Gender and Medical Debt

A large swath of women in the U.S. are finding themselves deeply in debt with medical bills. The problem can range from having difficulty paying for an unexpected medical charge to confronting a pileup of debt that leads to collections and bankruptcy.

According to a July 2020 Gallup Poll, just over half (51%) of women were concerned that a major health event could lead to bankruptcy, compared to 47% of women polled in 2019. By February 2021, most Americans (73%) said they would have trouble paying an unexpected $500 expense or bill, according to a Cision poll. And of the 20% who have medical debt, most have seen an increase since March 2020.

A key reason behind these concerns is that health insurance coverage has gotten skimpier. The healthcare costs that consumers pay out of pocket, including insurance premiums, deductibles, and coinsurance, have been rising in recent years.

The result is that even women with good health insurance can face large bills in the event of an accident or illness. This is true whether they receive their health insurance through an employer or purchase it at healthcare.gov. Not surprisingly, women without health insurance (11% in 2019) have the highest amount of medical debt. Transgender and gender-nonconforming individuals face these issues as well.

The Gender Wage Gap Can Lead to a Debt Gap

Income difference is another reason that men have lower medical (and other) debt than women and others not identifying as men. On average, women of all races earn 80 to 82 cents for every dollar men earn, according to an analysis of 2018 data (the most recent) from the U.S. Census Bureau. Hispanic women earned just 55 cents for every dollar earned by White non-Hispanic men, while Black women earned 63 cents, White non-Hispanic women earned 79 cents, and Asian women earned 85 cents, according to 2019 Census Bureau data compiled by the National Partnership for Women & Families. (Note that much of the gender data currently collected is binary; this article will report the broader picture where it can.)

Added to this underlying income inequality, the COVID-19 pandemic has led to many more women losing jobs and health insurance. In December 2020, for example, women accounted for 100% of the 140,000 jobs shed by the U.S. economy. According to the National Women’s Law Center, since February 2020, women have lost a net 5.4 million jobs, or 55% of the more than 9.8 million U.S. jobs that have been lost.

Black and Latina women working in retail, restaurants, and other service-sector industries, often for very low pay, have been disproportionately laid off amid the pandemic’s lockdowns and business closures. And leisure and hospitality employers cut 498,000 jobs—almost 57% of which were held by women. Transgender and gender-nonconforming individuals are at even greater risk for unemployment and poverty. Here are some of the affected areas:

COVID-19 Medical Bills

The pandemic has many Americans on edge—and fear of high medical bills has many people avoiding treatment. In recent months, for example, 14% of Americans with likely COVID-19 symptoms reported that they would avoid care because of cost.

Fear that a major health event could leave them bankrupt was common in a recent Gallup Poll, with people under 65 years old, and especially those ages 18 to 29, most concerned about paying medical bills.

These fears are not unfounded. During the pandemic, medical debt has been growing sharply. In an analysis of 20 million of its U.S. members, Credit Karma found that medical debt totaled $45 billion, with an average of $2,200 per member. More than half (56%) of U.S. adults have had medical debt sent to collections, according to a separate Debt.com survey conducted during summer 2020.

Hospitalizations accounted for a quarter of the medical debt, followed by diagnostic tests and lab fees (22%), emergency room visits (19%), and doctor visits (15%). People with lower incomes have been hit hardest, with 28% of households earning less than $40,000 carrying long-term medical debt versus only 6% of those earning $100,000.

The Cision poll cited earlier found that COVID-19-related increases in medical debt occurred because an individual or someone in their household had increased doctor visits because of potential COVID exposure, had contracted the virus, or had lost health insurance coverage and had to pay more out of pocket.

Confusion abounds about how COVID-19 tests, treatments, and vaccines are being covered by health insurance or the federal government. Uninsured patients may not be told, for example, that their costs will be covered by the federal government’s CARES Act, and they may decide to forego treatment.

Gender Dysphoria Treatments

For the estimated 1.4 million transgender people in the U.S., the cost of medical treatments can add up. Health insurance coverage for procedures has been a political football in recent years. The 2014 Affordable Care Act (ACA), as well as other laws with anti-discrimination provisions, requires insurers to cover medically necessary care for trans people. And in 2020, almost 1,000 large employers included at least one transgender-specific service in their health plans, up from 49 in 2009.

Yet in August 2020, the Trump administration revised U.S. Department of Health and Human Services (HHS) rules to return “to the government’s interpretation of sex discrimination according to the plain meaning of the word ‘sex’ as male or female and as determined by biology.” The rule change was issued on June 12, 2020, just days before the Supreme Court ruled that the civil rights law that prohibits sex discrimination applies to discrimination based on sexual orientation and gender identity.

The Biden administration has issued an executive order expanding LGBTQ nondiscrimination protections, so the recent HHS change may also be reversed.

How to Avoid Long-Term Medical Debt

Medical bills can arrive soon—sometimes too soon—after an illness or accident. While it’s tempting to ignore them until things improve, it’s more prudent to act quickly, even if you have to ask friends or relatives for help in sorting them out. Here are three things that it’s best to do right away:

1. Check the bills

Many medical bills contain errors. Always request itemized bills and carefully review each line for duplications, services you didn’t receive, price discrepancies, and any other issues. If you spot inaccuracies, immediately reach out to your provider’s billing department to resolve any issues.

2. Consider new appeals measures

The No Surprises Act was signed into law on Dec. 27, 2020, as part of the Consolidated Appropriations Act of 2021. The law, set to go into effect on Jan. 1, 2022, protects consumers from surprise bills for emergency services provided by out-of-network healthcare providers and for nonemergency services provided by out-of-network providers in in-network facilities to which consumers have not consented. The law also provides a notice-and-consent process for nonemergency services.

Specialties such as radiology, anesthesiology, and neonatology—which commonly send surprise medical bills—are prohibited from asking for consent. The law protects consumers from bills for emergency air transport. Ground ambulances, which are regulated differently, are not covered by the new law.

If you get a surprise bill, you can appeal to your health insurer. If that fails, ask for arbitration. The new law instructs arbiters to consider the median in-network rate paid by the insurer—not a provider’s higher billed charges—in selecting between the amounts submitted by the two parties.

3. Avoid collection

Contact your medical provider immediately if you can’t pay what’s being billed. Inquire about financial assistance programs and, if need be, plead your case with the billing administrator and try to negotiate the final balance.