Empowering Health Care Consumers

Grantee Name

Urban Institute

Funding Area

Empowering Health Care Consumers

Publication Date

June 2024

Grant Amount


Grant Date:

October 2022 – September 2023

Medical debt is a crushing burden for New Yorkers. A recent survey found that more than half of New Yorkers struggle to pay medical bills.

Initial analysis of medical debt lawsuits suggested that low-income communities and communities of color outside of New York City were particularly hard hit by medical debt, exacerbating existing health and socioeconomic inequities. A coalition of partners ran a successful End Medical Debt in New York campaign, with NYHealth and other philanthropic support, to advocate for policy solutions that protect New Yorkers from unfair medical debt. In 2022, NYHealth awarded the Urban Institute a grant to support policy advocacy by examining the scope and nature of medical debt across New York State. 

Under this grant, the Urban Institute produced a report that demonstrated how medical debt varied across New York State. It analyzed the disproportionate burden of medical debt across regions and on certain communities, including people of color and those with low income. Urban also examined the average amount of medical debt in communities and showed which ones would stand to benefit most from credit reporting changes. Findings provided consumers, advocates, and policymakers with the most comprehensive picture of medical debt patterns in New York State to date. 

Outcomes and Lessons Learned

  • Analyzed a representative random sample of deidentified credit reports from one of the national credit reporting agencies. It showed that:  
    • 740,000 New York adults and their families (or approximately 6% of New Yorkers) had medical debt in collections as of February 2022, with wide variation across regions and communities.   
    • The highest rates and amounts of medical debt were almost always found in communities of color and communities with lower incomes. 
    • High-debt communities were also more rural, had higher rates of disability, and had lower rates of educational attainment and employment than communities with the lowest rates of medical debt. 
    • Rates of medical debt were especially high in upstate cities like Elmira (where 35% of adults had medical debt in collections) and Syracuse (24%).
  • Published: 
    • A comprehensive report showing patterns across the State, regional profiles, and characteristics of communities most burdened by medical debt.   
    • Interactive maps developed by NYHealth, based on Urban’s data, to depict these patterns visually. 
    • A fact sheet sharing the most striking disparities by region, race/ethnicity, and income status. 
    • A supplemental brief showing medical debt hotspots in various cities, legislative districts, and other geographies.  
  • Received widespread media attention from outlets including the Syracuse Post-Standard, Rochester Democrat & Chronicle, Spectrum News/NY1, and Lohud.com.    
  • Informed the policy conversation and contributed to additional protections against unfair medical debt. Since publication of Urban’s analysis, New York State has secured numerous consumer protections, including requiring hospitals to use a uniform patient financial assistance application, expanding hospital financial assistance programs, limiting the size of monthly payments for medical debt, prohibiting hospitals from suing patients with incomes below 400% of the federal poverty level for medical debt, and removing medical debt of all amounts from consumers’ credit reports. Governor Hochul cited Urban data in both her State of the State and announcement of the final Fiscal Year 2025 budget describing some of these proposed and finalized consumer protections. 

Co-Funding and Additional Funds Leveraged: N/A