This analysis of government data estimates that 9% of adults – or roughly 23 million people – owe more than $250 due to health costs. About half of those reporting significant medical debt owe more than $2,000. A small share (representing about 1 percent of all adults) owes more than $10,000, and the group accounts for the vast majority of all medical debt owed by people in the United States.

The analysis is based on data from the 2020 Survey of Income and Program Participation, a nationally representative survey that asks every adult in a household whether they owed money for medical bills in 2019 and how much they owe.

The 2020 survey suggests Americans’ collective medical debt totaled at least $195 billion in 2019, though with quite a bit of uncertainty. A small share of adults account for a huge share of the total, with considerable variation from year to year. The estimate is significantly higher than other commonly cited estimates, which generally rely on data from credit reports that may not capture medical debts charged to credit cards or included in other debts rather than being directly owed to a provider.

The report also examines variations in medical debt by age, race and ethnicity, health status, and for people with a disability.

The analysis is available through the KFF-Peterson Health System Tracker, an online information hub that monitors and assesses the performance of the U.S. health system.