Healthcare costs pushed Americans to borrow $74 billion in 2024 — despite most having insurance

WASHINGTON — In a country with world-class medical care, millions of Americans face a tough choice: go into debt or forgo needed treatment. A new West Health-Gallup survey shows more than 31 million Americans borrowed an eye-popping $74 billion last year for medical bills. What’s worse? Most already had health insurance, exposing serious flaws in America’s healthcare system.

Nearly one-third of Americans (28%) are “very concerned” a health emergency could sink them into debt. As medical costs keep outpacing both wages and inflation, more families find themselves financially exposed.

The Medical Debt Divide

Not everyone borrows equally for healthcare, with clear patterns showing who’s hit hardest. Age matters significantly. Almost 20% of Americans under 50 borrowed for medical costs compared to just 9% of those 50-64. Only 2% of Medicare recipients (those over 65) needed loans. With gender, women aged 50-64 were twice as likely as men to borrow for healthcare (12% vs. 6%).

Race reveals even starker differences. Black adults (23%) and Hispanic adults (16%) borrowed at much higher rates than White adults (9%). Among people under 50, these gaps widened further: 29% of Black adults, 19% of Hispanic adults, and 14% of White adults borrowed for healthcare.

Family status also impacts borrowing needs. Households with kids under 18 were twice as likely to borrow as those without children (19% vs. 8%).

Dollars and Medical Debt

The $74 billion Americans borrowed isn’t spread evenly. Most borrowers (58%) needed $500 or more, while 41% borrowed $1,000+. At the high end, 14% borrowed over $5,000 for medical care.

“Too many Americans are racking up medical debt whether they have health insurance or not,” says Tim Lash, president of West Health Policy Center, in a statement. “A high-priced healthcare system that requires Americans to take out loans or make painful tradeoffs just to stay healthy is in desperate need of policy reform or things will get even worse.”

Money Worries Cross Demographics

Fear of healthcare costs extends far beyond those already in debt. Most Americans (58%) worry a health crisis could push them into debt, with 28% “very concerned” about this possibility.

This anxiety also cuts across income levels. Over 60% of households making under $120,000 worry about medical debt. Even the well-off aren’t immune, with 40% of households earning over $180,000 concerned about healthcare costs.

Medicare doesn’t fully ease these fears either. Over half (52%) of seniors worry they could face medical debt from a major health event despite having Medicare coverage. This points to gaps in protection and ongoing out-of-pocket costs for older Americans.

Worry runs especially high among Black adults (62%), Hispanic adults (63%), and women (62%). Only 14% of Americans say they have no concerns about medical debt, a tiny fraction that shows how widespread this problem has become.

“It is clear that high healthcare costs continue to burden the American people, and financial insecurity around care is not limited to any one demographic,” says Dan Witters, director of wellbeing research at Gallup. “These findings underscore the need for solutions that make healthcare more affordable for all Americans.”

Why Insurance Isn’t Enough

That $74 billion in borrowing is just one way Americans handle medical costs. Many skip care entirely due to expenses, risking worse health problems down the road. Others drain savings, max out credit cards, or lean on family for help.

The fact that 12% of Americans with insurance still needed loans exposes fundamental problems in how we pay for healthcare. High deductibles, copays, and coverage gaps leave many families facing bills they simply can’t afford.

The racial disparities in the survey connect to broader economic inequalities. Black and Hispanic Americans typically have lower household wealth and income, making healthcare costs hit harder and potentially worsening health outcomes over time.

Fixing a Broken System

The survey points to an urgent need for healthcare affordability solutions that work for everyone. Medicare clearly helps seniors avoid borrowing, shown by their much lower borrowing rates, but even this program leaves gaps that worry more than half of those covered.

For Americans under 65, especially those under 50, the numbers suggest much more substantial changes are needed. High borrowing rates among younger Americans, racial minorities, and families with children show current insurance models aren’t offering enough protection.

Medical debt damages more than just health. It can wreck credit scores, limit housing options, and even hurt job prospects. Addressing this issue could improve financial stability across the board.