Some lost their homes. Some emptied their retirement accounts. Some struggled to feed and clothe their families. Medical debt now touches more than 100 million people in America, as the U.S. health care system pushes patients into debt on a mass scale. Debtors are from all walks of life and all corners of the country. 

Here are their stories ? how they got into debt, what they’ve given up for it, and how they’re living with the burden.

An Air Force career held up because of debt owed for medical bills 

By Aneri Pattani, KHN

Samaria Bradford, 27, Goldsboro, North Carolina

Approximate Medical Debt: $5,000

Medical Issue: Emergency room care

What Happened: In late August 2022, Samaria Bradford was prepared to leave for basic training any day. She’d been in contact with an Air Force recruiter. Her qualifying test score from two years earlier was still valid, and she’d lost weight to meet the physical requirements. She felt so good about it that she gave two weeks’ notice at her nursing home job.

Then the recruiter sent a text: “We got your credit check back you have multiple accounts in collects.”

Bradford had unpaid bills — mostly from hospitals and ambulance companies — that had gone to collections. The recruiter said she needed to set up payment plans to address the debts before she could enlist.

“I was very upset and surprised,” Bradford said. “I didn’t know your medical debt could stop you from joining.”

Bradford had dreamed of enlisting in the Air Force for years. She took the qualifying exam in 2020 but delayed her enlistment so she could stay close to home and support her younger sister, who was in high school at the time.

She worked a variety of jobs to stay afloat — as a cashier, then as a cook and a staff member at a bowling alley for a bit. Later, she took overnight shifts at a hospital. The pay covered rent, utilities, and food, but she had little left over.

Most of the jobs didn’t offer benefits, and since North Carolina had not expanded Medicaid, Bradford did not qualify for the public insurance.

Over the years, when she landed in the emergency room without insurance, bills racked up quickly. One time, she had a rash along her back that she feared was an allergic reaction. Another time, she was dehydrated and had to be brought to the hospital by ambulance. A car wreck led to another visit.

By 2022, when the Air Force recruiter looked into her finances, Bradford owed roughly $5,000 spread across a half-dozen bills. In response to his text about the debts, she wrote, “I’m guessing is doctor bills?”

What’s Broken: Several branches of the military check financial histories when evaluating recruits. “Credit checks aid in determining recruit financial responsibility while aiming to safeguard national security,” said Christine Cuttita, an Air Force Recruiting Service spokesperson. Depending on the particulars of the case, she confirmed, an individual can be disqualified from enlisting because of debt.

Red flags on a credit report include late payments, long-term debts, or total debt — including student loans, mortgages, and medical debt — that exceeds 40% of the person’s income. There’s no strict disqualifier; rather, a squadron commander evaluates each case and assesses it in the “best interest of the Air Force,” Cuttita said.

Employers in other sectors also commonly use credit checks to evaluate candidates.

However, research from the federal Consumer Financial Protection Bureau suggests medical debts should be treated differently than other debts.

The CFPB found that unlike credit card debt, medical bills that have gone to collections aren’t an accurate predictor of someone’s likelihood to pay bills. In fact, the agency determined that people with “paid medical collections were less likely to be delinquent than other consumers with the same credit score.”

The Biden administration this year advised federal lenders to no longer consider medical debt when evaluating loan applications. VantageScore, one of the companies that calculate consumers’ credit scores, has said it will stop using medical collections in its formula.

But running credit checks on job candidates remains common. For those with medical debt, that can mean being turned away from jobs because of the bills they are trying to pay off.

What’s Left: After receiving the recruiter’s text, Bradford set out to make payments on as many medical bills as she could. Using savings from the nursing home job she had recently left, she closed out two accounts on which she owed a few hundred dollars and made smaller payments toward bills of $1,000 or more.

But, it turned out, those were not the debts showing up on the Air Force credit check.

“Of the five payments I made, only one of them was connected to what my recruiter saw on his end,” Bradford said.

Medical debts can be difficult to track, especially once hospitals and doctors’ offices sell them to collection agencies. A given bill may be reported to one credit agency but not another, meaning any single report cannot give a full picture of someone’s debt.

Adding to the confusion, the credit check that Bradford’s recruiter shared with her showed the amount of each debt but not to whom it was owed.

Bradford is now getting help to track down each debt from a friend who used to work in hospital billing. She has also taken a new job to ensure she can pay down those bills.

With the time that has passed, her previous score for the Air Force’s qualifying test is no longer valid. She’s planning to retake the exam and try to enlist next year.

“I’m trying to solve the problem now to go ahead,” Bradford said. But she still questions why the Air Force would delay anyone’s enlistment for this kind of debt.

“If you need people to be there for the country and to fight for the country,” she said, “why would you hold them up for a medical bill?”

Her credit was ruined by medical debt. She’s been turned away from doctors, jobs, and loans 

By Aneri Pattani, KHN

Penelope Wingard, 58, Charlotte, North Carolina

Approximate Medical Debt: More than $50,000

Medical Issue: Breast cancer

What Happened: After a year of chemo and radiation, in 2014, Penelope Wingard finally heard the news she’d been praying for: Her breast cancer was in remission. But with relief immediately came worry about her finances.

Wingard had received Medicaid coverage through a temporary program for breast cancer patients. When her treatment ended, she became uninsured.

Bills for follow-up appointments, blood tests, and scans quickly piled up. Soon, her oncologist said he wouldn’t see her until she paid down the debt.

“My hair hadn’t even grown back from chemo,” Wingard said, “and I couldn’t see my oncologist.”

It took about six months to find a doctor who would see her while unpaid bills accrued.

Wingard was later diagnosed with an aneurysm that required brain surgery and, separately, vision problems that prompted corneal transplants in both eyes. Within a few years, she was buried under tens of thousands of dollars in medical debt.

She learned to recognize the phone numbers of bill collectors and ignore the past-due notices arriving in the mail. She wanted to pay them but had to prioritize rent, utilities, and food. After taking care of those expenses, she had little money left from her jobs as a covid-19 contact tracer and a driver for ride-hailing services.

The unpaid medical bills began hitting her credit. Soon, she struggled to qualify for loans. Applying for apartments and jobs became a nightmare.

“It’s like you’re being punished for being sick,” Wingard said.

What’s Broken: Unpaid medical bills can be reported to credit agencies and show up as black marks on a person’s financial record, making it harder to qualify for a car loan, rent an apartment, or get a job.

Earlier this year, three national credit agencies announced new policies that would remove from credit reports paid medical debts and those that are less than $500 even if they are unpaid.

The changes, slated to go into full effect in 2023, are expected to benefit an estimated 16 million Americans.

But millions of Americans who owe far more than $500 may not benefit — 1 in 4 U.S. adults with health care debt owe more than $5,000, according to a KFF poll conducted for this project; 1 in 8 owe more than $10,000.

recent report by the Consumer Financial Protection Bureau also suggests that the changes to credit reports may disproportionately benefit wealthier Americans living in predominantly white neighborhoods. They’re more likely to have health insurance, experts say, and collections under $500 often come from an unpaid copay or coinsurance.

In contrast, people with the highest levels of medical debt tend to be Black or Hispanic, have low incomes, and live in the South. According to the KFF poll, 56% of Black adults and 50% of Hispanic adults said they have debt because of medical or dental bills, compared with 37% of white adults. And a study published in 2021 found that medical debt was highest within low-income communities and in Southern states that had not expanded Medicaid.

As an uninsured Black woman living in North Carolina, Wingard sits squarely among the communities hit hardest by medical debt. Yet she will not benefit from the credit agencies’ new policies.

What’s Left: Wingard has resigned herself to living with medical debt. That means worrying that another doctor will turn her away because of unpaid bills and having employers reject her from jobs because poor credit shows up as a red flag on background checks.

Her fridge and stove have both been broken for over a year. She can’t qualify for a loan to replace them, so instead of making baked chicken from her favorite family recipe, she often settles for a can of soup or fast-food chicken wings.

But there are signs that help is on the way. The Biden administration has asked the Consumer Financial Protection Bureau to investigate whether medical debt should ever appear on credit reports, and some states — including North Carolina — are considering strengthening protections against medical debt.

Wingard is hopeful she’ll get relief soon. “I’m hoping someone will listen and say we need to focus more on health care for all Americans,” she said. “I don’t know if they will, but it’s just a blind hope.”

A retiree returns to work after a calamitous year of health emergencies 

By Noam N. Levey, KHN

David Zipprich, 65, Fort Worth, Texas

Approximate Medical Debt: More than $200,000

Medical Issue: Diabetes and covid-19

What Happened: David Zipprich, a Fort Worth businessman and grandfather, was forced out of retirement after a series of hospitalizations left him owing more than $200,000.

Zipprich had spent a career in financial consulting. He owned a small bungalow in a historical neighborhood near the Fort Worth rail yards. His daughters, both teachers, and his four grandchildren lived nearby. He had health insurance and some savings, and he’d paid off his mortgage.

In early 2020, though, Zipprich landed in the hospital. While he was driving, his blood sugar dropped precipitously, and he blacked out and crashed his car.

Three months later, after he was diagnosed with diabetes, another complication sent him back to the hospital. In December 2020, covid-19 put him there again. “I look back at that year and feel lucky I even survived,” Zipprich said.

What’s Broken: Of the nation’s 20 most populous counties, none has a higher prevalence of medical debt than Tarrant County, where Fort Worth is located. Second is adjacent Dallas County, credit bureau data shows.

Nevertheless, Dallas-Fort Worth medical systems have been thriving. Though many are exempt from taxes as nonprofit institutions, several notched double-digit profit margins in recent years, outperforming many of the area’s Fortune 500 companies.

A KHN review of hospital finances in the country’s 306 hospital markets found that several of the most profitable markets also have some of the highest levels of patient debt.

Overall, about a third of the 100 million adults in the U.S. with health care debt owe money for a hospitalization, according to a poll conducted by KFF for this project. About a quarter of those owe $10,000 or more.

“The fact is, if you walk into a hospital today, chances are you are going to walk out with debt, even if you have insurance,” said Allison Sesso, chief executive of RIP Medical Debt, a nonprofit that buys debt from hospitals and debt collectors so patients won’t have to pay it.

Overall in Tarrant County, 27% of residents with credit reports have medical debt on their records, credit bureau data analyzed by KHN and the nonprofit Urban Institute shows. In Dallas County, it’s 22.5%

What’s Left: Even with insurance, Zipprich was inundated with medical bills, debt notices, and calls from collectors.

As he struggled to pay, his credit score plummeted below 600, and he had to refinance his home. “My stress was off the charts,” he said, sitting in his tidy living room with his Shih Tzu, Murphy.

Last year, Zipprich returned to work, taking a job in New Jersey that required him to commute back and forth to Texas. He recently quit, citing the strain of so much travel. He’s job-hunting again. “I never thought this would happen to me,” he said.

From her view in Knoxville, the health system is ‘not designed for poor people’ 

By Noam N. Levey, KHN

Monica Reed, 60, Knoxville, Tenn.

Approximate Medical Debt: $10,000

Medical Issue: Cancer

What Happened: Monica Reed considers herself luckier than most. Born in Knoxville and raised by a single mother, Reed became the first in her family to own a home, a small house built after the city demolished The Bottom, a once thriving Black neighborhood that was systematically wiped out in a midcentury urban renewal campaign. For the past 15 years, Reed has worked for a faith-based nonprofit that assists low-income residents of Knoxville.

“It hasn’t always been easy,” Reed said. She raised her son by herself. And though she’s always worked, her modest salary made saving difficult. “I just tried to live a frugal kind of life,” she said. “And by the grace of God, I didn’t become homeless.”

She couldn’t escape medical debt, though. Diagnosed with cancer five years ago, Reed underwent surgery and chemotherapy. Although she had health insurance through work, she was left with close to $10,000 in medical bills she couldn’t pay.

What’s Broken: In and around Knoxville, residents of predominantly Black neighborhoods are more than twice as likely as those in largely white neighborhoods to owe money for medical bills, Urban Institute credit bureau data shows. That is one of the widest racial disparities in the country.

Health care debt in the U.S. now affects more than 100 million people, according to a nationwide KFF poll conducted for this project. The toll has been especially high on Black communities: Fifty-six percent of Black adults owe money for a medical or dental bill, compared with 37% of white adults.

The explanation for that startling disparity is deeply rooted. Decades of discrimination in housing, employment, and health care blocked generations of Black families from building wealth — savings and assets that are increasingly critical to accessing America’s high-priced medical system.

Against that backdrop, patients suffer. People with debt avoid seeking care and become sicker with treatable chronic conditions like diabetes or multiple sclerosis. Worse still, hospitals and doctors sometimes won’t see patients with medical debt — even those in the middle of treatment.

Nationwide, Black adults who have had health care debt are twice as likely as white adults with such debt to say they’ve been denied care because they owe money, the KFF poll found. Many Black Americans also ration their care out of fear of cost.

If Black patients go into debt, they face yet another challenge: a medical debt collection industry that targets Black debtors more aggressively than their white counterparts, particularly for smaller debts.

What’s Left: Reed has been pursued by debt collectors and even taken to court. That has forced Reed to make difficult choices. “There’s always a sacrifice,” she said. “You just do without some things to pay for other things.”

Reed said she cut back on trips to the grocery store: “I don’t buy a lot of food. Just plain and simple.”

She has adjusted, she said. “You just do what you have to do.” What angers Reed, though, is how she’s been treated by the cancer center where she goes for periodic checkups to make sure the cancer remains in remission. When she recently tried to make an appointment, a financial counselor told her she couldn’t schedule it until she made a plan to pay her bills.

“I was so upset, I didn’t even find out how much I owed,” Reed said. “I mean, I wasn’t calling about a little toothache. This is something that affects someone’s life.”

Reed said she tries to stay upbeat. “I don’t sweat the small stuff,” she said. “What am I going to do against this hospital?”

But, she said, she has realized one thing about the nation’s health care system: “It’s not designed for poor people.”

A medical cost-sharing plan left pastor with most of the cost 

By Bram Sable-Smith, KHN

Jeff King, 63, Lawrence, Kansas

Approximate Medical Debt: $160,000

Medical Issue: Heart ablation

What Happened: Kareen King calls it “the ultimate paradox”: The hospital that saved her husband’s heart also broke it.

Jeff King needed his heart rhythm restored to normal with a procedure called an ablation — sooner rather than later, his doctor said. Jeff asked the hospital for a cost estimate but said he didn’t hear back before his scheduled surgery in January 2021 at Stormont Vail Health in Topeka, Kansas.

The real pain came when the $160,000 bill arrived in the mail a few weeks later. The Kings, who were uninsured at the time, were on the hook for nearly all of it.

For health coverage, they’d joined a medical cost-sharing plan with a company called Sedera, which describes its service as a “refreshing non-insurance approach to managing large and unexpected healthcare costs.” With this alternative to health insurance, members agree to share one another’s expenses. The plans are often faith-based and have surged in popularity because they can be cheaper than traditional insurance — the Kings said their plan cost $534 a month, plus an additional $118 a month to join a direct primary caremedical practice.

But the sharing plans offer fewer protections than insurance and come with provisos. The Kings said their plan did not fully cover preexisting conditions like Jeff’s heart condition for the first two years of coverage — and he needed the surgery after 16 months.

In a statement, a Sedera spokesperson said it’s important that members understand the cost-sharing model and membership guidelines. “Sedera members read and agree to these prior to joining,” the statement read.

The Kings have dabbled in all sorts of health coverage in their 42 years of marriage. Jeff’s work as an evangelical pastor in his hometown of Osage City, Kansas, almost never provided insurance for the couple or their five children, all of whom are now grown. The exception came during Jeff’s most recent stint leading a congregation, starting in 2015. Kareen remembered feeling “unworthy” of the $1,800 a month the congregation paid for their insurance.

“We certainly had never come up with those kinds of premiums ourselves,” she recalled.

But Jeff decided he had to leave that job in 2018. He said he felt forced out over differences with some of his congregants on eternal damnation (“As a loving parent, I could never punish my child forever”) and gay marriage (“Maybe God is a whole lot more inclusive than we are”).

After Jeff resigned, the Kings briefly bought insurance through the Affordable Care Act marketplace but later dropped it because they weren’t eligible for subsidies and felt they couldn’t afford it.

That’s when they joined the Sedera plan. They knew the preexisting condition clause was a gamble, but medication had managed Jeff’s heart condition for years, and they didn’t expect he’d need medical procedures to address it.

What’s Broken: Without employer-sponsored insurance or federal subsidies to help fund their coverage, the Kings felt priced out of traditional insurance. But being uninsured left them exposed to hospital charges that ordinary patients typically never see.

Hospital charges are generally understood by health economists to bear little resemblance to the actual prices that are typically paid. Instead, they are more of an opening salvo in the high-stakes negotiations between hospitals trying to get as much money as they can for providing care and insurance companies trying to pay as little as possible.

But patients lack the bargaining power of large insurers, which may cover hundreds of thousands of patients in any given hospital’s catchment area. For patients like Jeff, the main recourse is to go through a hospital’s financial assistance program, although even with that help many patients can’t afford the bills hospitals send them.

Stormont Vail’s assistance program eventually knocked about $107,000 off Jeff’s original bill. Sedera provided a negotiator to help him haggle over costs.

Stormont Vail provided $19.5 million in financial assistance in tax year 2020 and wrote off about $13 million in bad debt, according to tax filings. Its net revenue from patient services was $838.7 million.

Bill Lane, a Stormont Vail administrator, said that in addition to providing financial assistance, the hospital works with patients facing high bills and offers payment plans with zero interest. Payments are often in the range of 10% of a person’s monthly income, Lane said. For some patients the hospital has a “catastrophic discount” program that caps their balance at 30% of their gross household income. The hospital also works with a local bank to provide loans to patients to pay their bills. And the hospital sometimes sends patients’ balances to debt collection agencies.

Lane said he generally recommends for patients to carry traditional insurance. He also said the hospital now offers a “patient estimates module” and suggests patients wait to schedule surgery, if possible, if they want an estimate “to make an informed decision.”

What’s Left: Despite Sedera’s two-year waiting period to cover preexisting conditions, the plan did give Jeff $15,000 to help with his bills. After Jeff paid that to the hospital and then negotiated for several months, his final balance was reduced to $37,859.34 in November 2021.

For his payment plan, Jeff said he was told the hospital would accept no less than $500 per month — the equivalent of an additional mortgage payment for the Kings. Jeff estimates it will take the family more than six years to pay it off.

“I never expected this to not cost me anything,” Jeff said, “but I wasn’t expecting what it turned out to be either.”

The Kings are piecing together the funds to pay what they owe the hospital. A few months after Jeff’s ablation, they sold their home in Osage City — where they raised five children and where Jeff grew up — and bought a smaller house in Lawrence. They had hoped to use that money to build their retirement account, since Jeff’s decades of pastoral work didn’t include a pension or 401(k).

Instead, the home sale is helping pay Jeff’s medical debt. Kareen has part-time jobs, and the couple leveraged their life insurance policy, as well.

Jeff began work as a hospice chaplain — for the extra income, but especially to qualify the couple for health insurance. That meant less time for his passion project, running a nonprofit called Transmuto through which he provides spiritual guidance.

In February, Kareen checked again on whether the couple could afford Affordable Care Act insurance so Jeff could get back to Transmuto full time. Her Google searches for the federal government’s health insurance marketplace (healthcare.gov) instead unwittingly landed her on websites that sell consumer information to insurance brokers. Speaking to one of those brokers on the phone, she bought what she said she was told was an Aetna plan. But it turned out to be a membership in a cost-sharing plan with a company called Jericho Share, which has received over 160 complaints on the Better Business Bureau website in the past year.

Jericho Share spokesperson Mark Hubbard said in a statement that the organization is “issuing full refunds when there is consumer confusion” and is continuing to “evaluate and update our marketing efforts to increase transparency and awareness.”

Hubbard also said Jericho Share is cooperating with regulators in California and New Hampshire that have questioned whether the organization meets state requirements of a health care sharing ministry. California is also questioning whether Jericho Share has indeed received 501(c)(3) nonprofit status from the IRS.

After canceling that plan and getting their money back, the Kings eventually did sign up for an Affordable Care Act marketplace plan. Jeff has reduced his hours as a chaplain, freeing up more time for Transmuto. All in all, the couple feels pretty fortunate.

“It’s just so tragic the way our system is,” Jeff said. “It puts so many people into impossible financial straits.”

Double shifts, credit card debt, and family loans when twins were born early 

By Noam N. Levey, KHN

Allyson Ward, 43, Chicago

Approximate Medical Debt: $80,000

Medical Issue: Childbirth

What Happened: There were times after her sons were born 10 years ago when Allyson Ward wondered whether she and her family would lose their home.

On some days, she would tick through a list of friends and family, considering who could take them in. “We had a plan that we were not going to be homeless,” Ward recalled.

Ward is a nurse practitioner who works at a neonatal intensive care unit in Chicago. Her husband, Marcus, runs a small nonprofit.

But when the couple’s boys, Milo and Theo, were born 10 weeks prematurely, their lives were upended financially.

The twins were diagnosed with cerebral palsy. One required multiple surgeries to fix a breathing disorder. The babies spent more than three months in a NICU.

Ward and her husband scrambled to get the boys the care they needed, including years of physical and occupational therapy. The bills, which topped out at about $80,000, overwhelmed them.

Much of it at first was from hospital care. Then their health plan denied thousands of dollars in claims for the boys’ therapies, deeming some unnecessary.

Desperate, Ward and her husband loaded up credit cards, borrowed from relatives, and delayed repaying student loans. They moved back to the Midwest from Dallas to be closer to family who could help them.

In Chicago, Ward took on extra nursing shifts, working day and night several times a week. Her husband, who was finishing a master