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Health Equity Crisis: The Impact of Medical Debt on Women

Gregory Brodie

J.D. from Georgia had no health insurance but had heart issues that required a trip to the ER. When J.D. received a letter in the mail informing her that her outstanding $826.72 of medical debt was erased, she reached out to Undue Medical Debt to share her experience, commenting that when she was in the ER she “had just moved out of a shelter with my children and didn’t have much funds other than to pay for rent and utilities.” She couldn’t afford the bill for her visit, but also didn’t have the resources and couldn’t navigate setting up a payment plan, noting, “I planned on setting up payments, but was never able to as I was still adjusting to being a single mother after my divorce.” Years went by, her credit was impacted, and she was even pursued with a subpoena for the medical bill.

Unfortunately, J.D. is not alone; women across the country carry medical debt and are disproportionately impacted by its harms. Medical debt unevenly impacts people across myriad social strata, and gender, in particular, is an increasingly significant identifier that deserves focus with regard to medical debt and patient experiences. In August 2023, to dig deeper on patient experiences with medical debt, Undue Medical Debt launched a survey and report in partnership with American Cancer Society Cancer Action Network (ACS CAN) and the Leukemia & Lymphoma Society (LLS). The national poll captures the impact of medical debt from a sample of over 2,000 respondents. Compared to men surveyed, women appear to be more affected by medical debt. Gender differences are consistent throughout the survey results with women generally feeling the effects of high health care costs — including anxiety and making tradeoffs between food, housing and other basic needs.

Medical debt is cyclical, especially for people with ongoing health care needs. This makes medical debt a particularly daunting specter on the patient experience; for example, 61% of women surveyed agreed that they were very concerned about going into medical debt when they use the health system. This alarming majority signals the need for stakeholders to have a more holistic understanding of the cyclical impacts of medical debt and address the high cost of health care for patients.

Even without the burden of medical debt, women already endure economic inequality through the gender pay gap. Pew Research Center reported in 2022 that women in America earn 82 cents for every dollar earned by men — a gap that has not narrowed for over two decades. In 2023, More than 75% of the 17% of caregivers the US adult population that provide unpaid care to an adult over the age of 50 were women. Despite an enduring overrepresentation of mostly white, middle-class women as caregivers in research and media portrayals, currently, nearly 40% of caregivers identify as Black, Indigenous, or People of Color (BIPOC). Additionally, a recent report from the Urban Institute found that women endure an average lifetime employment-related cost of $295,000 for providing unpaid care to children and certain adults with care needs. Lastly, a report from Deloitteshowed that women spend $15.4 billion more than men in out-of-pocket healthcare costs each year, based on deductibles, coinsurance and out-of-pocket maximums. These systemic inequities detrimentally exacerbate the impacts of medical debt on women.

According to our survey results, women’s experiences stand out:

  • Almost half of women (48%) reported having current or past medical debt, which was higher than the average response and specifically 5% higher than men who completed the survey.
  • 45% of women also reported that they are more likely to delay care due to their medical debt, compared to only 39% of men.
  • The social stigma of medical debt compounded by the financial anxiety of medical debt often isolates people and exacerbates the issue. 51% of women surveyed reported feeling trapped by their medical debt, compared to 45% of men.
  • Prolonged stress and anxiety can wreak havoc on people’s mental health, and 35% of women versus 28% of men report being more likely to say they became more depressed due to their medical debt.

Without necessary social support or financial resources, the stress, anxiety and isolating impacts of medical debt will not only magnify the negative effects, but also reinforce the helplessness that is experienced.

Undue Medical Debt’s policy agenda holds first and foremost that medical debt is about the failures of policies and systems, not people. Navigating and educating patients on financial assistance is a major intervention to break down barriers to health care literacy, advocacy, and empowerment. Whether it’s because patients don’t know they exist, or are too ashamed to see if they qualify, our survey showed that only 26% of women have reported asking for financial assistance from a provider. Many patients don’t know that not only is financial support available to them, but often you can question and challenge a medical bill. Below the national average, only 29% of women reported having fought or appealed a health care bill in the past; additionally, of the already low number of women who challenged a bill, women also reported lower levels of success in having medical bills lowered/dismissed than men.

Financial assistance is a promising resource, but not a panacea for medical debt. For example, some patients feel pressured to use a credit card or payment plan; these can carry high interest rates and transform medical debt into financial debt. While women are 63% more likely to have a payment plan to pay off their medical debt than 57% of men, 51% of women reported feeling pressure into getting the payment plan, medical credit card, or paying in installments by the health provider, bank or collection agency.

Across all dimensions of medical debt women reported higher impacts than men. Highlighting the issues of how women are impacted by medical debt opens opportunities to have broader and more productive conversations on how medical debt not only impacts people differently but also impacts unequally across gender, race, class and geography. For instance, our poll found that 50% of women believe policies seeking to protect patients from medical debt should also try to reduce systemic racism. Gender equity conversations can contribute to health equity agendas, and in turn, inform policies to redress the issue of medical debt generally, and then also more specifically for the communities who are disproportionately predisposed to incur medical debt.

Gregory Brodie