Changes In Medical Debt And Bankruptcy After Acute Traumatic Injuries, 2019-21

Despite expanded insurance coverage after the Affordable Care Act, medical debt remains a significant burden for millions of Americans, particularly after acute medical events such as traumatic injuries. We evaluated the financial impact of hospitalization for acute traumatic injury, using data from a statewide trauma registry linked to consumer credit reports from the period 2019-21. Using a stacked difference-in-differences event study design, we compared financial outcomes for 12,823 injured patients versus 25,195 not-yet-injured matched controls. At eighteen months post-injury, the proportion of patients with medical debt in collections increased by 5.2 percentage points (a 24 percent relative increase compared with the pre-injury baseline), and the mean medical debt in collections (including patients with no debt) rose by $290 (a 76 percent relative increase). Post-injury changes in bankruptcy filings peaked at 3.2 per 1,000 patients (a 6 percent relative increase) at fifteen months post-injury. Financial hardship disproportionately affected uninsured, younger, lower-income, and privately insured patients, whereas those with Medicare and Medicaid experienced minimal change. These findings highlight persistent financial vulnerabilities, even among privately insured patients, and they underscore the need for policy enhancements that strengthen protections against the financial consequences of unanticipated acute medical events.