Iowa has experienced the sharpest increase in medical debt in the United States, according to a new study by Whitley Law Firm. Between 2020 and 2023, the number of Iowa residents struggling with unpaid medical bills jumped by 54.97%, the highest increase recorded nationwide.
The study, which examined Census Bureau data, shows how unevenly medical debt burdens fall across the country — with some states facing steep rises while others see major reductions.
Iowa Leads the Nation
In 2020, 5.93% of Iowa residents reported having medical debt. By 2023, that figure had climbed to 9.20%, representing a nearly 55% increase over three years. The rise means thousands more Iowa families are facing financial strain from medical expenses.
Other States With Large Increases
Iowa is not alone in facing this challenge. Four other states rounded out the top five for growth in medical debt:
- Hawaii: Up 34.87%, from 3.00% in 2020 to 4.05% in 2023. The state’s high cost of living and geographic isolation contribute to barriers in accessing affordable care.
- Nebraska: Up 32.91%, rising from 8.51% to 11.30%. Nebraska now has one of the highest overall rates of medical debt in the country.
- Alaska: Up 32.22%, increasing from 4.90% to 6.48%.
- Maine: Up 26.75%, climbing from 8.04% to 10.19%.
Other states, including South Carolina, Colorado, and New Mexico, saw smaller increases — under 10% — highlighting just how varied the problem is across the U.S.
Where Medical Debt Is Falling
While many states saw worsening conditions, others made remarkable progress in reducing medical debt.
- Delaware achieved the largest improvement, cutting its rate by 80.29%, from 11.03% in 2020 to just 2.17% in 2023.
- Kansas reduced medical debt by 42.66%, with rates dropping from 10.38% to 5.95%.
- Kentucky saw a 38.53% decrease, from 11.86% to 7.29%.
- Wyoming lowered its rate by 35.24%, dropping from 13.73% to 8.89%.
- Alabama reported a 34.12% decrease, moving from 10.43% to 6.87%.
These improvements suggest that targeted policies and consumer protections can help relieve the burden.
States With the Biggest Increases in Medical Debt, 2020–2023
| Rank | State | % in Medical Debt (2020) | % in Medical Debt (2023) | % Change |
|---|---|---|---|---|
| 1 | Iowa | 5.93% | 9.20% | +54.97% |
| 2 | Hawaii | 3.00% | 4.05% | +34.87% |
| 3 | Nebraska | 8.51% | 11.30% | +32.91% |
| 4 | Alaska | 4.90% | 6.48% | +32.22% |
| 5 | Maine | 8.04% | 10.19% | +26.75% |
Why Medical Debt Matters
Medical debt is unlike other forms of debt. It often arises from unavoidable healthcare needs such as emergency surgeries, chronic illnesses, or unexpected injuries. Even families with insurance coverage can quickly become overwhelmed by out-of-pocket costs, deductibles, and uncovered treatments.
A spokesperson for Whitley Law Firm explained:
“This study shows an alarming rise in medical debt across several states, with Iowa’s nearly 55% rise being particularly concerning. This growing burden affects families’ financial stability and can lead to difficult choices between healthcare and other essential needs.
Medical debt is unique because it comes from unavoidable needs rather than discretionary spending. Over 60% of bankruptcies in the U.S. are tied to medical debt. The reductions we’ve seen in states like Delaware prove that policy changes and consumer protections can make a real difference.”
The Bigger Picture
The study highlights how uneven medical debt is across the U.S. While states like Iowa and Nebraska are seeing more families pushed into financial hardship, others such as Delaware and Kansas are moving in the opposite direction.
Policy experts argue that solutions may include:
- Expanding Medicaid coverage and subsidies
- Strengthening consumer protections against aggressive collections
- Offering more transparent healthcare pricing
- Supporting targeted debt-relief programs for vulnerable populations
Without intervention, millions of Americans may continue to face difficult trade-offs between paying medical bills and meeting other essential household expenses.
