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50% in U.S. Fear Bankruptcy Due to Major Health Event

50% in U.S. Fear Bankruptcy Due to Major Health Event

Story Highlights

  • Half in U.S. now, vs. 45% in 2019, concerned about health-related bankruptcy
  • 15%, including 20% of non-White adults, carry long-term medical debt
  • Lowering drug prices a key voting issue for 35% of adults

WASHINGTON, D.C. -- Half of all U.S. adults are concerned that a major health event in their household could lead to bankruptcy, an increase from 45% measured in early 2019 (PDF download). These results, based on a new study by West Health and Gallup, also show that the percentage of non-White adults who harbor this concern has risen from 52% to 64%.

Fear of Health Event Leading to Bankruptcy
How concerned are you that a major health event in your household could lead to bankruptcy? Extremely concerned, concerned, not very concerned or not at all concerned?
  January-February 2019 July 2020 Change
  % Extremely concerned/
% Extremely concerned/
pct. pts.
U.S. total 45 50 +5*
Women 47 51 +4
Men 42 49 +7*
White adults 41 43 +2
Non-White adults 52 64 +12*
18-29 43 55 +12*
30-49 46 55 +9*
50-64 52 48 -4
65+ 38 40 +2
* Statistically significant change (p<.05), design effect included
Gallup-West Health U.S. Healthcare Study, July 2020

This study is based on 1,007 interviews with U.S. adults conducted from July 1-24, 2020. Over the past year, concerns about medical bankruptcy have increased 12 and nine percentage points, respectively, among adults aged 18-29 and 30-49. Fifty-five percent of both groups now report being extremely concerned or concerned that a major health event could bankrupt them. Men's concern is up seven points to 49% and is now statistically tied with concern among women (51%).

One-Fifth of Non-White Adults Carry Long-Term Medical Debt

Amid rising concerns nationally about bankruptcy arising from a significant health event, 15% of adults report that at least one person in their household currently has medical debt that will not be repaid -- either in full or in part -- within the next 12 months. This includes 12% of White adults and 20% of non-White adults.

Those in households earning less than $40,000 per year are more than four times as likely as those in households earning $100,000 or more to be carrying long-term medical debt (28% vs. 6%, respectively). The rate is also about twice as high among self-identified political independents (18%) and Democrats (16%) as among Republicans (8%).

Percentage of U.S. Adults Unable to Repay Current Medical Debt Within Next 12 Months
Do you or someone in your household currently have medical debt that you will be unable to repay in the next 12 months?
  Yes, have medical debt
U.S. total 15
White adults 12
Non-White adults 20
Annual household income  
Less than $40,000 28
$40,000-<$100,000 12
$100,000+ 6
Political identity  
Independent 18
Democrat 16
Republican 8
Gallup-West Health U.S. Healthcare Study, July 2020

One-Quarter of U.S. Adults Must Borrow Money for $500 Medical Bill

With substantial percentages of adults reporting that they currently have medical debt that they cannot pay in a year or less, it is probably unsurprising that 26% report they would need to borrow money to pay a $500 medical bill. To do this, 12% say they would use a credit card or get a loan from a financial institution, while another 14% would borrow from a family member or friend. For some persons, these forms of borrowing could ordinarily be characterized by prompt repayment (such as simply paying off the credit card at the end of the month), but for many others, it is likely to feed into a cycle of accumulating medical debt that cannot be readily repaid.

The need to borrow money to pay a $500 medical bill is particularly common among non-White adults (43%) and those living in households earning less than $40,000 per year (46%).

Sources of Payment for $500 Medical Bill
If you had a $500 medical bill that you needed to pay today, from where would the money most likely come?
  U.S. Total White adults Non-White adults $100,000+ $40,000-
Less than
  % % % % % %
Funds from a checking or savings account that were not dedicated to healthcare-related expenses 54 62 40 61 63 39
A medical flexible spending account or health savings account 14 17 11 30 11 8
A credit card or a loan from a financial institution 12 9 17 7 13 15
A loan from a family member or friend 14 8 26 1 9 31
Credit card or any loan type 26 17 43 8 22 46
Gallup-West Health U.S. Healthcare Study, July 2020

Fourteen percent of U.S. adults report using a medical flexible spending or health savings account to pay medical bills, but use of these tax-benefited financial tools is more than twice as common (30%) among those in households with $100,000 or more in annual income.

Drug Pricing Continues to Influence Candidate Choice for 35% of Adults

About one-third (35%) of Americans say that lowering the cost of prescription drugs is either the single most important issue (5%) or among the most important issues (30%) that will influence their vote in 2020. This is up five percentage points since February, returning to the level measured in September 2019. Another 40% report that the issue is of "mid-range" importance, while 24% report that it is the least or among the least important.

Across key subgroups, little change has been measured since September. Views of women (36%) and men (33%) have converged since last fall, but neither is significantly different from 2019 views. Race and household income, in turn, currently closely match 2019 results. Non-White adults continue to place much higher importance on the issue than their White adult counterparts (48% vs. 29%, respectively), while half (52%) of respondents from households earning under $40,000 per year continue to report that the issue will be highly influential to their vote.

Importance of Lowering Drug Costs to Candidate Support in 2020 (% Single Most Important Issue or Among the Most Important Issues)
Which of the following best describes how influential a candidate's position on lowering drug costs will be to determine your vote in the 2020 elections? Is it the single most important issue, among the most important issues, mid-range in importance, among the least important issues or the least important issue?
  September 2019 February 2020 July 2020 Change since 2019
  % % % pct. pts.
U.S. total 35 30 35 0
Women 41 33 36 -5
Men 29 28 33 +4
White adults 29 23 29 0
Non-White adults 48 45 48 0
Annual household income  
Less than $40,000 52 45 52 0
$40,000-<$100,000 31 31 29 -2
$100,000+ 19 14 22 +3
Gallup-West Health U.S. Healthcare Study, July 2020


The sharp rise in U.S. healthcare costs, which was already a significant problem for Americans before the COVID-19 pandemic, has only been exacerbated by new challenges presented by the outbreak. In recent months, for example, 14% of Americans with likely COVID-19 symptoms reported that they would avoid care because of cost, and 88% are concerned about rising drug costs due to the pandemic. These COVID-19-related cost worries also come with a substantial racial divide.

Dovetailing with the new health-related concerns brought on by the coronavirus outbreak is the economic catastrophe that -- despite the recouping of millions of jobs since May -- persists in the form of 28 million people receiving some form of unemployment aid at the end of July. As such, Americans' concerns about a major health event putting them in bankruptcy, while substantial in early 2019, are likely only intensified today because of the pandemic.

The disproportionate manner in which minorities have suffered the effects of the pandemic is reflected in higher rates of concern about bankruptcy among non-White respondents, which have jumped from 52% in early 2019 to 64% today. And the elevated level of bankruptcy concerns among adults younger than 50 corresponds with substantially higher percentages of younger adults (versus older adults) who report that a friend or family member passed away in the prior five years after not having the money to pay for needed treatment.

The troublesome confluence of the need to borrow money to pay a medical bill and subsequently carrying medical debt for a year or more comes at a time when two-thirds of Americans are reporting an increase in the price of their prescription drugs.

In the midst of this burgeoning crisis in healthcare costs and associated debt, a U.S. election looms. Despite the severe disruption the global pandemic is causing most Americans, curtailing the ongoing rising costs of prescription drugs could be an important issue factoring into their choice of candidate.

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