Despite nearly universal health insurance coverage in Massachusetts, more than one in eight residents carry medical debt, according to a report released Thursday by a state agency.
The vast majority of those people were insured when bills started to pile up, said the study by the Center for Health Information and Analysis, which monitors the Massachusetts health care landscape. But many had insurance plans with high deductibles.
“Massachusetts prides itself on its near-universal health insurance coverage rate, but it’s a hollow victory when more than 12 percent of residents are incurring debt for their care,” said Lauren Peters, executive director of the center.
The study comes as Massachusetts officials are preparing for medical debt to potentially balloon amid federal policy changes that could lead to more uninsured and underinsured people. The state estimates that up to 300,000 recipients of Medicaid, the government insurer for the poor and disabled, could lose coverage due to new eligibility and work requirements, and the expiration of certain subsidies will make health insurance more expensive for people who purchase their own.
The consequences of such debt are far-reaching, said the study, causing people to forgo medical care and struggle to pay for food and housing.
In 2006, then-governor Mitt Romney signed a law intended to provide health insurance to nearly all state residents, a statute that became the model for the federal Affordable Care Act. But the state, which boasts premier hospitals and doctors, also has some of the highest health care costs in the nation.
The new study found Massachusetts residents in families with incomes between 139 and 500 percent of the federal poverty level — or roughly $39,000 to $139,000 for a family of four — as well as Black residents were more likely to have $2,000 or more in medical debt. They were also more likely to have been in debt for more than a year.
Medical debt stemming from a time when not all family members were insured was more common among Black residents and residents with family incomes below 300 percent of the federal poverty level, or about $83,000 for a family of four, said the report.
Interruptions in insurance strongly contributed to medical debt. Residents who had periods without insurance in their family reported nearly double the rate of debt as those where all family members were continuously insured, said the report.
But having no interruptions in health insurance is hardly an impregnable shield against debt, the report said. For residents with continuous insurance, the most common causes of medical debt were deductibles (72 percent), copays (65 percent), or medical care not being covered by insurance (53 percent).
The report, called “Burdened by the Bill: Understanding Medical Debt in Massachusetts,” pooled data from health insurance surveys in 2021 and 2023 to generate a detailed analysis of unpaid medical bills for the state’s 7.1 million residents.
Ashley Blackburn, interim executive director of the nonprofit Health Care For All, said the burden of medical debt in Massachusetts is deeply troubling and only growing.
“We know that this burden isn’t borne equally, with low- and moderate-income families and Black residents more likely to carry debt that exceeds $2,000 and to repay that debt over a longer and costlier period,” she said. “Massachusetts must act now to protect consumers already facing mounting debt that will only grow and worsen with upcoming federal cuts to health coverage and care.”
Lora Pellegrini, chief executive of the Massachusetts Association of Health Plans, which represents 13 insurers in the state excluding Blue Cross Blue Shield of Massachusetts, said medical debt is straining families’ finances.
She pointed a finger at health care systems, doctors, drug makers, and complex socioeconomic factors for contributing to the problem.
“High provider prices, the rising cost of prescription drugs, billing practices, and factors such as health status and income all contribute to medical debt and to the underlying growth in premiums and out-of-pocket costs,” she said in a statement.
The report came out when health care costs for millions of Americans are poised to rise next year. The enhanced tax credits for Affordable Care Act insurance premiums are due to expire at the end of the year without action by Congress and President Trump, and some experts predict that out-of-pocket costs could double. The expiration of the tax credits was a key factor in the record-breaking 43-day government shutdown.
“If Congress and the president refuse to extend the enhanced subsidies, the problems described in this report will look even worse just a few years from now,” said Alan Sager, a professor of health policy and management at the Boston University School of Public Health and member of the council that oversees the center that issued the report. “People will suffer, and people will go without health care.”
Governor Maura Healey has called on Trump and congressional Republicans to extend Affordable Care Act tax credits and condemning Medicaid cuts.
“It’s also why we are taking action here in Massachusetts to lower costs, including by capping copays and deductibles for the first time,” she said.
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