The United States is grappling with growing income inequality, but the widening chasm between these two Americas isn’t always easy to see. Even at the state level, the wealthiest can live in posh incorporated-township bubbles with their own fire and police departments, just a few miles away from some of the poorest Americans in the same city. These are the cities hit hardest by poverty in every state.
One factor that is particularly damaging, to the middle class as well as those with marginal incomes, is the cost of health care in this country. America is the most expensive place among wealthy nations to get sick. And not only do we pay more for healthcare — our health outcomes are worse, too.
According to “U.S. Health in International Perspective,” a paper published by the National Institutes of Health, Americans live shorter lives in poorer health than their counterparts in prosperous countries in Europe and Asia. That’s despite how much we spend on doctors, hospital stays, emergency room visits, and prescription drugs. Consider how Americans’ medical bills compare to those in other countries.
Though healthcare-related personal bankruptcies dropped by half after implementation of the Affordable Care Act in 2010, millions of Americans still suffer from medical debts they can’t afford to pay off. The situation has been made worse by the job-destroying COVID-19 pandemic, because most Americans get health insurance through their employers.
USA Today reported last year that a sample of 20 million Americans had $45 billion in medical debt in collection, which means that a third party is trying to collect unpaid bills on behalf of creditors. A 2020 Gallup poll concluded that more than half the population fears a major health event will lead to personal bankruptcy.
Click here to see the counties with the most medical debt in collections.
People struggle with medical debt in collections across the country, with the debt unsurprisingly linked to local levels of poverty, access to decent health insurance or Medicaid, and medical costs. These are the counties that suffer the most.
To identify the counties with the most medical debt in collections, 24/7 Wall St. reviewed the share of people with a credit report in each state who have medical debt in collections from “Debt in America 2021,” a report by the Urban Institute, based on credit bureau data from 2020.
Each county’s adult population that self-reported fair or poor health was obtained from “County Health Rankings and Roadmaps,” a collaboration between the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation. The percentage of each county’s residents who do not have health insurance came from the U.S. Census Bureau’s 2019 1-year American Community Survey.
50. Custer County, Oklahoma
> Median medical debt in collections: $1,593
> Adults with medical debt in collections: 29.5% — #269 out of 2,934 counties
> Adults self-reporting fair or poor health: 19.9% — #999 out of 3,136 counties
> Residents without health insurance: 13.4% — #613 out of 3,136 counties
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49. Craig County, Oklahoma
> Median medical debt in collections: $1,594
> Adults with medical debt in collections: 24.4% — #634 out of 2,934 counties
> Adults self-reporting fair or poor health: 22.1% — #575 out of 3,136 counties
> Residents without health insurance: 14.9% — #438 out of 3,136 counties
48. Martinsville city, Virginia
> Median medical debt in collections: $1,596
> Adults with medical debt in collections: 28.2% — #336 out of 2,934 counties
> Adults self-reporting fair or poor health: 21.6% — #672 out of 3,136 counties
> Residents without health insurance: 11.2% — #977 out of 3,136 counties
47. Clark County, Wisconsin
> Median medical debt in collections: $1,597
> Adults with medical debt in collections: 15.2% — #1,771 out of 2,934 counties
> Adults self-reporting fair or poor health: 14.1% — #2,404 out of 3,136 counties
> Residents without health insurance: 21.0% — #91 out of 3,136 counties
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46. Harrison County, Mississippi
> Median medical debt in collections: $1,602
> Adults with medical debt in collections: 21.7% — #919 out of 2,934 counties
> Adults self-reporting fair or poor health: 21.0% — #773 out of 3,136 counties
> Residents without health insurance: 15.2% — #405 out of 3,136 counties
45. Atoka County, Oklahoma
> Median medical debt in collections: $1,607
> Adults with medical debt in collections: 26.1% — #487 out of 2,934 counties
> Adults self-reporting fair or poor health: 22.1% — #568 out of 3,136 counties
> Residents without health insurance: 17.0% — #268 out of 3,136 counties
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44. Lamb County, Texas
> Median medical debt in collections: $1,610
> Adults with medical debt in collections: 39.3% — #38 out of 2,934 counties
> Adults self-reporting fair or poor health: 26.1% — #162 out of 3,136 counties
> Residents without health insurance: 23.0% — #63 out of 3,136 counties
43. Palo Pinto County, Texas
> Median medical debt in collections: $1,611
> Adults with medical debt in collections: 35.2% — #89 out of 2,934 counties
> Adults self-reporting fair or poor health: 18.9% — #1,194 out of 3,136 counties
> Residents without health insurance: 19.5% — #133 out of 3,136 counties
42. Lincoln County, Tennessee
> Median medical debt in collections: $1,619
> Adults with medical debt in collections: 23.6% — #711 out of 2,934 counties
> Adults self-reporting fair or poor health: 21.2% — #741 out of 3,136 counties
> Residents without health insurance: 8.4% — #1,643 out of 3,136 counties
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41. Howard County, Texas
> Median medical debt in collections: $1,631
> Adults with medical debt in collections: 36.9% — #68 out of 2,934 counties
> Adults self-reporting fair or poor health: 20.8% — #816 out of 3,136 counties
> Residents without health insurance: 17.0% — #270 out of 3,136 counties
40. Hart County, Georgia
> Median medical debt in collections: $1,634
> Adults with medical debt in collections: 24.7% — #611 out of 2,934 counties
> Adults self-reporting fair or poor health: 19.2% — #1,137 out of 3,136 counties
> Residents without health insurance: 12.1% — #793 out of 3,136 counties
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39. Choctaw County, Oklahoma
> Median medical debt in collections: $1,642
> Adults with medical debt in collections: 32.9% — #144 out of 2,934 counties
> Adults self-reporting fair or poor health: 27.7% — #108 out of 3,136 counties
> Residents without health insurance: 22.1% — #70 out of 3,136 counties
24/7 Wall St.
38. Laurens County, South Carolina
> Median medical debt in collections: $1,645
> Adults with medical debt in collections: 36.0% — #76 out of 2,934 counties
> Adults self-reporting fair or poor health: 21.3% — #719 out of 3,136 counties
> Residents without health insurance: 11.7% — #855 out of 3,136 counties
37. Matagorda County, Texas
> Median medical debt in collections: $1,670
> Adults with medical debt in collections: 26.2% — #476 out of 2,934 counties
> Adults self-reporting fair or poor health: 23.5% — #387 out of 3,136 counties
> Residents without health insurance: 17.9% — #213 out of 3,136 counties
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36. Payne County, Oklahoma
> Median medical debt in collections: $1,676
> Adults with medical debt in collections: 23.8% — #697 out of 2,934 counties
> Adults self-reporting fair or poor health: 19.9% — #992 out of 3,136 counties
> Residents without health insurance: 11.7% — #858 out of 3,136 counties
35. Cassia County, Idaho
> Median medical debt in collections: $1,684
> Adults with medical debt in collections: 20.1% — #1,113 out of 2,934 counties
> Adults self-reporting fair or poor health: 15.6% — #2,013 out of 3,136 counties
> Residents without health insurance: 13.5% — #586 out of 3,136 counties
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34. Madison County, Texas
> Median medical debt in collections: $1,691
> Adults with medical debt in collections: 33.7% — #130 out of 2,934 counties
> Adults self-reporting fair or poor health: 19.5% — #1,077 out of 3,136 counties
> Residents without health insurance: 15.4% — #381 out of 3,136 counties
33. Pickens County, South Carolina
> Median medical debt in collections: $1,703
> Adults with medical debt in collections: 25.8% — #507 out of 2,934 counties
> Adults self-reporting fair or poor health: 16.6% — #1,710 out of 3,136 counties
> Residents without health insurance: 9.7% — #1,302 out of 3,136 counties
32. Monroe County, Alabama
> Median medical debt in collections: $1,710
> Adults with medical debt in collections: 25.6% — #527 out of 2,934 counties
> Adults self-reporting fair or poor health: 30.0% — #56 out of 3,136 counties
> Residents without health insurance: 11.4% — #911 out of 3,136 counties
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31. Fremont County, Wyoming
> Median medical debt in collections: $1,711
> Adults with medical debt in collections: 25.9% — #502 out of 2,934 counties
> Adults self-reporting fair or poor health: 14.4% — #2,344 out of 3,136 counties
> Residents without health insurance: 18.3% — #192 out of 3,136 counties
30. Buchanan County, Virginia
> Median medical debt in collections: $1,713
> Adults with medical debt in collections: 23.2% — #768 out of 2,934 counties
> Adults self-reporting fair or poor health: 21.2% — #742 out of 3,136 counties
> Residents without health insurance: 12.4% — #730 out of 3,136 counties
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29. Red River County, Texas
> Median medical debt in collections: $1,724
> Adults with medical debt in collections: 32.3% — #174 out of 2,934 counties
> Adults self-reporting fair or poor health: 21.4% — #714 out of 3,136 counties
> Residents without health insurance: 14.4% — #483 out of 3,136 counties
28. Gaines County, Texas
> Median medical debt in collections: $1,743
> Adults with medical debt in collections: 27.9% — #354 out of 2,934 counties
> Adults self-reporting fair or poor health: 20.0% — #978 out of 3,136 counties
> Residents without health insurance: 33.7% — #09 out of 3,136 counties
27. Tyler County, Texas
> Median medical debt in collections: $1,748
> Adults with medical debt in collections: 33.9% — #126 out of 2,934 counties
> Adults self-reporting fair or poor health: 17.1% — #1,609 out of 3,136 counties
> Residents without health insurance: 16.9% — #278 out of 3,136 counties
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26. Bryan County, Oklahoma
> Median medical debt in collections: $1,764
> Adults with medical debt in collections: 34.7% — #106 out of 2,934 counties
> Adults self-reporting fair or poor health: 19.6% — #1,056 out of 3,136 counties
> Residents without health insurance: 17.9% — #214 out of 3,136 counties
25. San Jacinto County, Texas
> Median medical debt in collections: $1,781
> Adults with medical debt in collections: 29.3% — #280 out of 2,934 counties
> Adults self-reporting fair or poor health: 19.8% — #1,031 out of 3,136 counties
> Residents without health insurance: 19.5% — #134 out of 3,136 counties
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24. Madison County, Missouri
> Median medical debt in collections: $1,782
> Adults with medical debt in collections: 29.4% — #273 out of 2,934 counties
> Adults self-reporting fair or poor health: 21.6% — #656 out of 3,136 counties
> Residents without health insurance: 10.8% — #1,044 out of 3,136 counties
23. Albany County, Wyoming
> Median medical debt in collections: $1,784
> Adults with medical debt in collections: 19.2% — #1,218 out of 2,934 counties
> Adults self-reporting fair or poor health: 15.8% — #1,951 out of 3,136 counties
> Residents without health insurance: 8.2% — #1,688 out of 3,136 counties
22. Texas County, Missouri
> Median medical debt in collections: $1,796
> Adults with medical debt in collections: 22.0% — #889 out of 2,934 counties
> Adults self-reporting fair or poor health: 22.0% — #579 out of 3,136 counties
> Residents without health insurance: 16.1% — #325 out of 3,136 counties
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21. Callahan County, Texas
> Median medical debt in collections: $1,799
> Adults with medical debt in collections: 33.0% — #141 out of 2,934 counties
> Adults self-reporting fair or poor health: 16.8% — #1,672 out of 3,136 counties
> Residents without health insurance: 17.9% — #215 out of 3,136 counties
20. Cass County, Indiana
> Median medical debt in collections: $1,804
> Adults with medical debt in collections: 27.8% — #363 out of 2,934 counties
> Adults self-reporting fair or poor health: 20.4% — #897 out of 3,136 counties
> Residents without health insurance: 9.4% — #1,370 out of 3,136 counties
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19. Potter County, Texas
> Median medical debt in collections: $1,844
> Adults with medical debt in collections: 40.8% — #22 out of 2,934 counties
> Adults self-reporting fair or poor health: 24.2% — #299 out of 3,136 counties
> Residents without health insurance: 22.1% — #71 out of 3,136 counties
17. Maverick County, Texas
> Median medical debt in collections: $1,851
> Adults with medical debt in collections: 25.1% — #576 out of 2,934 counties
> Adults self-reporting fair or poor health: 35.2% — #15 out of 3,136 counties
> Residents without health insurance: 31.1% — #14 out of 3,136 counties
17. Stephens County, Texas
> Median medical debt in collections: $1,851
> Adults with medical debt in collections: 42.1% — #18 out of 2,934 counties
> Adults self-reporting fair or poor health: 20.0% — #981 out of 3,136 counties
> Residents without health insurance: 19.2% — #143 out of 3,136 counties
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16. Jackson County, Indiana
> Median medical debt in collections: $1,881
> Adults with medical debt in collections: 23.8% — #696 out of 2,934 counties
> Adults self-reporting fair or poor health: 20.9% — #802 out of 3,136 counties
> Residents without health insurance: 8.4% — #1,651 out of 3,136 counties
15. Park County, Wyoming
> Median medical debt in collections: $1,884
> Adults with medical debt in collections: 17.1% — #1,505 out of 2,934 counties
> Adults self-reporting fair or poor health: 13.3% — #2,617 out of 3,136 counties
> Residents without health insurance: 11.5% — #903 out of 3,136 counties
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13. Victoria County, Texas
> Median medical debt in collections: $1,910
> Adults with medical debt in collections: 30.4% — #230 out of 2,934 counties
> Adults self-reporting fair or poor health: 22.0% — #601 out of 3,136 counties
> Residents without health insurance: 16.8% — #280 out of 3,136 counties
13. Upson County, Georgia
> Median medical debt in collections: $1,910
> Adults with medical debt in collections: 31.1% — #211 out of 2,934 counties
> Adults self-reporting fair or poor health: 19.9% — #1,000 out of 3,136 counties
> Residents without health insurance: 11.8% — #830 out of 3,136 counties
12. Morris County, Texas
> Median medical debt in collections: $1,967
> Adults with medical debt in collections: 42.5% — #14 out of 2,934 counties
> Adults self-reporting fair or poor health: 18.1% — #1,354 out of 3,136 counties
> Residents without health insurance: 15.8% — #353 out of 3,136 counties
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11. Monroe County, Wisconsin
> Median medical debt in collections: $1,978
> Adults with medical debt in collections: 10.4% — #2,299 out of 2,934 counties
> Adults self-reporting fair or poor health: 13.0% — #2,688 out of 3,136 counties
> Residents without health insurance: 9.0% — #1,470 out of 3,136 counties
10. Natrona County, Wyoming
> Median medical debt in collections: $1,988
> Adults with medical debt in collections: 22.8% — #808 out of 2,934 counties
> Adults self-reporting fair or poor health: 14.5% — #2,292 out of 3,136 counties
> Residents without health insurance: 13.3% — #621 out of 3,136 counties
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9. Fairbanks North Star Borough, Alaska
> Median medical debt in collections: $2,042
> Adults with medical debt in collections: 17.3% — #1,478 out of 2,934 counties
> Adults self-reporting fair or poor health: 12.0% — #2,938 out of 3,136 counties
> Residents without health insurance: 9.8% — #1,274 out of 3,136 counties
8. Jackson County, Oklahoma
> Median medical debt in collections: $2,051
> Adults with medical debt in collections: 31.9% — #185 out of 2,934 counties
> Adults self-reporting fair or poor health: 20.5% — #876 out of 3,136 counties
> Residents without health insurance: 12.8% — #688 out of 3,136 counties
7. Karnes County, Texas
> Median medical debt in collections: $2,055
> Adults with medical debt in collections: 37.2% — #63 out of 2,934 counties
> Adults self-reporting fair or poor health: 22.9% — #455 out of 3,136 counties
> Residents without health insurance: 14.4% — #481 out of 3,136 counties
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6. Allen County, Kansas
> Median medical debt in collections: $2,110
> Adults with medical debt in collections: 26.3% — #468 out of 2,934 counties
> Adults self-reporting fair or poor health: 17.8% — #1,428 out of 3,136 counties
> Residents without health insurance: 5.1% — #2,573 out of 3,136 counties
5. Douglas County, Nevada
> Median medical debt in collections: $2,143
> Adults with medical debt in collections: 13.6% — #1,961 out of 2,934 counties
> Adults self-reporting fair or poor health: 15.3% — #2,097 out of 3,136 counties
> Residents without health insurance: 7.8% — #1,802 out of 3,136 counties
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4. Rush County, Indiana
> Median medical debt in collections: $2,149
> Adults with medical debt in collections: 26.5% — #456 out of 2,934 counties
> Adults self-reporting fair or poor health: 18.6% — #1,258 out of 3,136 counties
> Residents without health insurance: 9.8% — #1,280 out of 3,136 counties
3. Humboldt County, Nevada
> Median medical debt in collections: $2,162
> Adults with medical debt in collections: 22.4% — #840 out of 2,934 counties
> Adults self-reporting fair or poor health: 18.0% — #1,393 out of 3,136 counties
> Residents without health insurance: 12.1% — #784 out of 3,136 counties
2. Kenai Peninsula Borough, Alaska
> Median medical debt in collections: $2,181
> Adults with medical debt in collections: 14.7% — #1,838 out of 2,934 counties
> Adults self-reporting fair or poor health: 14.7% — #2,235 out of 3,136 counties
> Residents without health insurance: 16.0% — #343 out of 3,136 counties
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1. Plumas County, California
> Median medical debt in collections: $2,463
> Adults with medical debt in collections: 16.0% — #1,635 out of 2,934 counties
> Adults self-reporting fair or poor health: 13.8% — #2,498 out of 3,136 counties
> Residents without health insurance: 3.1% — #3,070 out of 3,136 counties
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