Gender and Medical Debt

A large number of women in the United States find themselves deeply in debt with medical bills. The problem can range from having trouble paying unexpected medical bills to dealing with mounting debt that leads to collections and bankruptcy.

According to a July 2020 Gallup poll, just over half (51%) of women feared a major health condition could lead to bankruptcy, up from 47% of women surveyed in 2019. In February 2021, most Americans (73%) said they would struggle to pay 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.

One of the main reasons for these concerns is that health insurance coverage has become thinner. Healthcare costs that consumers pay out of pocket, including insurance premiums, deductibles and coinsurance, have increased 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 from Unsurprisingly, women without health insurance (11% in 2019) have the highest amount of medical debt. Transgender and gender non-conforming people also face these issues.

Key points to remember

  • Medical debt has risen sharply during the pandemic, with many Americans having bills sent to collections.
  • Women are particularly vulnerable as they earn less than men, on average, and are more likely to have lost their jobs due to the COVID-19 pandemic.
  • Black, Hispanic and low-income women, as well as transgender and gender nonconforming people, are particularly at risk of medical debt.
  • New law without surprisewhich will come into force in early 2022, will protect consumers from surprise medical bills, such as those for emergency care provided by out-of-network providers.

The gender pay gap can lead to a debt gap

The income difference is another reason why men have lower medical (and other) debt than women and other people who do not identify 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 United States Census Bureau. According to 2019 Census Bureau data compiled by the National Partnership for Women and Families. (Note that much of the gender data currently collected is binary; this article will present the broader picture where possible.)

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

Black and Latinx women working in retail, restaurants and other service-sector industries, often for very low wages, have been disproportionately laid off amid pandemic shutdowns and business shutdowns . And leisure and hospitality employers cut 498,000 jobs, nearly 57% of which were held by women. Transgender and gender non-conforming people are at even greater risk of unemployment and poverty. Here are some of the affected areas:

COVID-19 medical bills

The pandemic has many Americans worried, and fear of high medical bills is causing many people to avoid treatment. In recent months, for example, 14% of Americans with likely symptoms of COVID-19 said they would avoid care because of the cost.

Fear that a major health event could put them out of business was common in a recent Gallup poll, with people under 65, and particularly those aged 18-29, most concerned about paying bills medical.

These fears are not unfounded. During the pandemic, medical debt rose sharply. In an analysis of 20 million of its US members, Credit Karma found that medical debt was $45 billion, with an average of $2,200 per member. More than half (56%) of American adults have had a medical debt sent for collection, according to a separate survey conducted during the summer of 2020.

Hospitalizations accounted for a quarter of medical debt, followed by diagnostic tests and lab costs (22%), emergency room visits (19%) and doctor visits (15%). Low-income people have been hardest hit, with 28% of households earning less than $40,000 having long-term medical debt compared to just 6% of those earning $100,000.


The average unpaid medical bill for women in 2018 compared to $3,231 for men.

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

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

Treatments for gender dysphoria

For the approximately 1.4 million transgender people in the United States, the cost of medical treatment 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 containing anti-discrimination provisions, require insurers to cover medically necessary care for trans people. And in 2020, nearly 1,000 major 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 US Department of Health and Human Services (HHS) rules to return “to the government’s interpretation of sex discrimination under the ordinary meaning of the word ‘sex’ as male or female and as determined by biology”. The rule change was released 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 identity. of gender.

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

How to Avoid Long-Term Medical Debt

Medical bills can arrive quickly, sometimes too soon, after an illness or accident. While it’s tempting to ignore them until things get better, it’s safer to act quickly, even if you need to ask friends or loved ones for help to sort them out. Here are three things that are best done right away:

1. Check invoices

Many medical bills contain errors. Always ask for itemized invoices and carefully review each line for duplicates, services you didn’t receive, price discrepancies, and any other issues. If you find any inaccuracies, contact your provider’s billing department immediately to resolve any issues.

The No Surprises law cited below does not come into force before January 1, 2022.

2. Consider new appellate measures

The no-surprises law was signed into law on December 27, 2020, as part of the Consolidated Appropriations Act of 2021. The law, which is due to come into force on January 1, 2022, protects consumers from surprise bills for emergency services provided by out-of-network healthcare providers and for non-emergency services provided by out-of-network providers in network establishments for which consumers have not consented. The law also provides for a notification and consent process for non-emergency services.

Specialties such as radiology, anesthesiology and neonatology – which typically send surprise medical bills – are prohibited from asking for consent. The law protects consumers from emergency airline bills. Land ambulances, which are regulated differently, are not covered by the new law.

If you receive a surprise bill, you can appeal to your health insurer. If that fails, seek arbitration. The new law asks arbitrators to consider the median network rate paid by the insurer — not the higher billed fees from a provider — when choosing between the amounts submitted by the two parties.

3. Avoid collection

Contact your doctor immediately if you can’t pay what is charged. Ask about financial assistance programs and, if necessary, plead your case with the billing administrator and try to negotiate the final balance.

Comments are closed.