A sobering report by the think tank Third Way and the U.S. Census Bureau reveals a startling reality: nearly a quarter of middle-class American households will be unable to fully cover their health care costs in 2020. This alarming trend disproportionately affects black and Hispanic households, highlighting systemic disparities in medical debt.

In 2020, about 17 million middle-class individuals (representing 23.5% of those with household incomes between $50,000 and $100,000) were unable to pay their medical bills. Strikingly, the middle class population faced the highest rates of medical debt, even when they had higher levels of robust insurance coverage. This situation persists even though lower-income families may be foregoing medical care because of cost concerns.

The Third Way study, which controlled for factors such as education, parental status, insurance coverage and geographic location, still confirmed that middle-class Americans carry the heaviest burden of medical debt. Racial and ethnic disparities exacerbate the problem, with middle-class blacks and Hispanics disproportionately affected.

Key findings:

Approximately 37.5% of black middle-class individuals had medical debt, compared to 29% of low-income individuals and 21.5% of high-income individuals.

Hispanic middle-class individuals also experienced high levels of medical debt, with 25.2% carrying unpaid medical expenses.

Middle-class Americans with a bachelor’s degree had slightly lower levels of medical debt (16.5%) than those with a high school diploma (26%).

Middle-class Americans, with the exception of those aged 65 and over, had higher levels of medical debt than other income groups.

Geographical differences were evident, with the South and Midwest having the highest proportions of middle-class individuals with medical debt (28.1% and 24.6%, respectively).

It’s worth noting that Third Way’s analysis is based on income and census data, which classifies individuals as having medical debt if someone in their household has such debt. However, according to the Kaiser Family Foundation (KFF), an estimated 100 million Americans have some form of medical debt.

While the pandemic and ensuing financial turmoil inevitably contributed to this crisis, the exact extent of its impact remains uncertain. The troubling data underscore the urgent need for comprehensive reforms in the accessibility, affordability and support of health care, particularly for middle-class Americans struggling with this growing burden.