Medical Debt Emerges as Risk Factor for Housing Instability

Medical debt was associated with a substantially higher risk of housing instability in the following year, according to a new study published in JAMA Network Open, underscoring the broader financial and social consequences of health care–related debt.¹

In the nationally representative cohort study of US adults using longitudinal survey data collected between 2023 and 2025, researchers found that adults who reported carrying medical debt were significantly more likely to experience difficulty paying rent or a mortgage, eviction, or foreclosure in the subsequent year, even after accounting for prior housing instability and other financial and demographic factors.

The cohort study included 1515 adults participating in the Cumulative Life Stressors Impact on Mental Health and Well-Being Study, a nationally representative panel. Participants had a mean (SD) age of 52.2 (16.2) years, and nearly half were women (49.7%). In 2024, 240 participants (16.4%) reported having medical debt. In 2025, 110 individuals (8.7%) reported housing instability, including rent burden (7.8%) and loss of housing due to eviction or foreclosure (1.5%); outcomes were not mutually exclusive.

Unadjusted analyses showed stark differences between those with and without medical debt. Nearly one-quarter of adults with medical debt experienced housing instability in the following year (23.5%; 95% CI, 18.2%-29.9%), compared with 5.8% (95% CI, 3.6%-9.4%) of those without medical debt.

To estimate the association while accounting for confounding factors, investigators used propensity score weighting based on data collected before the onset of medical debt in 2023, along with doubly robust estimation. After adjustment, medical debt was associated with a 7.0 percentage point increase (95% CI, 5.2-8.8) in the probability of experiencing housing instability in the subsequent year.

Adults with medical debt differed from those without debt across several socioeconomic dimensions. Compared with participants without medical debt, those with debt were more likely to report household incomes below $60,000 (61.3% vs 39.8%), less than $5000 in household savings (51.9% vs 22.4%), and children younger than 18 years living in the home (39.7% vs 25.0%). They were also more likely to be uninsured (8.0% vs 4.1%). Although most participants were homeowners overall (69.5%), prior housing instability was more common among those who later reported medical debt.

Sensitivity analyses supported the robustness of the findings. Estimates remained stable when alternative propensity score approaches were applied and when extreme values were winsorized. An e-value of 3.3 suggested that a relatively strong unmeasured confounder would be required to fully explain away the observed association. A placebo test found no association between medical debt and an unrelated outcome, further strengthening causal inference.

The findings add to growing evidence that medical debt extends beyond financial strain to affect core social determinants of health, including housing stability. The high costs associated with health care in the US have been shown to discourage people from getting treatment altogether.² Prior research has linked medical debt to evictions, foreclosures, and homelessness, but this study extends earlier work by using recent, longitudinal data from a nationally representative sample to assess downstream housing consequences.¹

The authors noted that the results carry heightened policy relevance amid ongoing changes to US health insurance and consumer protection policies. Recent Medicaid eligibility changes and the reversal of a federal rule that would have removed medical debt from credit reports may increase exposure to medical debt and related collection actions, potentially exacerbating housing insecurity.

“These findings have critical implications, especially in an evolving policy environment,” they wrote. “For one, the 2025 budget reconciliation act, signed into law on July 4, 2025, represents a considerable rollback of health insurance coverage in US history, marked by significant changes to the Medicaid program, including work requirements and eligibility redeterminations every 6 months, among other reforms. As a result, an estimated 7.6 million individuals in the US are projected to lose health insurance coverage by 2034. These changes raise concerns about the affordability of care that ultimately may contribute to the growing burden of medical debt, potentially igniting a cascade of consequences that imperil housing stability.“

References

1. Moon KJ, Linton SL, Stuart EA, Galea S, Ettman CK. Housing instability following medical debt exposure among US adults, 2023 to 2025. JAMA Netw Open. 2026;9(1):e2553617. doi:10.1001/jamanetworkopen.2025.53617

2. Kalousova L, Burgard SA. Debt and foregone medical care. J Health Soc Behav. 2013;54(2):204-220. doi:10.1177/0022146513483772