America’s medical-debt relief cannot fix a healthcare affordability system

Medical-debt relief is expanding, but the underlying bill is expanding faster than the political imagination. Millions of Americans have had debts erased in recent years, yet experts say the assistance remains a stopgap because people are still being pushed into financial trouble by the cost of care.¹

KFF estimates that people in the United States owed at least $220bn in medical debt in 2024; about 14 million owed more than $1,000, and 3 million owed more than $10,000.¹ Those are not the contours of a niche problem or a handful of reckless patients. They describe a financing system that turns illness into a household liability.

The household measure matters. In 2024, 21% of US households had a past-due medical bill, while the Consumer Financial Protection Bureau found that medical care accounted for more than half of bills sent to collectors in 2021.¹ Debt on a credit report is not the same thing as every underlying obligation, but either measure points to a problem embedded in ordinary family budgets.

Insurance does not end the exposure. High deductibles and cost-sharing can leave insured patients unable to pay, while the uninsured face the full force of providers’ charges.¹ The Ohio evidence makes the same point: medical debt affects insured people too, not only those without coverage.²

Undue Medical Debt can buy portfolios cheaply and erase roughly $100 for every $1 donated, but charity cannot substitute for affordable prices, reliable coverage or enforceable billing obligations.¹ Its work is humane precisely because the system is failing people before they ever reach a debt collector.

States are trying to repair the gaps: 18 require hospitals, including for-profit hospitals, to offer assistance under minimum standards, and six require screening for presumptive eligibility.¹ Those reforms may reduce harm, but they also reveal how much depends on geography, disclosure and a patient’s ability to navigate bureaucracy while sick.

Mary Shannon of Care Over Collections put the necessary remedy plainly: “Addressing the affordability crisis in healthcare” is what reaches the heart of the issue.¹ Washington and state governments should treat forgiveness as triage, not success. Until the price and payment structure changes upstream, every cleared balance will be evidence of relief—and of the next balance waiting behind it.