Deferred Healthcare Among Lower-Wage Workers with Medical Debt and Chronic Health Conditions

Background and Purpose: Lower-wage workers in the U.S. face significant financial challenges, with medical debt as a pressing issue (Hannon et al., 2025). Health insurance coverage often does not shield individuals from the high costs of healthcare, especially for those managing chronic health conditions (Vogeli et al., 2007). For lower-wage workers, the burden of healthcare costs is even more acute, as they often lack the financial resources to manage both medical expenses and daily living costs. This study seeks to better understand the intersection of chronic health conditions, medical debt, and healthcare access among lower-wage workers:

1. Are lower-wage workers with chronic health conditions more likely to have medical debt than lower-wage workers without chronic health conditions?
2. Does the risk for medical debt among lower-wage workers vary based on health insurance type?
3. What is the relationship between medical debt and chronic health conditions concerning the likelihood of deferring healthcare due to cost?

Methods: Data for this study are from wave one of the Workforce Economic Inclusion and Mobility (WEIM) project survey administered in November 2023 with a nationally representative sample (N=2,426) of U.S. households with lower-wage workers from the AmeriSpeak panel. We restricted the sample to respondents currently employed (N=2,110) and ran a series of probit regressions to produce predicted probabilities using the margins command in Stata 18, controlling for demographic variables (e.g., age, family composition), household income, non-retirement savings, and self-assessed health status.

Results: Most (89%) workers had a form of health insurance, primarily employer-based coverage (37%) and Medicaid (21%). Over a quarter (26%) of workers said they had a chronic disease or health condition, and 35% had medical debt, with 61% indicating they are unable to pay this debt. The model-predicted probability of medical debt was 50% among workers with chronic health conditions compared to 33% without (p < .001) while among all workers, this probability was 61% higher among those with employer coverage compared to Medicaid. The probability of deferring seeing a doctor and obtaining prescription medication due to cost was 28% and 29% among those with medical debt, respectively, compared to 10% and 11% among those without debt, respectively (p < .001). For seeing a doctor, this did not differ based on chronic health condition status yet workers with chronic health conditions were more than twice as likely (37%) to put off paying for prescription medication if they had medical debt than if they did not (15%).

Conclusions and Implications: While most workers in this study had some form of health insurance, medical debt remains a significant issue, particularly for those with chronic health conditions. The high levels of medical debt, particularly among workers with chronic health conditions, suggest a need for more comprehensive policies that address the financial burden of healthcare.