State Protections Against Medical Debt: A Look at Policies Across the U.S.

By Maanasa Kona and Vrudhi Raimugia

Medical debt is one of the leading causes of bankruptcy in the United States. As many as 40 percent of U.S. adults, or about 100 million people, are currently in debt because of unpaid medical or dental bills. Medical debt can be subject to aggressive collections efforts by hospitals and debt collectors—a consumer can even lose their home or a portion of their paycheck. Though federal law has some safeguards against medical debt and its downstream consequences, the federal framework of medical debt protection has significant gaps.

In a new report for the Commonwealth Fund, CHIR’s Maanasa Kona and Vrudhi Raimugia examine how states are filling gaps in federal law. Authors analyzed relevant federal and state laws and conferred with several state experts in medical debt law and policy.

Key findings from the report include:

  • Twenty states have their own financial assistance standards, and 27 have community benefit standards. However, the strength of these standards varies widely.
  • Relatively few states regulate billing and collections practices or limit the legal remedies available to creditors.
  • Only five states have reporting requirements that are robust enough to identify both noncompliance with state law and patterns of discriminatory practices.
  • Many states can further protect patients by improving access to financial assistance, ensuring that nonprofit hospitals are earning their tax exemption, and limiting aggressive billing and collections practices.

You can read the full report here and find more detailed state-by-state information in the interactive map here. For any questions, contact Maanasa Kona at

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The opinions expressed here are solely those of the individual blog post authors and do not represent the views of Georgetown University, the Center on Health Insurance Reforms, any organization that the author is affiliated with, or the opinions of any other author who publishes on this blog.