The Los Angeles County Department of Public Health has released an update for its report, “Medical Debt in LA County: Baseline Report and Action Plan”, which found that total medical debt burden now exceeds $2.9 billion with an approximate $300 million increase from 2021 to 2022.

Medical debt continues to affect approximately 1 in 10 adults in LA County in 2022, similar to the prevalence of major health conditions such as asthma and diabetes.

Insurance Expansion Failed to Curb Debt

With expanding insurance coverage and the Public Health Emergency protections for COVID-19, the percentage of uninsured residents dropped by approximately 13% from 2021 to 2022. However, during the same time period, medical debt still increased, indicating that insurance expansion, while important for healthcare access, has not fully addressed the underlying factors contributing to medical debt.

Mirroring trends observed during COVID-19, medical debt has disproportionately impacted vulnerable groups. Latino adults (12.0%), Black adults (11.0%), and American Indian/Alaskan Native, Native Hawaiian/Pacific Islander and multiracial adults (11.3%) were more burdened than White (8.2%) and Asian (6.5%) adults. Adults in households with incomes below the Federal Poverty Level (FPL) (12.2%), from 100-199% FPL (13.3%), and from 200-299% FPL (13.0%), were more burdened by medical debt than those in households with incomes at 300% or more of the FPL (7.5%). In 2022, 300% of the Federal Poverty Level for a family of 4 was $83,250.

Additionally, Medi-Cal recipients were approximately twice as likely to have medical debt than those on Medicare. More than 25% of uninsured adults experience medical debt and were over eight times more likely to be burdened by medical debt than those with Medicare.

Detrimental Effects on Health and Well-being

Medical debt remains a priority public health issue, as medical debt impeded patients’ ability to access necessary care and treatment, creating a cycle of health and financial hardship. Adults with medical debt were over three times more likely to skip or delay needed healthcare, and approximately three and a half times more likely to delay or not pick up prescriptions compared to those who were not burdened with medical debt. Additionally, adults with medical debt burden were almost two and a half times more likely to experience food insecurity and over 3 times more likely to experience housing instability.

“Financial security is a key social determinant of health and medical debt erodes a person’s ability to take care of their financial and physical health. The Department of Public Health is working with partners across the county to advance solutions to this distressing issue,” said Barbara Ferrer, Ph.D., M.P.H., M.Ed., Director of the Los Angeles County Department of Public Health. “Our coalition of community organizations, hospitals and healthcare plans developed a comprehensive plan, and with leadership from the Los Angeles County Board of Supervisors, we are working together to strengthen protections for health care consumers.”

Strengthening Protections for Health Care Consumers

On Oct. 3, 2023, the Board of Supervisors passed a motion recognizing the impact medical debt has on County residents that calls for the Los Angeles County Department of Public Health, working with coalition members and the Departments of Health Services, Mental Health, Consumer and Business Affairs, Public Social Services, and Economic Opportunity, County Counsel, and the Chief Executive Office, to take multiple actions to better understand the extent of medical debt challenges and design solutions to reduce financial hardships.

The following actions will be taken in response to the motion:

-Public Health will draft an ordinance to gather data on LA County hospital debt collection and financial assistance activities to highlight hospital best practices.

-Public Health will collaborate with Consumer and Business Affairs to identify policies, practices, and programs to prevent medical debt.

-Public Health will work with the CEO to assess the feasibility for retiring medical debt with funding sources, whether government or philanthropic, similar to programs in Cook County, IL and New York City.

-In consultation with Public Health and partner County agencies, the CEO Office of Legislative Affairs and Intergovernmental Relations will advocate for policy changes that will improve consumer protections and mitigate medical debt.

Data Source

This analysis used data from the 2017-2022 California Health Interview Survey, the nation’s largest state-level health survey conducted by the University of California, Los Angeles. Most of the analyses were based on 2019-2022 survey responses from a representative sample of 18,002 adults (18+) in Los Angeles County who were asked if they have had problems paying medical bills for themselves or their household members in the past 12 months.

To view the update and the original report online, visit the website.