Kearney, Alex Montero, Liz Hamel, and Mollyann Brodie, “Health Care Debt in the US: The Broad Consequences of Medical and Dental Bills,” kff.org, June 16, 2022, https://www.kff.org/report-section/kff-health-care-debt-survey-main-findings/ For example, even before the pandemic, an estimated 7.4% of American households faced catastrophic health spending, in which out-of-pocket healthcare costs are so high that individuals cannot afford both healthcare costs and necessities, like food, housing, and other living expenses.Noam N. Levey, “Americans’ Struggles With Medical Bills Are a Foreign Concept in Other Countries,” latimes.com, September 12, 2019, https://www.latimes.com/politics/story/2019-09-11/american-struggle-insurance-deductibles-unique In contrast, the prevalence of catastrophic healthcare spending was 1.1% in the Netherlands, 1.5% in the United Kingdom, 2.1% in France, 2.4% in Germany, 2.6% in Japan, and 3.2% in Australia.Noam N. Levey, “Americans’ Struggles With Medical Bills Are a Foreign Concept in Other Countries,” latimes.com, September 12, 2019, https://www.latimes.com/politics/story/2019-09-11/american-struggle-insurance-deductibles-unique OECD, "Health at a Glance, 2023," oecd.org, 2023, https://www.oecd.org/health/health-at-a-glance/
The Medical Debt Crisis
Continually rising costs of healthcare in the United States have culminated in a medical debt crisis. The U.S. Census Bureau defines medical debt as, “medical costs people were unable to pay up front or when they received care.”Neil Bennett, Jonathan Eggleston, Laryssa Mykyta, Briana Sullivan, “Who Had Medical Debt in the United States?” census.gov, April 7, 2021, https://www.census.gov/library/stories/2021/04/who-had-medical-debt-in-united-states.html They collect information on medical debt among U.S. adults in the Survey of Income and Program Participation (SIPP).Neil Bennett, Jonathan Eggleston, Laryssa Mykyta, Briana Sullivan, “Who Had Medical Debt in the United States?” census.gov, April 7, 2021, https://www.census.gov/library/stories/2021/04/who-had-medical-debt-in-united-states.html In 2021, SIPP data estimated that 15% of U.S. households carried medical debt, with debts totaling at least $220 billion.Shameek Rakshit, Matthew Rae, Gary Claxton, Krutika Amin, Cynthia Cox, “The Burden of Medical Debt in the United States,” healthsystemtracker.org, February 12, 2024, https://www.healthsystemtracker.org/brief/the-burden-of-medical-debt-in-the-united-states/ Approximately 6% of U.S. adults hold more than $1,000 in medical debt, and 1% owes more than $10,000 in medical debt.Shameek Rakshit, Matthew Rae, Gary Claxton, Krutika Amin, Cynthia Cox, “The Burden of Medical Debt in the United States,” healthsystemtracker.org, February 12, 2024, https://www.healthsystemtracker.org/brief/the-burden-of-medical-debt-in-the-united-states/
However, some types of debt are difficult to capture using SIPP’s definition of medical debt, such as medical bills paid with conventional credit cards or informal borrowing from family and friends.Lunna Lopes, Audrey Kearney, Alex Montero, Liz Hamel, and Mollyann Brodie, “Health Care Debt in the US: The Broad Consequences of Medical and Dental Bills,” kff.org, June 16, 2022, https://www.kff.org/report-section/kff-health-care-debt-survey-main-findings/ When including these debts, the KFF (formerly known as The Kaiser Family Foundation) Health Care Debt Survey found that as many as 41% of U.S. adults carry some form of medical debt (including dental bills).Lunna Lopes, Audrey Kearney, Alex Montero, Liz Hamel, and Mollyann Brodie, “Health Care Debt in the US: The Broad Consequences of Medical and Dental Bills,” kff.org, June 16, 2022, https://www.kff.org/report-section/kff-health-care-debt-survey-main-findings/
Consequences of Medical Debt
The consequences of medical debt are broad and can last for years. While paying down medical debt, 63% of U.S. adults reported cutting back spending on food, clothing, and basic necessities and 48% said the debt depleted their savings.Lunna Lopes, Audrey Kearney, Alex Montero, Liz Hamel, and Mollyann Brodie, “Health Care Debt in the US: The Broad Consequences of Medical and Dental Bills,” kff.org, June 16, 2022, https://www.kff.org/report-section/kff-health-care-debt-survey-main-findings/ Medical debt can also prevent individuals from saving money to buy a home, invest in education, or build retirement savings.Noam Levey, “Sick and Struggling To Pay, 100 Million People in the US Live with Medical Debt,” npr.org, June 16, 2022, https://www.npr.org/sections/health-shots/2022/06/16/1104679219/medical-bills-debt-investigation
Over one-third (37%) of medical debt holders also said the debt has made them miss or delay payments on other bills, such as mortgage payments or student loans, which can negatively impact credit scores.Lunna Lopes, Audrey Kearney, Alex Montero, Liz Hamel, and Mollyann Brodie, “Health Care Debt in the US: The Broad Consequences of Medical and Dental Bills,” kff.org, June 16, 2022, https://www.kff.org/report-section/kff-health-care-debt-survey-main-findings/ In the U.S., credit score is a critical factor influencing financing options for vehicle and home purchases, and getting approved for renting a home, and a negative credit score can even prevent someone from getting a job.Lunna Lopes, Audrey Kearney, Alex Montero, Liz Hamel, and Mollyann Brodie, “Health Care Debt in the US: The Broad Consequences of Medical and Dental Bills,” kff.org, June 16, 2022, https://www.kff.org/report-section/kff-health-care-debt-survey-main-findings/
Healthcare-related debt is a leading cause of personal bankruptcy in the U.S., and an estimated $88 billion of medical debt is in collections.Jesse Bedayn, “States Confront Medical Debt That’s Bankrupting Millions,” apnews.com, April 12, 2023, https://apnews.com/article/medical-debt-legislation-2a4f2fab7e2c58a68ac4541b8309c7aa# A 2019 study found that medical issues were cited as a cause in approximately two-thirds (66.5%) of U.S. bankruptcies, including 58.5% who specifically stated medical expenses as a reason. The authors estimated there were about 530,000 medical bankruptcies annually.David Himmelstein, et al., “Medical Bankruptcy: Still Common Despite the Affordable Care Act,” American Journal of Public Health, Vol. 109, No. 3, https://doi.org/10.2105%2FAJPH.2018.304901
Beyond financial consequences, medical debt can impact someone’s ability to access healthcare in the future. According to KFF polling, 15% of medical debt holders “have been denied care by a hospital or other medical or dental provider because of their debt.”Lunna Lopes, Audrey Kearney, Alex Montero, Liz Hamel, and Mollyann Brodie, “Health Care Debt in the US: The Broad Consequences of Medical and Dental Bills,” kff.org, June 16, 2022, https://www.kff.org/report-section/kff-health-care-debt-survey-main-findings/
Unequal Distribution of Medical Debt
Regardless of whether they have insurance or not, many Americans are at risk of going into debt over medical expenses. KFF reported that half of adults cannot afford an unexpected medical bill of $500 without going into debt. However, medical debt is not distributed evenly.Lunna Lopes, Audrey Kearney, Alex Montero, Liz Hamel, and Mollyann Brodie, “Health Care Debt in the US: The Broad Consequences of Medical and Dental Bills,” kff.org, June 16, 2022, https://www.kff.org/report-section/kff-health-care-debt-survey-main-findings/
KFF analyzed SIPP data on who owes “significant medical debt,” defined as unpaid medical bills exceeding $250, and found that significant medical debt is more prevalent among women (9%) than men (7%), and nearly twice as many Black adults (13%) owe significant debt related to medical bills compared to white adults (7%). Moreover, the prevalence of significant medical debt decreases as household income level increases, ranging from 11% of low and modest income households to 7% of upper-middle income households and 4% among the highest income households. The analysis showed that “20 million people (nearly 1 in 12 adults) owe medical debt.”Shameek Rakshit, Matthew Rae, Gary Claxton, Krutika Amin, Cynthia Cox, “The Burden of Medical Debt in the United States,” healthsystemtracker.org, February 12, 2024, https://www.healthsystemtracker.org/brief/the-burden-of-medical-debt-in-the-united-states/
The strongest predictors of significant medical debt are disabilities and chronic illness, such as cancer, diabetes, or heart disease.Noam Levey, “Sick and Struggling To Pay, 100 Million People in the US Live with Medical Debt,” npr.org, June 16, 2022, https://www.npr.org/sections/health-shots/2022/06/16/1104679219/medical-bills-debt-investigation The prevalence of medical debt exceeding $250 among U.S. adults with disabilities (13%) is more than twice that of individuals without disabilities (6%).Shameek Rakshit, Matthew Rae, Gary Claxton, Krutika Amin, Cynthia Cox, “The Burden of Medical Debt in the United States,” healthsystemtracker.org, February 12, 2024, https://www.healthsystemtracker.org/brief/the-burden-of-medical-debt-in-the-united-states/
Chronic Disease and Medical Debt: The Rise of Long COVID
The COVID-19 pandemic has complicated the medical debt crisis in the United States. Perhaps surprisingly, the number of U.S. non-elderly adults with medical debt decreased between March 2019 to April 2021, in large part because pandemic-era policies prohibited states from removing Medicaid beneficiaries during the public emergency, thereby expanding access to healthcare at little or no out-of-pocket cost.Michael Karpman, Kassandra Martinchek, and Breno Braga, “Medical Debt Fell During the Pandemic. How Can the Decline Be Sustained?” urban.org, May 2022, https://www.urban.org/research/publication/medical-debt-fell-during-pandemic-how-can-decline-be-sustained Further, pandemic relief measures, like stimulus checks and unemployment benefits, alleviated financial burdens on many households and may have enabled some families to pay off past due bills like medical debts.Michael Karpman, Kassandra Martinchek, and Breno Braga, “Medical Debt Fell During the Pandemic. How Can the Decline Be Sustained?” urban.org, May 2022, https://www.urban.org/research/publication/medical-debt-fell-during-pandemic-how-can-decline-be-sustained
Declining healthcare use also contributed to the decrease in adults owing medical debt, as many individuals avoided hospitals and healthcare facilities amid shutdowns and fears of exposure to the virus.Michael Karpman, Kassandra Martinchek, and Breno Braga, “Medical Debt Fell During the Pandemic. How Can the Decline Be Sustained?” urban.org, May 2022, https://www.urban.org/research/publication/medical-debt-fell-during-pandemic-how-can-decline-be-sustained For example, in June 2020, 40% of U.S. adults reported that the pandemic drove them to delay medical care, such as routine cancer screenings.Karen Hacker, et al., “COVID-19 and Chronic Disease: The Impact Now and in the Future,” Preventing Chronic Disease, Vol. 18, 2021, http://dx.doi.org/10.5888/pcd18.210086 With fewer people using health care services, fewer people took on new debts.
Ultimately, however, the total amount of medical debt owed by U.S. adults increased from $195 billion in 2019 to $220 billion in 2021, despite the decline in the number of households carrying medical debt.Michael Karpman, Kassandra Martinchek, and Breno Braga, “Medical Debt Fell During the Pandemic. How Can the Decline Be Sustained?” urban.org, May 2022, https://www.urban.org/research/publication/medical-debt-fell-during-pandemic-how-can-decline-be-sustained Noam Levey, “Sick and Struggling To pay, 100 Million People in the US Live with Medical Debt,” npr.org, June 16, 2022, https://www.npr.org/sections/health-shots/2022/06/16/1104679219/medical-bills-debt-investigation Shameek Rakshit, Matthew Rae, Gary Claxton, Krutika Amin, Cynthia Cox, “The Burden of Medical Debt in the United States,” healthsystemtracker.org, February 12, 2024, https://www.healthsystemtracker.org/brief/the-burden-of-medical-debt-in-the-united-states/ Some of this increase may be attributable to the steep costs for treating severe COVID-19 illness. According to KFF, the average out-of-pocket cost for COVID-19 hospitalizations was $1,880 among patients enrolled in large employer health insurance plans in 2020.This figure refers to patients enrolled in health plans with at least some cost-sharing. In 2020, many insurance companies temporarily waived cost-sharing, thereby eliminating out-of-pocket costs, for COVID-19 treatment. However, by 2021, most companies stopped waiving out-of-pocket costs. See, Emma Wager, et al., “Cost of COVID-19 Hospital Admissions Among People With Private Health Coverage,” healthsystemtracker.org, November 14, 2022, https://www.healthsystemtracker.org/brief/cost-of-covid-19-hospital-admissions-among-people-with-private-health-coverage/ Moreover, according to healthcare policy researchers at the University of Michigan, 42% of patients with private health insurance coverage who were hospitalized with severe COVID-19 infection had low credit scores six months following hospitalization, and 27% had a medical bill sent to collections.All patients in the study had health insurance at the time of treatment. See, Institute for Healthcare Policy & Innovation, “COVID-19 Linked to Financial Toll on Patients,” ihpi.umich.edu, April 27, 2023, https://ihpi.umich.edu/news/covid-19-linked-financial-toll-patients
Moreover, according to the CDC, severe COVID-19 illnesses can damage multiple organ systems, including the lungs, heart, kidney, and brain, which may increase the risk of developing new chronic conditions like diabetes, heart disease, and neurological conditions, thereby increasing the prevalence of chronic conditions and individuals’ risk of medical debt.Centers for Disease Control and Prevention (CDC), “Long COVID,” cdc.gov, March 14, 2024, https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html Complicating matters further, the pandemic gave way to the emergence of a new chronic illness, Post Acute Sequelae of COVID-19 (PASC), or long COVID.Karen Hacker, et al., “COVID-19 and Chronic Disease: The Impact Now and in the Future,” Preventing Chronic Disease, Vol. 18, 2021, http://dx.doi.org/10.5888/pcd18.210086
Treating Long COVID
Long COVID refers to a host of symptoms that persist for at least 30 days after an initial COVID-19 illness, although symptoms can last for months or even years in some cases.David Cutler, “The Costs of Long COVID,” JAMA Health Forum, Vol. 3, No. 5, 2022, https://doi:10.1001/jamahealthforum.2022.1809 Centers for Disease Control and Prevention, “Long COVID or Post-COVID Conditions,” cdc.gov, March 14, 2024, https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html Harvard economist David Cutler said, “The most common symptom of long COVID is fatigue, but every organ system has been implicated."David Cutler, “The Economic Cost of Long COVID: An Update - David Cutler,” hks.harvard.edu, July 2022, https://www.hks.harvard.edu/centers/mrcbg/programs/growthpolicy/economic-cost-long-covid-update-david-cutler
Those who had a severe COVID-19 illness are more likely to develop long COVID, but anyone who has had a COVID infection can develop it, and people who were not vaccinated have a higher risk of long COVID, according to the CDC.Centers for Disease Control and Prevention (CDC), “Long COVID,” cdc.gov, March 14, 2024, https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html People with chronic conditions such as hypertension, lung disease, or diabetes are at highest risk of developing long COVID.Zirui Song and Mia Giuriato, “Demographic And Clinical Factors Associated With Long COVID,” Health Affairs, Vol. 42, No. 3, 2023, https://doi.org/10.1377/hlthaff.2022.00991
More than 200 symptoms have been associated with long COVID, though common symptoms include fatigue, chest pain, shortness of breath, disrupted sleeping patterns, cognitive dysfunction, as well as a host of respiratory and digestive issues.Hannah Davis, et al., “Characterizing Long COVID in an International Cohort: 7 Months of Symptoms and Their Impact,” eClinicalMedicine,Vol. 38, 2021, https://doi.org/10.1016/j.eclinm.2021.101019 Centers for Disease Control and Prevention (CDC), “Long COVID,” cdc.gov, March 14, 2024, https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html Given the wide ranging, often ambiguous symptoms, diagnosing long COVID is difficult, and there remains no official test to diagnose long COVID.Centers for Disease Control and Prevention (CDC), “Long COVID,” cdc.gov, March 14, 2024, https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html
KFF estimates that, since the start of the COVID-19 pandemic, 43 million people have had long COVID. In March 2024, 7% of U.S. adults, which is about 17 million people, were currently suffering from long COVID.Alice Burns, “As Recommendations for Isolation End, How Common is Long COVID?,” kff.org, April 9, 2024, https://www.kff.org/coronavirus-covid-19/issue-brief/as-recommendations-for-isolation-end-how-common-is-long-covid That’s about the same number of adults who have cancer each year, which was 17.4 million in 2021 (the most recently available data at the time of writing).National Cancer Institute, “Cancer Stat Facts: Cancer of Any Site,” seer.cancer.gov (accessed April 17, 2024), https://seer.cancer.gov/statfacts/html/all.html
Researchers at UCLA found that 30% of people who were treated for COVID-19 went on to develop long COVID, which matches what the CDC’s Household Pulse Survey showed.Sun M. Yoo, “About 30% of COVID Patients Develop ‘Long COVID,’ UCLA Research Finds,” uclahealth.org, April 18, 2022, https://www.uclahealth.org/news/about-30-covid-patients-develop-long-covid-ucla-research Alice Burns, “As Recommendations for Isolation End, How Common is Long COVID?,” kff.org, April 9, 2024, https://www.kff.org/coronavirus-covid-19/issue-brief/as-recommendations-for-isolation-end-how-common-is-long-covid The prevalence of long COVID may actually be much higher, as many of those experiencing long COVID may not have recognized it. For example, one woman who was diagnosed with long COVID in 2022 initially wondered if dementia was causing the brain fog and fatigue she experienced.Jamie Ducharme, “Long COVID Doesn’t Always Look Like You Think It Does,” time.com, February 27, 2024, https://time.com/6835566/what-are-long-covid-symptoms/
Without an official, accurate test, diagnosing long COVID typically entails several assessments to rule out other conditions, followed by a range of treatments or interventions to manage symptoms.Sujata Srikanth, et al., “Identification and Diagnosis of COVID-19: A Scoping Review,” Progress in Biophysics and Molecular Biology, Vol. 182, 2023, https://doi.org/10.1016/j.pbiomolbio.2023.04.008 The cause of long COVID remains unknown, and the treatment process is largely “guesswork,” as infectious disease expert Dr. Jeffrey Parsonnet told CNBC.Greg Iacurci, “Millions Suffer From Long COVID – And It Costs Them $9,000 a Year in Health-Care Expenses, on Average,” cnbc.com, December 1, 2022, https://www.cnbc.com/2022/12/01/long-covid-costs-patients-an-average-9000-a-year-in-medical-expenses.html
The Costs of Long COVID
Data on the costs of long COVID are sparse, but available data suggest that long COVID has had dramatic financial consequences and contributed to the rise in total medical debt. Harvard researchers estimated a total economic impact of $3.7 trillion, including loss in quality of life, lower earnings, and about $528 billion in out-of-pocket medical costs. That economic toll represents about 17% of the U.S. GDP in 2019.David Cutler, “The Economic Cost of Long COVID: An Update,” scholar.harvard.edu, 2022, https://www.hks.harvard.edu/centers/mrcbg/programs/growthpolicy/economic-cost-long-covid-update-david-cutler
To understand the financial impact of long COVID, CDC researchers analyzed adjudicated medical claims for privately insured adults aged 18-64 in the years 2020 and 2021. They compared medical costs between patients with a past diagnosis of COVID-19 who demonstrated long COVID symptoms versus medical costs for patients who had no history of COVID-19.Jamison Pike, et al., “Direct Medical Costs Associated with Post-COVID-19 Conditions Among Privately Insured Children and Adults,” Preventing Chronic Disease, Vol. 20, 2023, https://doi.org/10.5888/pcd20.220292
The researchers found that medical costs incurred by patients who developed long COVID symptoms between one and six months following an initial COVID-19 illness were between 1.5 and 1.7 times higher ($393 to $1,562 more) than the medical costs incurred by those who were never diagnosed with COVID-19.Jamison Pike, et al., “Direct Medical Costs Associated with Post-COVID-19 Conditions Among Privately Insured Children and Adults,” Preventing Chronic Disease, Vol. 20, 2023, https://doi.org/10.5888/pcd20.220292 The disparity was especially dramatic among long COVID patients who had been hospitalized with COVID-19, whose medical costs were 3.2 to 5.2 times higher ($2,676 to $8,412 more) than those who had COVID-19 but were never hospitalized.Jamison Pike, et al., “Direct Medical Costs Associated with Post-COVID-19 Conditions Among Privately Insured Children and Adults,” Preventing Chronic Disease, Vol. 20, 2023, https://doi.org/10.5888/pcd20.220292
The CDC’s estimates represent total medical costs paid to providers, including out-of-pocket payments and payments made by health insurance companies.Jamison Pike, et al., “Direct Medical Costs Associated with Post-COVID-19 Conditions Among Privately Insured Children and Adults,” Preventing Chronic Disease, Vol. 20, 2023, https://doi.org/10.5888/pcd20.220292
Long COVID generates high healthcare costs and puts patients at risk of medical debt in several ways. For example, given the current approach to diagnosing and treating long COVID, which involves screening for other conditions and managing symptoms, many of those who seek medical care see multiple specialists.Greg Iacurci, “Millions Suffer From Long COVID – And It Costs Them $9,000 a Year in Health-Care Expenses, on Average,” cnbc.com, December 1, 2022, https://www.cnbc.com/2022/12/01/long-covid-costs-patients-an-average-9000-a-year-in-medical-expenses.htm Although insurance companies often cover specialist visits, patients can still face high co-pays and deductibles.Greg Iacurci, “Millions Suffer From Long COVID – And It Costs Them $9,000 a Year in Health-Care Expenses, on Average,” cnbc.com, December 1, 2022, https://www.cnbc.com/2022/12/01/long-covid-costs-patients-an-average-9000-a-year-in-medical-expenses.html For example, the Los Angeles Times reported on one couple who spent over $3,000 in co-pays alone, not including the costs of medical equipment like compression garments and stair lifts.Sandhya Kambhampati, “$62,000 and Three Years Later: Long COVID Continues to Upend This California Couple’s Lives,” latimes.com, April 15, 2023, https://www.latimes.com/california/story/2023-04-15/long-covid-symptoms-impact-california-couple In total, the couple has reportedly spent $62,000 on medical expenses related to long COVID.Sandhya Kambhampati, “$62,000 and Three Years Later: Long COVID Continues to Upend This California Couple’s Lives” latimes.com, April 15, 2023, https://www.latimes.com/california/story/2023-04-15/long-covid-symptoms-impact-california-couple
Those without insurance bear all medical costs out-of-pocket, as do patients whose insurance companies reject their claims. Generally, health insurance companies want proof that a treatment, procedure, or intervention is effective and “medically necessary” based on substantial research or scientific evidence.Karen Davenport, “COVID ‘Long Haulers’ Can Carry Additional Burden of Getting Insurers to Cover Care,” ccf.georgetown.edu, October 26, 2021, https://ccf.georgetown.edu/2021/10/26/covid-long-haulers-can-carry-additional-burden-of-getting-insurers-to-cover-care/ Given how recently long COVID emerged, the condition is still not fully defined, and research is ongoing. Consequently, some treatments and testing may not meet the threshold for medical necessity, leaving insured patients responsible for full costs.Lauren Schatzman, “Long COVID Patients Face Medical Debt After Insurance Denies Claims,” nbcnews.com, March 9, 2023, https://www.nbcnews.com/health/health-news/long-covid-symptoms-treatment-insurance-coverage-rcna72012
Many long COVID symptoms have well-established treatments. For example, asthma-related symptoms like coughing and tightness in the chest are common among long COVID patients.Miriam Marchon, Andrea Stieger, and Severin Wittmer, “Development of Asthma-Related Symptoms in Mild or Moderate COVID-19 Patients Several Months Post Infection: A Descriptive Case Series From a Pneumologist Outpatient Clinic,” European Respiratory Journal, Vol. 56, No. 65, 2021, https://doi.org/10.1183/13993003.congress-2021.PA1169 Albuterol inhalers have been shown to be effective at treating mild to moderate asthma symptoms in most patients since the 1960s, and today, most insurance companies – including Medicaid plans in all 50 U.S. states – cover at least one type of albuterol inhaler for managing asthma.Stephen Stein and Charles Thiel, “The History of Therapeutic Aerosols: A Chronological Review,” Journal of Aerosol Medicine and Pulmonary Drug Delivery, Vol. 30, No. 1, 2017, https://doi.org/10.1089%2Fjamp.2016.1297 Jacqueline Link, et al., “Medicaid Coverage of Guidelines-Based Asthma Care Across 50 States, the District of Columbia, and Puerto Rico, 2021–2022,” Preventing Chronic Disease, Vol. 20, 2023, http://dx.doi.org/10.5888/pcd20.230022
However, other treatments for long COVID symptoms remain in experimental phases and clinical trials. Hyperbaric oxygen therapy, for example, is frequently used to treat emergency medical conditions such as carbon monoxide poisoning, cyanide poisoning, radiation injuries, and a range of other conditions.Johns Hopkins Medicine, “Hyperbaric Oxygen Therapy,” hopkinsmedicine.org, accessed March 9, 2024, https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/hyperbaric-oxygen-therapy Recently, medical researchers have found that hyperbaric oxygen therapy may also be effective at alleviating chronic fatigue in people with long COVID, and some patients have described the treatment as a “total game changer.”Annika Kim Constantino, “A New Long COVID Treatment Shows Promise, but Insurance Won’t Cover It and Some Doctors Are Skeptical: Here’s Why,” cnbc.com, April 20, 2023, https://www.cnbc.com/2023/04/20/treating-long-covid-hyperbaric-oxygen-therapy-shows-promise-concerns.html
Medicare, Medicaid, and most private insurance companies will cover some or all hyperbaric oxygen therapy expenses for conditions such as carbon monoxide poisoning and severe, complicated skin burns, but it has not been approved by the Food and Drug Administration to treat long COVID symptoms, and is not covered by insurance for long COVID patients.Johns Hopkins Medicine, “Hyperbaric Oxygen Therapy,” hopkinsmedicine.org, accessed March 9, 2024, https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/hyperbaric-oxygen-therapy Annika Kim Constantino, “A New Long COVID Treatment Shows Promise, but Insurance Won’t Cover It and Some Doctors Are Skeptical: Here’s Why,” cnbc.com, April 20, 2023, https://www.cnbc.com/2023/04/20/treating-long-covid-hyperbaric-oxygen-therapy-shows-promise-concerns.html One clinic in Florida charges up to $51,000 for the number of treatments needed by long COVID patients.Annika Kim Constantino, “A New Long COVID Treatment Shows Promise, but Insurance Won’t Cover It and Some Doctors Are Skeptical: Here’s Why,” cnbc.com, April 20, 2023, https://www.cnbc.com/2023/04/20/treating-long-covid-hyperbaric-oxygen-therapy-shows-promise-concerns.html
Compounding the financial pressure of medical bills, many people with long COVID are unable to work. Approximately 25% of working age adults who were diagnosed with long COVID and had worked prior to infection were no longer working, and an additional 31% had reduced their working hours (compared to 7% and 21% of all working age adults, respectively, in 2019).Alice Burns, “What are the Implications of Long COVID for Employment and Health Coverage?” kff.org, August 1, 2022, https://www.kff.org/policy-watch/what-are-the-implications-of-long-covid-for-employment-and-health-coverage/ In other words, as long COVID patients’ medical costs increase, many are also seeing their income decrease, making it more difficult to afford basic expenses and medical bills alike.
Considering that most Americans cannot afford an unexpected medical bill of $500 without taking on debt, one could reasonably conclude that the excess costs associated with long COVID - whether the treatment is approved but subject to a deductible or if the patient is responsible for all costs - are pushing long COVID patients into medical debt.Lunna Lopes, Audrey Kearney, Alex Montero, Liz Hamel, and Mollyann Brodie, “Health Care Debt in the US: The Broad Consequences of Medical and Dental Bills,” kff.org, June 16, 2022, https://www.kff.org/report-section/kff-health-care-debt-survey-main-findings/
Moreover, individuals with a history of chronic illnesses are at the highest risk of developing severe long COVID symptoms, and this group is already the most vulnerable to medical debt.Centers for Disease Control and Prevention (CDC), “Long COVID,” cdc.gov, March 14, 2024, https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html Noam Levey, “Sick and Struggling To Pay, 100 Million People in the US Live with Medical Debt,” npr.org, June 16, 2022, https://www.npr.org/sections/health-shots/2022/06/16/1104679219/medical-bills-debt-investigation As such, although estimates on the impact of long COVID on medical debt are not currently available, it is possible that many of the approximately 43 million Americans who have experienced long COVID symptoms have been pushed into medical debt.Berkeley Lovelace Jr., “Long Covid Patients Face Medical Debt After Insurance Denies Claims,” nbcnews.com, March 9, 2023, https://www.nbcnews.com/health/health-news/long-covid-symptoms-treatment-insurance-coverage-rcna72012 Nearly half of long COVID patients surveyed by the Patient Advocate Foundation, a nonprofit group, reported increased medical expenses.Patient Insight Institute, “PAF’s COVID-19 Survey Work,” published online, 2022, https://static1.squarespace.com/static/616da4e0a5a5080a7f683e99/t/635ae4eac1c7b62bd39ef7b0/1666901227592/PAF’s+COVID-19.pdf
Solutions
COVID-19 and long COVID have exacerbated the medical debt crisis in the United States, although the magnitude of medical debt caused by long COVID-related healthcare expenses is difficult to quantify. Given the multitude of causes of medical debt, the dearth of options currently available to treat long COVID, and the variability in treatment costs, there is no single solution.
The best protection against long COVID may be a COVID-19 vaccination, which can prevent individuals from becoming sick with COVID-19, reduce the severity of symptoms, and reduce the likelihood of developing long COVID.Centers for Disease Control and Prevention (CDC), “Long COVID,” cdc.gov, March 14, 2024, https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html A recent study conducted by medical researchers at the University of Michigan, in partnership with the CDC and the Michigan Department of Health and Human Services, found that long COVID was 40%-60% less prevalent among adults who received a COVID-19 vaccination prior to the onset of a COVID-19 illness compared to those who did not receive a vaccination.Colleen MacCullum-Bridges, et al., “The Impact of COVID-19 Vaccination Prior to Sars-Cov-2 Infection on Prevalence of Long COVID Among a Population-Based Probability Sample of Michiganders, 2020-2022,” Annals of Epidemiology, Vol. 92, 2024, https://doi.org/10.1016/j.annepidem.2024.02.007
Federal Policy Approaches: Funding Long COVID Research
U.S. policymakers have introduced a range of policy initiatives to help alleviate these burdens. In 2021, for example, Congress allocated $1.15 billion in government funding to establish the Researching COVID to Enhance Recovery (RECOVER) Initiative, which is dedicated to researching long COVID and identifying potential treatments. In 2024, the National Institutes of Health announced an additional $515 million investment in the research.Monica M. Bertagnolli, “NIH to Bolster RECOVER Long COVID Research Efforts Through Infusion of $515 Million” nih.gov, February 13, 2024, https://www.nih.gov/about-nih/who-we-are/nih-director/statements/nih-bolster-recover-long-covid-research-efforts-through-infusion-515-million
However, the initiative’s progress has faced widespread criticism. Patient advocates and medical researchers alike have characterized the federal approach as “wholly unsatisfactory,” lamenting the slow pace of research as well as the small size and simplicity of federally funded clinical trials, which test one drug at a time in isolation. For example, David Putrino, the director of Rehabilitation Innovation at Mount Sinai Health System, told USA Today that the current approach is akin to “taking one nail out of someone’s foot while leaving four more deeply embedded.”Eduardo Cuevas and Karen Weintraub, “Millions of Americans Suffer From Long COVID. Why Do Treatments Remain Out of Reach?” usatoday.com, February 26, 2024, https://www.usatoday.com/story/news/health/2024/02/26/long-covid-treatments-out-of-reach/72690587007/
The federal government has attempted to improve data collection on long COVID, centralize resources, share information, and expand access to care through two Congressional bills introduced in 2022, the “Covid-19 Long Haulers Act,” and the “The Care For Long Covid Act.”Morgan Stephens, “Long COVID Disabled Them. Then They Met a ‘Broken’ Social Security Disability Process,” cnn.com, March 20, 2023, https://www.cnn.com/2023/02/25/business/long-covid-workforce-issues-disability-claims/index.html However, neither bill has progressed out of committee.Morgan Stephens, “Long COVID Disabled Them. Then They Met a ‘Broken’ Social Security Disability Process,” cnn.com, March 20, 2023, https://www.cnn.com/2023/02/25/business/long-covid-workforce-issues-disability-claims/index.html
Long COVID as a Disability
Beyond treatments, the U.S. government officially recognized long COVID as a disability under the Americans with Disabilities Act (ADA) in 2021, making some long COVID patients eligible for accommodations and protections, such as rest breaks, flexible and/or remote working arrangements, and leave to attend appointments or treatments.National Conference of State Legislatures, “Long COVID-19 and Disability Accommodations in the Workplaces,” ncsl.org, March 13, 2024, https://www.ncsl.org/labor-and-employment/long-covid-19-and-disability-accommodations-in-the-workplace
Disability accommodations are undoubtedly necessary to help people recover from long COVID and return to work. But, many patients find themselves unable to work at all and seek financial assistance through the Social Security Administration’s (SSA) monthly disability support payments, which generally range from $800 to $1,300 depending on household size.Morgan Stephens, “Long COVID Disabled Them. Then They Met a ‘Broken’ Social Security Disability Process,” cnn.com, March 20, 2023, https://www.cnn.com/2023/02/25/business/long-covid-workforce-issues-disability-claims/index.html However, long COVID is not on the SSA’s list of qualifying disabilities to receive Social Security Disability Insurance (SSDI).Morgan Stephens, “Long COVID Disabled Them. Then They Met a ‘Broken’ Social Security Disability Process,” cnn.com, March 20, 2023, https://www.cnn.com/2023/02/25/business/long-covid-workforce-issues-disability-claims/index.html
Some long COVID patients may qualify for SSDI payments with comprehensive notes from doctors identifying the patient’s symptoms, diagnostic information, and details on how the symptoms impact their daily functioning, all of which is also required for accessing ADA accommodations. Given the ambiguity of long COVID symptoms and the lack of information about the condition, some doctors express discomfort in approving patient requests to confirm that their symptoms are related to long COVID.Tinker Ready, “Long COVID Patients Turn to Doctors for Help With Disability Claims,” medscape.com, July 7, 2023, https://www.medscape.com/viewarticle/994115?form=fpf Moreover, long COVID patients applying for SSDI face long wait times as the SSA faces its lowest staffing levels in 25 years, resulting in a backlog of unreviewed applications that can take months or even years to process.Morgan Stephens, “Long COVID Disabled Them. Then They Met a ‘Broken’ Social Security Disability Process,” cnn.com, March 20, 2023, https://www.cnn.com/2023/02/25/business/long-covid-workforce-issues-disability-claims/index.html
State and Federal Initiatives to Solve the Medical Debt Crisis
State governments have also introduced legislation to mitigate some of the worst consequences of medical debt. New York and Colorado, for example, have each enacted statewide legislation that bans the reporting of any medical debt and removes medical debt from credit reports.Maysoon Khan, “New York Removes Medical Debt From Credit Reports,” apnews.com, December 13, 2023, https://apnews.com/article/medical-debt-new-york-credit-reports-1e7d840e28e409f9de82bfacf8c6cddf California is currently considering similar legislation, and the Consumer Financial Protection Bureau is developing rules to ban medical debt reporting at the federal level.Molly Castle Work “A California Bill Banning Medical Debt From Credit Reports Gets a Boost from California Atty. Gen. Bonta,” latimes.com, March 11, 2024, https://www.latimes.com/business/story/2024-03-11/a-california-bill-banning-medical-debt-from-credit-reports-gets-a-boost-from-california-attorney-general-bonta Noam Levey, “With Medical Debt Burdening Millions, a Financial Regulator Steps In to Help,” kffhealthnews.org, March 1, 2024, https://kffhealthnews.org/news/article/medical-debt-consumer-financial-protection-bureau/ Although these rules will not eliminate medical debt, removing medical debt from credit reports may make it easier for debt holders to rent homes and purchase vehicles.Noam Levey, “With Medical Debt Burdening Millions, a Financial Regulator Steps In to Help,” kffhealthnews.org, March 1, 2024, https://kffhealthnews.org/news/article/medical-debt-consumer-financial-protection-bureau/ However, these rules will not apply to medical bills that are paid using a conventional credit card, personal loan, or money borrowed from family or friends.Maysoon Khan, “New York Removes Medical Debt From Credit Reports,” apnews.com, December 13, 2023, https://apnews.com/article/medical-debt-new-york-credit-reports-1e7d840e28e409f9de82bfacf8c6cddf
Several states also administer federally funded “customer assistance programs” to help consumers dispute their medical bills and communicate with their insurance providers.Lunna Lopes, Audrey Kearney, Alex Montero, Liz Hamel, and Mollyann Brodie, “Health Care Debt in the US: The Broad Consequences of Medical and Dental Bills,” kff.org, June 16, 2022, https://www.kff.org/report-section/kff-health-care-debt-survey-main-findings/ Inaccuracies and errors are common in medical bills, and 44% of medical debt holders reported that they did not pay a bill because they thought it was inaccurate.Lunna Lopes, Audrey Kearney, Alex Montero, Liz Hamel, and Mollyann Brodie, “Health Care Debt in the US: The Broad Consequences of Medical and Dental Bills,” kff.org, June 16, 2022, https://www.kff.org/report-section/kff-health-care-debt-survey-main-findings/ A service to help individuals dispute their bills could be a valuable resource to correct errors and prevent a medical bill from going to a collections agency, but state customer assistance programs have not received any federal funding since 2010.Lunna Lopes, Audrey Kearney, Alex Montero, Liz Hamel, and Mollyann Brodie, “Health Care Debt in the US: The Broad Consequences of Medical and Dental Bills,” kff.org, June 16, 2022, https://www.kff.org/report-section/kff-health-care-debt-survey-main-findings/
Debt Forgiveness: Local Government and Nonprofit Partnerships
In addition to state action, local governments around the country have partnered with RIP Medical Debt, a New York-based nonprofit that purchases debt in bundles from hospitals and other entities and forgives the debt for households earning up to four times the federal poverty level.Yuki Noguchi, “A Growing Wave of Local Governments Are Erasing Billions in Medical Debts,” npr.org, January 23, 2024, https://www.npr.org/sections/health-shots/2024/01/23/1225014618/nyc-joins-a-growing-wave-of-local-governments-erasing-residents-medical-debt
City and county governments that have partnered with RIP Medical Debt and forgiven debt include Washington, D.C., New York City, Cook County, Illinois, where Chicago is located, and Wayne County, Michigan, where Detroit is located.Yuki Noguchi, “A Growing Wave of Local Governments Are Erasing Billions in Medical Debts,” npr.org, January 23, 2024, https://www.npr.org/sections/health-shots/2024/01/23/1225014618/nyc-joins-a-growing-wave-of-local-governments-erasing-residents-medical-debt
Conclusion
The United States is embroiled in a medical debt crisis totaling at least $220 billion, with 15% to 41% of adults carrying some form of medical debt. Given the opacity of pricing in healthcare, high medical costs, and the prevalence of high deductible health insurance plans, almost anyone can find themselves facing medical bills they cannot afford, but individuals with chronic illnesses are at the highest risk.
COVID-19 and long COVID have exacerbated the medical debt crisis, especially as those who already face the highest risk of medical debt are at the greatest risk of developing severe long COVID symptoms. Further, because long COVID remains poorly understood, research into effective treatments is ongoing, and patients face a slew of doctor visits, tests, and treatments, some of which insurance companies refuse to cover.
Rigorous data on the excess out-of-pocket costs associated with long COVID is unavailable, but long COVID is responsible for an estimated $528 billion in increased medical spending. When adding in the loss in quality of life and reduced earnings, the total impact on the U.S. economy reaches $3.7 trillion.David Cutler, “The Economic Cost of Long COVID: An Update,” scholar.harvard.edu, 2022, https://www.hks.harvard.edu/centers/mrcbg/programs/growthpolicy/economic-cost-long-covid-update-david-cutler
On an individual level, CDC researchers estimate that long COVID may be associated with medical costs that are between 1.5 and 1.7 times higher ($393 to $1,562 more) than for people who never had COVID-19. Half of Americans cannot afford an unexpected medical bill of $500 without taking on debt, suggesting that much of the extra expenses have resulted in greater medical debt among some of the 43 million U.S. adults who have had long COVID.
The U.S. government, along with state and local governments, has attempted to address medical debt, primarily through removing medical debt from credit reports, and the U.S. has dedicated more than a billion dollars into funding long COVID research. While these efforts are undoubtedly necessary to alleviate the burdens of long COVID and medical debt among Americans, the medical debt crisis is the consequence of the high costs of healthcare and the prevalence of high deductible health insurance plans in the United States.
Without reforming how Americans pay for healthcare, high out-of-pocket medical costs will continue to devastate many American households, and long COVID will only make matters worse.