Roughly 3 in 10 working-age adults reported their families were carrying medical debt at the end of 2025, a figure that underscores the volume of unpaid health care obligations flowing into the collections pipeline even as broader affordability pressures intensify.
The finding comes from new Urban Institute research, funded by the Robert Wood Johnson Foundation, drawn from a December 2025 survey of more than 10,000 adults. It shows that 46% of adults ages 18 to 64 said their families had difficulty affording health care over the prior year. About 35% reported a family member skipped needed care because of cost, and 17% said they had trouble paying medical bills.
For agencies and debt buyers working medical paper, the data points to a persistent supply of receivables tied to financial strain rather than simple nonpayment. Nearly 30% of respondents said their families owed money for care, including bills past due, balances on payment plans, amounts charged to credit cards, and debts owed to banks, collection agencies, or other lenders.
The pressure was not confined to the uninsured, though that group reported the highest rate of difficulty at 60%. Even among insured families, affordability problems were common: 39% with employer coverage, 54% with individual market plans, and 57% with Medicaid. Among low-income families, differences across coverage types largely disappeared, with more than half of insured adults reporting trouble affording care.
Hardship clustered among specific populations. About 69% of adults with disabilities and 65% of those in fair or poor health faced challenges, as did more than 60% of people diagnosed with stroke, COPD, cancer, heart disease, or diabetes. Black and Hispanic adults, residents of the South, and those in rural areas also reported above-average difficulty.
Cost increases appear to be a driver. About 1 in 5 privately insured adults reported their premiums rose a lot in the prior year, with individual market enrollees nearly twice as likely as those with employer coverage to report steep increases.
The outlook suggests more of the same. The expiration of enhanced Marketplace premium tax credits in January 2026, combined with Medicaid changes under the One Big Beautiful Bill Act, is projected to push millions more into the uninsured ranks. Urban Institute analysts estimate the Medicaid provisions alone could reduce enrollment by between 4.9 million and 10.1 million adults by 2028, a shift likely to expand both unmet care needs and outstanding medical balances.
