The Health Divide: Medical debt, loss of internet and poor air quality are not shared equally

Medical debt linked with poor health, even death in study

Amid soaring health care costs, nearly one in five Americans has medical debt, a burden linked to worse health and premature death, according to a new study from the American Cancer Society. 

The researchers analyzed nearly 3,000 U.S. counties based on debt data from 2018. Medical debt was more pervasive in counties with populations that included more Black people, people with low education levels, people living in poverty, and those who lacked insurance or employment.

The scientists calculated that for every 1% of a county population with medical debt, there were on average about 18 more physically unhealthy days and 18 mentally unwell days per month, plus one year of life lost, per 1,000 people.

“The study did not show cause-and-effect,” caution Drs. Rebecca Yao and Gabriela Cleary at ABC News, “but it was a strong association, reinforcing existing studies suggesting that financial hardship can lead to poorer health outcomes.”

It’s worth noting that counties with higher levels of medical debt are also more likely to have other health challenges, which makes isolating the importance of any given variable very challenging for researchers. 

Medical debt “is a problem that needs to be addressed systematically,” study lead author Xuesong Han of the American Cancer Society in Atlanta told ABC. She suggested policies that boost affordable, comprehensive health insurance coverage and “providing financial navigation and connecting patients with relevant resources to minimize any adverse consequences.”

At the national level, the U.S. Consumer Financial Protection Bureau is stepping in to address the burgeoning medical debt problem, reports Noam N. Levey at KFF Health News. The office was originally created by President Barack Obama in 2010 to police banks, mortgage brokers, and student loan companies. 

“But as the U.S. health care system turns tens of millions of Americans into debtors, this financial watchdog is increasingly working to protect beleaguered patients, adding hospitals, nursing homes, and patient financing companies to the list of institutions that regulators are probing,” writes Levey.

For example, the bureau has warned or penalized lenders that target patients and medical debt collectors, as well as nursing homes that sue residents’ family and friends over unpaid bills.

The bureau found that unpaid medical bills are the most common debt type on consumer credit reports, but that these debts are often erroneous or have already been paid. The agency is now developing rules to prevent credit bureaus from including medical debt on credit scores.

“American families should not have their financial lives ruined by medical bills,” said Rohit Chopra, director of the Consumer Financial Protection Bureau

Millions of rural Americans about to lose Internet, telehealth access

The end of a federal program that subsidized internet bills for more than 20 million households will exacerbate health care disparities for rural and tribal residents that have come to rely on telehealth services, especially those whose disabilities, reports Julia Métraux at Mother Jones.

The Affordable Connectivity Program was launched during the pandemic in 2021 as a way to help consumers purchase computers or tablets and pay for broadband service for health care, as well as work and school. It’s set to wind down in April.

It’s assisted 23 million households to save $30 a month on internet bills, or $75 on some tribal lands — often enough to fully cover the costs, according to the Biden-Harris administration, which requested an extension for the program from Congress in October. 

One-quarter of enrolled households are African American, and another quarter are Latino, the White House said.

Lack of high-speed internet access is a major issue for nearly 25% of rural residents, who often don’t have ready access to physicians either, writes Métraux. Half of rural hospitals lost money over the past year, and more than 400 are “vulnerable to closure,” reports Jazmin Orozco Rodriguez at KFF Health News.

Research has found that telehealth is an effective way to fill the care gap and help patients manage chronic health issues.

The pandemic has made telehealth indispensable, and experts told Métraux that loss of internet would “worsen existing health care disparities.”

“This end of funding will most certainly impact folks with disabilities who access telehealth, specifically folks in rural areas who are unable to drive,” said Katy Schmid, a senior director at The Arc, an advocacy organization for people with disabilities.

While a bipartisan group of lawmakers supports an extension, as of late last week, Congress had not acted on it.

Health disparities linked to air quality on the rise

The air Americans breathe is getting better — but the health gains are greatest for white communities, according to a new study in the journal Environmental Health Perspective. 

A team of researchers analyzed health data from the U.S. Census Bureau alongside NASA satellite images to estimate pollution levels. 

Between 2010 and 2019, disease and death rates due to nitrogen dioxide and fine particulates in the air dropped overall. But study authors were surprised to find that the disparities in those rates between whites and other groups went up, reports Annalisa Merelli at STAT. 

Premature deaths linked to air pollution were 30% higher in minority communities, and childhood asthma associated with air pollution was almost eight times more prevalent in communities of color than in white communities, reports Dennis Thompson at HealthDay. 

Asthma rates went down overall, but increased in the South, particularly in lower income areas with ethnic and racial diversity.

Researchers said these disparities are an ongoing result of historical redlining, a practice that cut Black neighborhoods out of government home loan programs from 1934 to 1968. That meant communities of color were unable to get mortgages and as a result wound up living in less expensive neighborhoods where zoning officials sited air pollution sources such as factories and roads.

And the disparities have persisted even though the air in most communities met standards set by the Environmental Protection Agency at the time of the study, said study author Gaige Kerr of George Washington University.

The solutions, researchers told STAT, are regulations that are tailored to individual areas, with more stringent standards in high-risk regions or requirements that polluting companies financially assist residents to update their homes to keep pollution out.

From the Center for Health Journalism

April 10 is the deadline to apply for our National Fellowship, which prepares fellows to report a major enterprise project on the health or well-being of children, families and communities. The program includes an in-person learning intensive June 26–28, reporting grants of $2,000–$10,000, and five months of professional mentorship. Learn more here.

April 11 is the deadline to apply for the Domestic Violence Symposium and Impact Reporting Fund, which provides reporters with a roadmap to cover this public health epidemic with nuance and sensitivity. Grantees receive $2,000–$10,000 plus five months of professional mentorship. Learn more here.

What we’re reading

• “As opioid scourge devastates tribes in Washington, lawmakers advance a bill to provide relief,” by Hallie Golden, AP News
• “If your boss is the state of Texas, some pregnancy protections just ended for you,” by Chabeli Carrazana, The 19th
• “Medicaid challenges leave many Black Americans uninsured,” by Micah Washington, CNBC
• “First-of-its-kind study shows Native elders living in urban centers face untreated health issues,” by Vincent Moniz, Buffalo’s Fire
• “Many can’t access mental health services that save money, keep people out of jail,” by Ernie Mundell, HealthDay
• “Wisconsin’s Medicaid postpartum protection lags most of the country,” by Rachel Hale, Wisconsin Watch
• “Hispanic health disparities in the US trace back to the Spanish Inquisition,” by Margaret Boyle, The Conversation