Analysis 02 · Medical debt · United States

3.2% of adults in the United States have medical debt in collections.

There is no public count of medical bankruptcies — a bankruptcy filing does not record its cause. What can be measured is medical debt that has gone to collections on a credit record, which the Urban Institute reports for every county from a national credit-bureau panel.

This page sets that figure beside the prices in the same county: what local hospitals bill for every dollar they are paid, how many residents are uninsured, what households earn, and how long people live. Where a county has both, the share in communities of color averages 7.3% against 5.2% in majority-white ones.

State Back to prices

2,654

counties with a debt figure (of 3,152)

$1,430

median amount in collections, typical county

7.3%

share in communities of color

5.2%

share in majority-white communities

1,238

of those counties have a hospital in the Medicare files

01 · Map

Where medical debt lands

Every county, shaded by the share of adults with medical debt in collections. Switch the map to the uninsured rate, what local hospitals bill per dollar paid, or years of life lost, and the pattern either follows or it does not. The blank states are not debt-free. CA, CO, IL, NY, RI, VT, WA bar medical debt from consumer credit reports, so the credit-bureau panel this figure comes from cannot see it there.

≤ 1.8%1.8% – 3.5%3.5% – 5.3%5.3% – 8.3%> 8.3%not published

Explore this map

Every county, shaded by the share of adults whose credit records carry medical debt in collections. The switches change the lens — the uninsured rate, what local hospitals bill per dollar they are paid, years of life lost — and the question is always whether the dark counties stay dark. Clicking any county opens its full profile.

Zoom to one state's counties

Highest — medical debt in collections

Pecos County, TX24.9%

Scurry County, TX23.9%

Evans County, GA21.8%

Hutchinson County, TX21.6%

Ector County, TX20.0%

Coahoma County, MS19.9%

Lowest

Loudoun County, VA0.1%

Morrison County, MN0.1%

New Kent County, VA0.1%

The state pages re-rank every table on this page within that state.

02 · What travels with debt

Counties sorted four ways

Counties in the United States split into quarters by one measure, and the average share with medical debt in collections in each quarter. These are associations in one year of data; they show what moves together, not what causes what. Click a bar for the counties in that quarter.

By what local hospitals bill per dollar paid

counties with a hospital in the Medicare files

0.7× – 2.4× 5.1%

2.4× – 3.4× 4.6%

3.4× – 4.8× 5.0%

4.8× – 17.8× 5.8%

By uninsured rate

County Health Rankings

2% – 7% 2.9%

7% – 10% 4.2%

10% – 14% 5.5%

14% – 35% 8.2%

By median household income

lowest quarter first

$29K – $54K 7.3%

$54K – $62K 5.6%

$62K – $72K 4.5%

$72K – $174K 3.4%

03 · Debt and health

Where debt is higher, people die younger

Each point is a county: the share of adults with medical debt in collections across, years of potential life lost before 75 per 100,000 residents up. Orange points are counties whose hospitals bill five times or more what they are paid; faint ones have no hospital in the Medicare files.

Medical debt in collections vs. premature death, 2,646 counties click a point for the county

0%13%25% with medical debt in collections

Years of life lost per 100,000

by quarter of medical-debt share, lowest first

0–2% debt 8,335

2–4% debt 10,432

4–7% debt 11,556

7–25% debt 12,427

Adults in poor or fair health

by quarter of medical-debt share, lowest first

0–2% debt 16.4%

2–4% debt 19.3%

4–7% debt 21.4%

7–25% debt 23.1%

Preventable hospital stays per 100,000

by quarter of medical-debt share, lowest first

0–2% debt 2,489

2–4% debt 2,863

4–7% debt 2,997

7–25% debt 3,189

04 · Counties

Highest medical-debt share in the United States

Sort

County

Debt

Of color · white

Median

Uninsured

Income

Billed ÷ paid

YPLL

Pecos County, TX

24.9%

27% · 10%

$1,761

22.5%

$58K

—

12,159

Scurry County, TX

23.9%

24% · 19%

$1,956

20.9%

$70K

—

11,825

Evans County, GA

21.8%

— · 20%

$1,372

17.8%

$51K

4.5×

14,703

Hutchinson County, TX

21.6%

— · 22%

$1,756

16.4%

$65K

—

13,452

Ector County, TX

20.0%

20% · 12%

$1,600

21.8%

$67K

3.7×

12,481

Coahoma County, MS

19.9%

20% · —

$2,909

14.4%

$36K

3.0×

22,826

Screven County, GA

19.9%

— · 20%

$1,314

14.7%

$49K

—

15,035

Hardeman County, TX

19.8%

— · 20%

—

19.9%

$50K

—

10,561

Calhoun County, TX

19.7%

21% · 12%

$1,885

16.8%

$69K

—

9,452

Terry County, TX

19.6%

20% · —

$2,970

23.6%

$44K

—

13,280

West Feliciana Parish, LA

19.5%

— · 20%

$1,237

5.3%

$74K

—

14,259

Jackson County, FL

19.4%

20% · 19%

$2,335

11.5%

$51K

1.6×

13,579

Harmon County, OK

19.2%

22% · —

—

17.6%

$46K

—

17,825

Brooks County, GA

18.7%

20% · 14%

$1,458

15.1%

$47K

—

10,488

Marion County, TX

17.7%

— · 18%

$1,885

16.7%

$48K

—

14,249

Wilbarger County, TX

17.6%

— · 18%

$1,154

20.9%

$53K

1.7×

13,359

Potter County, TX

17.5%

22% · 15%

$2,190

22.9%

$51K

6.4×

13,394

Sharkey County, MS

17.5%

18% · —

—

13.6%

$37K

—

21,606

Hunt County, TX

17.5%

13% · 18%

$1,638

18.9%

$70K

3.7×

10,489

Jenkins County, GA

17.4%

— · 17%

—

14.7%

$43K

—

12,473

Calcasieu Parish, LA

17.4%

21% · 16%

$1,966

8.1%

$64K

4.5×

11,761

Mitchell County, GA

17.2%

15% · 21%

$1,260

14.1%

$49K

—

12,435

Hockley County, TX

17.0%

19% · 6%

$1,697

22.5%

$61K

—

13,651

Chicot County, AR

17.0%

14% · 20%

—

10.6%

$40K

—

16,985

Delta County, TX

17.0%

— · 16%

—

13.7%

$57K

—

13,605

Tattnall County, GA

16.8%

21% · 15%

$1,045

15.8%

$49K

—

11,557

Atoka County, OK

16.8%

— · 17%

$1,806

17.9%

$50K

—

12,958

Berrien County, GA

16.6%

— · 17%

$1,675

15.1%

$51K

—

14,035

Reeves County, TX

16.6%

17% · —

$1,638

22.0%

$57K

—

10,008

Stephens County, GA

16.5%

— · 16%

$1,837

14.4%

$51K

1.9×

12,943

Montague County, TX

16.4%

— · 16%

$1,669

20.9%

$60K

1.1×

13,687

Chattooga County, GA

16.3%

— · 16%

$1,505

16.7%

$51K

—

14,488

Nacogdoches County, TX

16.2%

19% · 15%

$1,783

19.2%

$53K

11.2×

11,089

Talbot County, GA

16.2%

18% · 14%

—

14.2%

$42K

—

13,334

Harrison County, TX

16.0%

22% · 13%

$1,712

17.4%

$63K

—

10,533

Taliaferro County, GA

16.0%

— · —

—

10.8%

$46K

—

9,410

Choctaw County, OK

15.9%

— · 16%

$1,933

15.4%

$44K

1.5×

17,858

Tyler County, TX

15.9%

— · 16%

$1,449

19.2%

$54K

—

14,227

Polk County, GA

15.9%

— · 16%

$1,580

15.3%

$56K

—

13,661

Swisher County, TX

15.8%

16% · —

—

28.1%

$52K

—

15,481

Debt figures are the Urban Institute's, from a 4% panel of credit records (August 2025); a county is blank where fewer than 50 records were available. "Of color · white" splits the county by whether a ZIP code is majority people of color. "Billed ÷ paid" is computed from the Medicare inpatient file for hospitals located in the county — everything they billed over everything they were paid, summed across every admission, the same fraction as the national figure; a dash means no hospital there published a row. Years of potential life lost (YPLL) before age 75 per 100,000, from County Health Rankings. Every county is in the API.

Sources

the files read, as fetched — not our copy of them

Debt in America 2025 — county-level medical debt · Urban Institute · August 2025 credit-bureau panel
Debt%20in%20America%20County-Level%20Medical%20Debt.xlsx · 396K bytes · fetched 2026-08-21 · sha256 4b2ec3982817… · publisher's page · ODC-BY
Debt in America 2025 — state-level medical debt · Urban Institute · August 2025 credit-bureau panel
Debt%20in%20America%20State-Level%20Medical%20Debt.xlsx · 10K bytes · fetched 2026-08-21 · sha256 343a63cba9ba… · publisher's page · ODC-BY
Debt in America 2025 — national medical debt · Urban Institute · August 2025 credit-bureau panel
Debt%20in%20America%20National-Level%20Medical%20Debt.xlsx · 3K bytes · fetched 2026-08-21 · sha256 c4e5f02de5a9… · publisher's page · ODC-BY
County Health Rankings 2025 — national analytic data · University of Wisconsin Population Health Institute · 2025 release (measures 2019–2023)
analytic_data2025_v3.csv · 13.1M bytes · fetched 2026-08-21 · sha256 5a129b856489… · publisher's page · free for non-commercial use with attribution; see countyhealthrankings.org
Medicare Inpatient Hospitals - by Provider and Service · CMS · 2024
MUP_INP_RY26_P03_V10_DY24_PrvSvc.CSV · 38.0M bytes · fetched 2026-08-21 · sha256 2ab6da15be4c… · publisher's page · public domain (US federal)
2020 ZCTA to County relationship file · US Census Bureau · 2020
tab20_zcta520_county20_natl.txt · 6.8M bytes · fetched 2026-08-21 · sha256 3ed41278d637… · publisher's page · public domain (US federal)

Every figure on this page is computed from these files by pipeline/prices/; the same rows are in the API.