Rural Pennsylvania impacted the most by medical debt

Medical debt is an issue that disproportionately impacts rural Pennsylvanians. Efforts to reduce medical debt have been thwarted by legislators representing those communities. 

While rural Pennsylvanians are struggling under the weight of rising medical debt burdens, it’s their representatives in the legislature who are often least likely to pass measures to help.

State Rep. Arvind Venkat (D-Allegheny), who is the only practicing physician in the Pennsylvania House, explained during a recent interview that it is not that surprising for rural areas to experience more medical debt.  

“If you want to look at where medical debt and collections is concentrated in Pennsylvania, it’s largely in rural Pennsylvania,” Venkat said. 

“[Urban and suburban areas] have health systems that are far more integrated on the insurance side and the provider side, and so they’re able to offset costs by perhaps not sending patients into collections with medical debt.”

Rural communities have been impacted by hospital closures and mergers over the past 20 years. During that time, 33 hospitals closed across Pennsylvania with nine closures impacting rural areas.

With close to $1.8 billion of medical debt sitting in collections across the commonwealth, Venkat, along with Gov. Josh Shapiro, took steps to combat medical debt during the previous legislative session, but those efforts stalled due to Republican inaction. 

The Pennsylvania House passed Venkat’s Medical Debt Relief Act with bipartisan support last year, but it has sat dormant in the Republican-controlled Senate since then. 

Shapiro then attempted to include $4 million in his latest budget that would have eliminated $400 million in medical debt, but that fell short as well. 

Data from the Urban Institute shows that Berks and Warren counties have close to 10% of their population with some sort of medical debt sitting in collections. That same data shows that those rural areas also have high rates of uninsured residents. 

“When you’re talking about rural hospitals, when you’re talking about rural clinics, to the extent that they still exist as isolated areas and you have an aging population in rural Pennsylvania that may be working longer and even with Medicare or even with Medicaid, they often can be uninsured or underinsured in areas where the health systems don’t have as much of a choice or a margin to be able to absorb some of these costs,” Venkat explained.

“It’s perhaps unsurprising that this is largely concentrated in terms of medical debt collections in rural Pennsylvania.”