Every candidate had a plan to revamp our broken healthcare system during the 2020 Democratic primary. They ranged from Medicare for All (Bernie Sanders) to expanding the Affordable Care Act (Joe Biden). 

Elizabeth Warren said a significant number of Americans got their health insurance from their employers. Pandemic lockdowns meant millions lost it. Kamala Harris touted a variation of Medicare for All. Amy Klobuchar pushed for lowering the age for Medicare to 50. 

The debate suggested whoever won the general would dedicate to fixing the system many have tried restructuring – including Hillary Clinton, who attempted in 1993 to institute a universal healthcare initiative – until the GOP ended the possibility of passage. 

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Never addressed in the 2020 primary was the extent of medical debt, despite a presidential race in the middle of a once-a-century pandemic hospitalizing people for days, weeks and months. The cost was astronomical. Medical debt has accrued exponentially since.

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In 2010, Speaker Nancy Pelosi shepherded the Affordable Care Act into law – which then-Vice President Biden called a “big fucking deal” after President Obama signed it. What the ACA did – Sarah Palin dubbed Obamacare – was set up a healthcare marketplace to buy insurance plans with different levels of coverage and affordability. 

The ACA also expanded Medicaid to the working poor. It allowed dependent children to stay on their parents plans until they were 26. It  forced insurance companies to charge men and women the same rates, instead of overcharging women for being female. The ACA addressed preexisting health conditions, forbidding companies from rejecting applicants on the basis of their prior health status.

The ACA was the most sweeping healthcare initiative since Lyndon Johnson signed Medicare and Medicaid into law in 1965. Thus Democrats did not expect pushback from Republicans on a law allowing millions of uninsured Americans to buy coverage.

Republican governors rejected Medicaid expansion. Some sued to deny adoption in their states. This meant millions of Americans in those states remained uninsured and vulnerable to medical debt.    

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Never addressed in the 2020 primary was the extent of medical debt, despite a presidential race in the middle of a once-a-century pandemic hospitalizing people for days, weeks and months.

The cost was astronomical. 

Medical debt has accrued exponentially since. 

A new study finds that healthcare is now the country’s largest source of debt. One in 10 Americans carry medical debt ranging from $250 – more than a week’s wages for a minimum wage worker – to $10,000. 

That latter number is most common. According to healthcare.gov, a three-day hospital stay – the average – costs more than $30,000. 

These medical debts are largest in states run by Republican governors who refused to expand Medicaid under the Affordable Care Act. 

Moreover, many households can’t pay cost-sharing in private health plans. That means they’re unable to pay for deductibles, copays and coinsurance like prescription plans. This makes it less likely for people to buy health insurance, even from the healthcare marketplace.

An investigation conducted and published by the Journal of the American Medical Association found that “an estimated 17.8 percent of individuals in the US had medical debt in collections in June 2020.” 

That’s well above what was previously thought.

The JAMA investigation was conducted before the true costs of the pandemic had been accrued and analyzed. Yet even without those numbers, the amount of medical debt was staggering at $140 billion. 

To put that in perspective, the total 2020 US State Department budget – including USAID – was $52 billion. The total US Department of Justice budget was $35 billion. Medical debt is nearly twice that.

Members of Congress, among them the House Progressive Caucus, frequently take to Twitter to call for student loan debt relief. 

But what about medical debt? 

According to a new study from the American Journal of Public Health, crowdfunding isn’t an answer. Researchers found that the funding acquired was “highly unequal, and success was low, especially in 2020.” A mere 12 percent of campaigns met their fundraising goals. 

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Moreover, crowdfunding raised far less money throughout 2020 in states that had more medical debt, higher uninsured rates and lower incomes – notably states controlled by Republican governors. 

These states also have the highest percentage of people of color who are significantly more likely to have medical debt than their white peers and who were disproportionately impacted by the covid. 

At a GOP debate in Pennsylvania on April 25 for what is arguably the most-watched Senate, five candidates railed against “lockdowns” and “mandates.” Mehmet Oz, a cardiothoracic surgeon and celebrity medical TV personality, was the most strident. He claimed his son was being forced in medical school to wear a mask against his will.

No one discussed the impact of the pandemic on the healthcare system nor on the debt being carried by average Americans.

Who will pay for their care? How do we end medical debt? 

With the 2024 presidential election looming, it’s a question future candidates on both sides of the aisle must prepare to address.

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