How Many People in Your State Are Burdened With Medical Debt?

About 1.1 million adults living in Alabama — roughly 29% of the state’s 18 and older population — have some form of medical debt. Nationwide, 22.7% of American adults have unpaid medical bills. Perhaps even more telling, 24.7% of adult residents — the second-largest share of any state — report having skipped a medical test, treatment, or follow-up that was recommended by a doctor because of the cost.

As is often the case in states where large shares of the population are struggling to afford medical care, Alabama has a higher than average uninsured rate. Roughly 10.0% of the population does not have health insurance compared to 8.9% of the U.S. population.

In Alaska, 26.1% of adults have unpaid medical bills, a larger share than the 22.7% of Americans 18 and older with some form of medical debt. Not only is medical debt more common than average in Alaska, but it also tends to be higher. The typical amount of medical debt that has been handed over to collections agencies in Alaska is $1,316, nearly double the comparable national median of $694.

Nearly 1 million adults in Arizona — or 18% of the 18 and older population — have unpaid medical bills. For reference, 22.7% of adults nationwide have some form of debt related to medical treatment. While Arizona residents are less likely than Americans overall to have debt, those who have debt tend to have a lot of it. The median amount of medical debt that has gone to collections agencies in the state is $888, well above the comparable national median of $694.

An estimated 29% of adults in Arkansas have some form of medical debt, a larger share than in all but five other states. The high cost of medical treatment is likely having a detrimental effect on the health of residents in the state as in the last year, 24.1% of adults said they had a medical problem but did not seek treatment due to cost.

Americans with health insurance have to shoulder a far smaller share of their overall medical bills than those without insurance. In California, 7.2% of the population lacks health insurance, a smaller share than the national uninsured rate of 8.9%. Likely due in part to the greater than average coverage, just 14.3% of adults in the state have some form of medical debt, the second smallest share of any state.

In Colorado, 19.8% of the 18 and over population has some form of outstanding medical debt, a smaller share than the 22.7% of American adults who do.

Colorado residents are also more likely to be healthy than Americans in much of the rest of the country. Adults in Colorado are more likely to exercise and less likely to smoke than most American adults, and Colorado’s 21% obesity rate is the lowest of any state in the country. These measures indicate a likely reduced risk of many serious — and potentially expensive — diseases and complications.

Just 16.2% of Connecticut residents 18 and older have unpaid health care bills, the fifth smallest share of any state. The lower prevalence of medical debt is due in part to the low uninsured rate in the state. Just 5.3% of Connecticut residents lack health insurance, well below the comparable 8.9% share of Americans. High incomes in the state also mean more residents have the resources to pay their bills. The median annual household income in the state of $76,348 is about $14,400 higher than the national median income.

Just 5.7% of Delaware residents lack health insurance, well below the national uninsured rate of 8.9%. Even with insurance, health care can be a considerable financial burden, and in Delaware, 27.6% of the 18 and older residents have unpaid medical bills, the ninth largest share among states.

The state’s poorer health outcomes may be contributing to the higher share of adults with medical debt. By several behavioral measures and indicators, Delaware residents are at increased risk of serious, and potentially expensive to treat, diseases and conditions. Adults in Delaware are more likely to smoke and less likely to exercise than the typical American adult. Additionally, 30.6% of adults in the state are obese, a slightly higher rate than the national obesity rate of 29.0%.

The 20.7% share of adults in Florida with medical debt is slightly below the 22.7% comparable share of adults nationwide. Still, those with debt in the state are likely to have more of it. The median amount of medical debt handled by collections agencies is $921, far more than the national median of $694.

Both the amount of health care debt and the share of residents who have it would likely be reduced through increased government assistance for lower-income residents. Florida is one of a minority of states not to have adopted Medicaid expansion under the Affordable Care Act.

There are some 2.4 million adults in Georgia with unpaid medical bills, or nearly 30% of the state’s 18 and older population. Nationwide, 22.7% of adults have medical debt. The higher likelihood of debt in Georgia is due in part to the state’s large uninsured population. An estimated 13.7% of state residents are without health insurance compared to 8.9% of adult Americans nationwide. The high cost of treatment has also kept a staggering 27.0% of adults in the state from seeking treatment for a medical problem due to cost. Nationwide, 20.6% of adults have not sought treatment for a problem due to costs.

Only 13.4% of adults in Hawaii have medical debt, the smallest share of any state in the country. The lower likelihood of medical debt in Hawaii is partially the product of low uninsured rates and high incomes. Just 4.1% of Hawaiians lack health insurance, less than half the 8.9% national uninsured rate. Additionally, the typical household in Hawaii earns $80,212 a year, about $18,300 more than what the typical American household earns. Hawaii also has the lowest median total turned over to collectors of any state, of just $232.

In Idaho, 23.9% of 18 and older adults have unpaid medical bills, slightly larger than the 22.7% national share. Americans without health insurance typically pay far more out of pocket for medical treatment than those with insurance, and in Idaho, 11.1% of the population is without insurance, well above the 8.9% uninsured rate.

A slightly lower than average share of adults in Illinois have unpaid medical bills at 19.8%. Those who do have outstanding medical debt are also more likely to have less of it than average. The median amount of medical debt that has been turned over to a collections agency in the state is just $555, well below the national average of $694.

The greater likelihood of Illinois residence being able to pay off their medical bills is likely partially due to higher incomes. The typical household in the state earns $65,030 a year, over $3,000 more than than the typical American household.

High medical costs appear to be taking a greater than average toll on the health of Indiana residents. More than one in every four adults in the state say they have opted not to receive care for a medical problem because of costs, compared to about one in every five adults nationwide. Indeed, Indiana residents are more likely to have medical debt than most Americans. An estimated 26.8% of state residents 18 and older have unpaid medical bills compared to 22.7% of adults nationwide.

The 22.0% share of Iowans 18 and older with unpaid medical bills is closely in line with the comparable national figure. The amount of debt most Iowans are carrying is lower than average, however, as the median medical debt in the hands of collection agencies in the state is just $535 compared to an average of $694 nationwide.

Though Iowans are nearly twice as likely as the typical American to have health insurance, medical treatment can still have high out of pocket expenses, and a higher than average 22.7% share of adults in the state have not sought treatment for a medical problem due to costs.

A far higher than average 27.2% share of adults in Kentucky have unpaid medical bills. Although Kansas residents are about as likely as Americans overall to be covered with health insurance, the higher share of adults with medical debt is likely largely due to lower incomes in the state. The typical Kansas household earns $58,218 a year, nearly $4,000 less than the typical American household.

An estimated 892,450 adults in Kentucky are saddled with unpaid medical bills, or about one in every four residents 18 and older. The fact that many residents appear unable to afford treatment is likely having a detrimental effect on public health in the state. In the last year, 23.1% of adults have had a medical problem yet not sought treatment due to the cost, compared to 20.6% of adults nationwide.

An estimated 28.4% of adults in Louisiana have unpaid medical bills, a larger share than in the majority of states. While people in Louisiana are more likely to have insurance coverage than most Americans, health care can still be expensive, even for those with coverage. And for Americans with low incomes, this can often mean incurring debt. The typical household in Louisiana has an annual income of $47,905. Meanwhile, the typical American household has an income of $61,937.

A greater than average share of adults in Maine have unpaid medical bills, at 26.0%. Though people in Maine are more likely than most Americans to have health insurance, health care can still have high out-of-pocket costs, even for those with insurance. Indeed, for many in the state, the inability to pay for a hospital visit, doctor appointment, or test, is likely due in part to limited financial resources. The typical Maine household earns $55,602 a year, well below the $61,937 median income nationwide.

Marylanders are more likely to be able to pay a bill from a doctor’s appointment or hospital visit than most Americans. Only 19.1% of adults in the state have unpaid medical bills compared to 22.7% of adults nationwide.

The lower likelihood of debt is likely attributable to higher incomes and lower uninsured rates. The typical Maryland household earns $83,242 a year, the most of any state in the country. Additionally, just 6.0% of state residents are uninsured, well below the 8.9% national uninsured rate.

Massachusetts residents are more likely than Americans in every other state to have health insurance coverage. Just 2.8% of people in the state lack insurance, well below the 8.9% national uninsured rate. Partially as a result, the share of adults in Massachusetts with unpaid medical bills, at 16.5%, is far lower than the 22.7% national average.

The state’s widespread insurance coverage is also likely improving public health in Massachusetts. Just 14.9% of adults in Massachusetts report not going to a doctor or clinic in the last year for a medical problem due to cost, a smaller share than the comparable 20.6% national figure.

An estimated 1.6 million adults in Michigan have outstanding medical debt, or one in every five residents 18 and older, which is a smaller share than in most states. This is likely because Michigan residents are more likely to have health insurance than the typical American. Just 5.4% of state residents are uninsured compared to 8.9% of Americans nationwide.

Nearly 750,000 adults living in Minnesota have unpaid medical bills. That amounts to 17.3% of the 18 and older population, which is considerably lower than the 22.7% of adults nationwide with unpaid medical bills.

Like many states where a smaller than average share of adults have unpaid medical bills, Minnesota is a relatively high-income state where a large share of the population has insurance coverage. The median annual household income in Minnesota is $70,315, and just 4.4% of the state’s population is uninsured. Nationwide, the median household income is $61,937, and 8.9% of the population is uninsured.

A staggering 40.9% of the 2.3 million adults living in Mississippi have unpaid medical bills, the largest share of any state in the country. Having health insurance can significantly reduce what a patient pays out of pocket for medical care. In Mississippi, a state that has not adopted expanded Medicaid coverage, 12.1% of the population is uninsured, one of the larger shares among states.

Many in Mississippi face additional challenges in paying their bills, mainly low incomes. The majority of households in the state earn less than $45,000 a year. Meanwhile, most households nationwide earn over $61,000.

Adults in Missouri are more likely than the typical American to have unpaid medical bills. As is the case in most states where similarly large shares of the population are saddled with health care debt, Missouri has a higher than average uninsured rate. An estimated 9.4% of the state population lacks health insurance, compared to 8.9% of the U.S. population. The state’s higher than average uninsured rate is partially because Missouri is one of a handful of states not to adopt Medicaid expansion.

High medical costs appear to be taking a greater than average toll on public health in Montana. About 23.2% of adults in the state say they opted not to receive care for a medical problem because of costs, compared to 20.6% of adults nationwide. Indeed, Montana residents are more likely to have medical debt than Americans nationwide. An estimated 26.0% of state residents 18 and older have unpaid medical bills compared to 22.7% of adults nationwide.

The 21.4% share of adults with unpaid medical bills in Nebraska is slightly below the 22.7% share of adults nationwide with debt from medical treatment, consultation, or testing. Those with medical debt in Nebraska are also more likely to owe less than the typical American. The median amount of medical debt that has been turned over to collections agencies in the state is $481, well below the national median of $694.

In Nevada, 23.0% of residents 18 and older have unpaid medical bills, in line with the 22.7% share of American adults with health care debt. Still, Nevada residents are more likely to skip treatment for a medical problem due to cost than the typical American.

The share of adults in Nevada with unpaid medical bills would likely considerably decline with greater insurance coverage. Currently, 11.2% of state residents are without health insurance, well above the national uninsured rate of 8.9%.

Over a quarter million adults in New Hampshire have unpaid bills from hospital visits, doctor’s appointments, or medical tests — or 24.6% of the 18 and older population. Nationwide, 22.7% of adults have unpaid medical bills.

While health insurance reduces the financial burden of health care, medical treatment can still come with high out-of-pocket costs for patients. In New Hampshire, 5.7% of the population is uninsured, a smaller share than the 8.9% of adults nationwide.

The 16.2% share of adults with unpaid medical bills in New Jersey is well below the comparable share in most other states and the 22.7% share of adults nationwide. Higher-income areas tend to have smaller shares of residents with medical debt, and in New Jersey, the typical household earns $81,740 a year, about $20,000 more than the typical American household. New Jersey residents are also more likely than most Americans to have health insurance coverage.

Most states with relatively low incomes and high uninsured rates are also home to relatively larger shares of adults with unpaid medical bills. But New Mexico is an exception. The median annual household income in the state is $47,169, and 9.5% of state residents are uninsured. Meanwhile, the median household income nationwide is $61,937, and 8.9% of the U.S. population does not have health insurance. Still, just 15.1% of adults in New Mexico have unpaid medical bills, well below the 22.7% share of adults nationwide.

There are 2.7 million adults in New York state with unpaid medical bills, or 17.7% of the 18 and older population — a smaller share than in most states. As is often the case where relatively small shares of adults have medical debt,

New York has high incomes and relatively more residents with health insurance coverage. The median annual household income in the state is $67,844 a year, and 5.4% of state residents are uninsured. Meanwhile, the median household income nationwide is $61,937, and 8.9% of the U.S. population does not have health insurance.

North Carolina is one of only 14 states not to have adopted Medicaid expansion. Partially as a result, North Carolina’s 10.7% uninsured rate is one of the 10 highest among all states. Health insurance takes a considerable financial burden off the patient, and North Carolina’s high uninsured rate likely helps explain why a higher than average share of adults have unpaid medical bills, at 27.0%.

While North Carolinians are more likely than most Americans to have medical debt, those with debt do not typically have more of it. The median amount of medical debt that has been turned over to collections agencies in the state is $698, in line with the comparable national median.

In North Dakota, 20.3% of residents 18 and older have unpaid medical bills, a smaller share than in most states. Still, North Dakota residents are less likely to seek treatment for a medical problem due to medical costs than the typical American.

The lower likelihood of medical debt among adults in North Dakota may be attributable to less frequent treatment, as state residents are more likely to have better assessments of their own health than Americans on average. For example, just 14.3% of adults in the state report being in fair or poor health, compared to 16.0% of American adults nationwide.

Ohio residents age 18 and up are slightly more likely than the typical American adult to be saddled with unpaid medical bills. Although Ohio residents are more likely to have health insurance coverage, even with insurance, health care can come with considerable out-of-pocket costs — and people in Ohio are more likely to have limited financial resources. The typical household in the state earns $56,111 a year, nearly $6,000 less than the typical American household.

Oklahoma is one of only 14 states not to have adopted Medicaid expansion through the Affordable Care Act, and partially as a result, state residents are less likely to have health insurance. Oklahoma’s uninsured rate of 14.2% is the second highest of any state and well above the comparable nationwide rate of 8.9%. Americans seeking medical treatment without health insurance have considerably higher out-of-pocket expenses, and in Oklahoma, 26.7% of adults have unpaid medical bills, well above the 22.7% of American adults nationwide who do.

Oregon residents are more likely to have health insurance coverage and higher incomes than the Americans nationwide. Partially as a result, just 20.3% of adults in the state have outstanding medical bills, a smaller share than in most other states.

Still, even with health insurance, trips to the doctor, emergency room, or a clinic can come with high out-of-pocket costs. In the last year, 21.1% of adults in Oregon have had a medical problem yet not sought treatment due to the cost, slightly higher than the 20.6% of adults nationwide.

Likely due in part to a lower than average uninsured rate, adults in Pennsylvania are less likely than most American adults to be saddled with medical debt. An estimated 21.1% of Pennsylvania residents 18 and older have unpaid health care bills — a slightly smaller share than the 22.7% of adults nationwide.

Pennsylvania residents are also less likely than most Americans to be deterred from seeking necessary medical treatment because of concerns over cost. Just 16.8% of adults in the state have opted to not get treatment in the last 12 months for a known medical problem because of cost, below the comparable share of adults nationwide of 20.6%.

Like many other states in the Northeast, all of which have adopted Medicaid expansion under the Affordable Care Act, Rhode Island has a low uninsured rate. Just 4.1% of state residents are without health insurance, less than half the 8.9% national uninsured rate. Partially as a result, adults in the state are far less likely than Americans nationwide to be saddled with unpaid medical bills. Additionally, Rhode Island residents are less likely than the average American to be deterred from seeking necessary medical treatment due to concerns related to cost.

A staggering 31.4% of adults in South Carolina have unpaid medical bills, the second largest share of any state. The prevalence of medical debt is likely due in large part to the high uninsured rate in the state, which is exacerbated by low incomes. The median annual household income in the state is $52,306, and 10.5% of state residents are uninsured. Meanwhile, the median household income nationwide is $61,937, and 8.9% of the U.S. population does not have health insurance.

In South Dakota, 25.7% of adults have not sought necessary medical treatment in the last year because of concerns related to cost — well above the 20.6% of American adults. Indeed, the percentage of South Dakota residents with unpaid medical bills is higher than average.

Concerns over medical costs in South Dakota are likely exacerbated for the state’s relatively large uninsured population. South Dakota is one of 14 states not to have adopted Medicaid expansion under the Affordable Care Act, and currently, 9.8% of residents are uninsured, compared to 8.9% of Americans nationwide.

In Tennessee, 25.6% of the 18 and older population has unpaid medical bills, slightly more than the 22.7% national share. That figure would likely be reduced by greater health insurance coverage. As one of the 14 states not to adopt Medicaid expansion, Tennessee currently has a 10.1% uninsured rate, which is higher than the uninsured rate in the vast majority of states.

Over the last 12 months, the high cost of medical care has discouraged 21.8% of adults in Tennessee from seeking treatment for a health problem — higher the comparable national figure of 20.6%.

In Texas, 17.7% of the population does not have health insurance, the highest uninsured rate of any state. Partially as a result, a staggering 6.2 million adults in the state have unpaid medical bills — or 29.0% of Texas residents age 18 and up. Nationwide, 22.7% of adults are saddled with medical debt.

The state’s high uninsured rate is a threat to overall public health. Over the last year, the high cost of medical care has discouraged 26.1% of adults in Texas from seeking treatment for a health problem — well above the comparable 20.6% national figure.

The share of adults in Utah with unpaid medical bills, at 20.1%, is slightly below the comparable share nationwide of 22.7%. However, those unpaid bills are likely higher than average for many in the state. The median unpaid hospital, clinic, or doctor bill that has been turned over to a collections agency in Utah is $997, about $300 more than the national average.

Having health insurance coverage can greatly reduce out-of-pocket medical expenses, and in Utah, 9.4% of the population is uninsured, slightly higher than the 8.9% national rate.

As is the case across much of New England and the broader Northeastern United States, Vermont has an exceptionally low uninsured rate. Just 4.0% of Vermonters do not have health insurance, less than half the 8.9% national uninsured rate.

However, even with insurance, health care can have high out-of-pocket costs that many Americans struggle to afford. Despite the high insurance coverage in Vermont, 23.4% of adults in the state have unpaid medical bills, higher than the 22.7% national share.

There are 1.5 million Virginia residents 18 and older with unpaid medical bills, or 23.1% of the adult population — a larger share than the 22.7% of American adults saddled with medical debt. Virginians are also more likely to be discouraged from seeking treatment for a medical problem than most Americans.

Overall, people in Virginia appear more likely to lead healthy lifestyles than most Americans. State residents are less likely to smoke and more likely to exercise regularly than average.

Health insurance coverage significantly reduces out-of-pocket medical expenses. In Washington state, only 6.4% of the population is uninsured, well below the 8.9% national uninsured rate. Washington residents are also far more likely than Americans nationwide to have the financial resources to pay their medical bills. The typical household in the state earns $74,073 per year, about $12,000 more than the typical American household.

Due in large part to these factors, adults in Washington are also far less likely than Americans 18 and older to be saddled with medical debt. Just 17.7% of adults in the state have unpaid medical bills, compared to 22.7% of adults nationwide.

West Virginia is one of only three states where over 30% of the 18 and older population have unpaid medical bills. Even though West Virginians are more likely than Americans in most states to have health insurance coverage, out-of-pocket medical expenses can be high even for those with insurance coverage — and in West Virginia, many lack the financial resources to cover those costs. The typical household in West Virginia earns just $44,097 a year, the lowest median income of any state and nearly $18,000 less than the median nationwide.

The share of adults in Wisconsin with unpaid medical bills, at 22.6%, is almost exactly in line with the national figure of 22.7%. However, those with medical debt in the state are more likely to have more of it compared to the average nationwide. The median amount of debt that has been turned over to collections agencies in Wisconsin is $1,015, more than in all but two other states and well above the national median of $694.

Older Americans typically need more frequent, and often more expensive medical treatment. In Wisconsin, 17% of the population is 65 or older compared to 16% of the total U.S. population.

In Wyoming, 26.8% of adults have not sought treatment for a medical problem because of concerns related to cost, well above the comparable national share of 20.6%. Indeed, the share of adults who are saddled with medical debt in the state is higher than the national average.

Out-of-pocket medical costs are higher for Americans without insurance, and in Wyoming, 10.5% of the population is uninsured.