Credit Scores and Care Costs: The Fight Over Medical Debt Reporting
August 5th 2025
While a record number of Americans were insured in 2024, the high cost of healthcare leaves many, including those insured, struggling to pay for healthcare or burdened by medical debt. Some national figures estimate as many as 100 million Americans struggle with medical debt, when defining medical debt as both unpaid medical bills in collections together with other borrowing used to pay for healthcare.
Residents in New Hampshire (NH) are also struggling to pay for healthcare. According to a survey of more than 1,300 New Hampshire adults by the Consumer Healthcare Experience State Survey, more than two-thirds (69%) of Granite Staters reported delaying or going without healthcare in the prior year due to cost. Among those who received medical care, more than two in five (41%) respondents experienced financial hardship due to medical bills, including difficulty paying, incurring debt, or struggling to afford other essential expenses. Those who reported financial hardship due to medical bills were most likely to have purchased their health insurance on the individual market, followed by those with Medicaid, employer-sponsored insurance, and then Medicare, reflecting the reality that even those with health insurance are struggling to manage their healthcare costs and could be incurring medical debt. According to the Urban Institute, 6% of New Hampshire residents had medical debt in the form of unpaid medical bills in collections in 2022-2023. In comparison, in 2023-2024, only 2% of NH residents had medical debt in collections, indicating a significant decrease. However, these numbers warrant closer inspection as this data does not necessarily reflect a reduction in the number of people with medical debt in NH, but rather a reflection of changes in medical debt reporting practices that were adopted by credit bureaus.
Changes in Treatment of Medical Debt by Credit Reporting Agencies
On July 1, 2022, three nationwide credit reporting agencies, Equifax, Experian, and TransUnion, exempted all fully paid medical debt from U.S. consumer credit reports—meaning they decreased the degree to which previously unpaid medical bills impact a consumer’s credit score. Consumers were also given an additional six months’ grace period to address medical collection debt before it appeared on their credit report. In the first half of 2023, all the credit bureaus removed unpaid medical collection debt for balances of $500 or less from credit reports.
Federal Rule Disallowing Medical Debt on Credit Reports Vacated
In 2025, the Consumer Financial Protection Bureau (CFPB) finalized a rule that disallowed an estimated $49 billion in unpaid medical bills from being included on the credit reports of approximately 15 million Americans. CFPB research revealed that medical debt is a poor predictor of creditworthiness, leading the agency to assert that people should not be denied access to essential economic opportunities such as purchasing a car or a home because they incurred unavoidable medical bills. The 2025 CFPB rule was challenged in court as having exceeded the agency’s legal authority. On July 11, a federal judge in Texas vacated the rule, allowing medical debt to continue to remain on Americans’ credit reports.
This withdrawal of federal protection from reporting medical debt comes at a time when federal health policy is projected to increase the number of uninsured and out-of-pocket costs, which will further contribute to ever-rising healthcare costs. However, states still have some flexibility to take steps to protect their citizens from medical debt. To date, approximately 14 states have enacted state legislation that prohibits credit reporting from including medical debt. Prohibiting unpaid medical bills from being included in credit reporting is one small and short-term step states can take to protect healthcare consumers from increasing healthcare costs as they continue to explore longer-term and systemic approaches to identifying and mitigating healthcare cost drivers and lack of affordability.
- Lia Kelvington
The lead researcher and author of this blog was IHPP intern Lia Kelvington. Lia is working with IHPP during the summer of 2025 to complete her undergraduate Health Management and Policy internship, a key component of the UNH Health Management and Policy curriculum. Over the course of the summer, Lia has been supporting the IHPP Health Law and Policy team’s project-based work and has been independently researching the impact of medical debt on citizens of New Hampshire. This blog is a preview to a more in-depth paper on the topic which will be released in early fall.
Blog Post Archive
Credit Scores and Care Costs: The Fight Over Medical Debt Reporting
August 5th 2025
While a record number of Americans were insured in 2024, the high cost of healthcare leaves many, including those insured, struggling to pay for healthcare or burdened by medical debt. Some national figures estimate as many as 100 million Americans struggle with medical debt, when defining medical debt as both unpaid medical bills in collections together with other borrowing used to pay for healthcare.
Hospital Safety Grades: Why "D" Hospitals Are Just as Important to Know as "A" Hospitals
May 7th 2025
The Leapfrog Group announces their Spring 2025 Hospital Safety Grades, Kimberly Persson details the grades across New Hampshire.
Impacts of Labor and Delivery Unit Closures
April 25th 2025
Labor and delivery units are closing all over the United States. Read about what is causing these closures, how they are effecting maternal care, and what can be done about it.
Tariffs, Cuts, and Consequences: Unpacking the Latest Healthcare Policy Shifts
April 17th 2025
Alison Mehlman breaks down how new tariffs could drive up drug prices, disrupt access, and reshape the future of healthcare in the United States, starting with pharmaceuticals.
The Brass Tacks on the Pink Tax
April 10th 2025
Women are consistently charged more for everyday essentials, a phenomenon know as the “pink tax.” This hidden cost of being a woman extends into healthcare, where out-of-pocket expenses can soar simply due to gender. Read Kimberly Persson's analysis on this issue and more, below.
UNH Healthcare Vitals: Medical Debt and the Rise of Rx Drug Costs
April 1st 2025
The cost of prescription medication costs are rising. See how this is effecting New Hampshire residents and what policymakers are doing about it.
Rising Trends in Behavioral Health: Chronic Conditions, and Pregnancy: A Seven Year Analysis
March 13th 2025
The prevalence of certain health conditions in New Hampshire are on the rise, to find out which ones, why, and the implications, read Bethany Swanson's summary here.
Out-of-Pocket Healthcare Costs Are Rising - Pregnancy Tops the List.
March 10th 2025
According to recent medical claims data, Pregnancy with delivery has the highest out-of-pocket costs. Read about other findings and implications here.
Understanding New Hampshire's Most Costly Health Conditions
February 27th 2025
Bethany Swanson explores the financial impact of the most costly conditions in New Hampshire based on a recent analysis of medical claims data from Medicaid, Medicare, and commercial insurers.
Hospital Cost Containment through Tax Legislation?
February 21th 2025
Kimberly Persson details how hospital prices have been dramatically increasing, and how legislation to tax hospitals on excessive prices could be part of the solution.
Strengthening Support for Youth: How New Hampshire is Expanding Awareness and Access to the 988 Suicide and Crisis Lifeline
February 18th 2025
In efforts to better market the 988 Suicide and Crisis Lifeline, New Hampshire plans use results from a recent survey conducted by IHPP on college and high school student's awareness and perceptions of the 988 Suicide and Crisis Lifeline. The findings of the survey, future recommendations, and more, are detailed and analyzed by Tess Pueschel and Susy Peoples.
Unaffordable Employer Sponsored Insurance - Could ICHRA Be the Solution Employers Need?
February 14th 2025
Increases in employer-sponsored insurance have left employees unable to afford premiums and out-of-pocket expenses. Individual Coverage Health Reimbursement Arrangements (ICHRAs) offered by employers are changing the benefits game; Kimberly Persson details how.
What is Old is New Again: Medicaid Work Requirements and Changing the Federal Share of Medicaid Spending
February 10th 2025
Deb Fournier details how Medicaid financing and work requirements are changing, and what that might mean for Americans depending on this program.
Understanding Pharmaceutical Utilization and Costs in New Hampshire: Key Insights from 2022
February 7th 2025
An analysis of New Hampshire pharmacy claims from major insurance payers presents interesting findings, read Bethany Swanson's take on the implications of the complex relationship between drug utilization and costs in NH.
Health Policy for New Hampshire and Country
February 3rd 2025
Read a list of what Deborah Fournier and the rest of the Health Law and Policy Team are reading in the health policy space this February:
Measuring Total Healthcare Expenditures
January 23rd 2025
Healthcare costs are rising, and we don't know how much we spend on healthcare, or what we're spending it on. Read Lucy Hodder's analysis of current healthcare expenditures and what we're doing about it in New Hampshire.
The Disparate Data on Opioid Overdose Deaths: A Call to Close the Gap
January 13th 2025
The United States is seeing a decrease in opioid overdose deaths for the first time since 2018, but not for all demographics. Susy Peoples shows that it is time to develop community-specific response strategies across the United States. Additionally, take a look at an analysis of New Hampshire's response to this epidemic.
US Continues to Receive Bad Marks in Healthcare
December 12th 2024
See an analysis of this year's Mirror, Mirror report from the Commonwealth Fund and continued reports of healthcare facilities struggling with inadequate staffing.
Four New Hampshire Hospitals Earn “A” on the Fall 2024 Leapfrog Hospital Safety Grade
November 15th 2024
On November 15th, The Leapfrog Group, a national nonprofit representing hundreds of the nation’s most influential employers and purchasers of health care, announced the Fall 2024 Leapfrog Hospital Safety Grades.
How Hospitals Use a Low-Cost Drug Program to Profit on Patient Care
November 2024
Have you ever heard of 340B? No? Well, it’s coming. Policy pundits across the country predict that 340B will be a prime topic of conversation for employers in the coming year because it is costing them a lot of money and contributing to the unsustainable growth in healthcare expenditures.
Continuing the quest for affordable and equitable healthcare
October 17th 2024
On October 17, IHPP held its annual symposium, this year entitled, “Continuing the quest for affordable and equitable healthcare.” Attendees discussed the wicked problem of healthcare costs and affordability in New Hampshire. The day’s dialogue included the current trends in healthcare prices and the affordability crisis in healthcare, affordability as a component of access and equity, primary care’s role in improving costs and outcomes, equity beyond affordability, and available state policy solutions to address cost and affordability, such as cost growth benchmarks with Rachel Block of Milbank Memorial Fund and prohibiting anti-competitive contracting with Maureen Hensley-Quinn at NASHP.
On October 25, the New Hampshire Insurance Department held its annual hearing on its report on NH healthcare premium rates and claims. Public comment is being accepted on the report through November 15, 2024. NHID also held a robust discussion of using a total healthcare expenditure model to learn more about New Hampshire’s drivers of healthcare costs – neatly echoing the cost growth benchmark discussion that was held the week prior at the symposium. Panelists included Rhode Island’s Health Insurance Commissioner, Cory King and President of the Milbank Memorial Funds, Chris Koller.
Meanwhile, the Attorney General’s office held a public hearing about the proposal for HCA to purchase Catholic Medical Center on October 23, 2024. Public comments are being accepted through November 1, 2024.
Last in this post, but certainly not least, Medicare Open Enrollment began on October 15 and Marketplace Open Enrollment begins November 1.
