Virginians have nearly $2.6 billion in medical debt that averages to about $2,083 per person, according to a report by NiceRX, a patient advocacy service.

Nationwide, non-Hispanic whites have the highest average value of medical debt at $14,450. More than a quarter of Black Americans have medical debt and are the racial group most likely to have unpaid medical bills, according to the report. NiceRX compiled the report using U.S. Federal Trade Commission’s Consumer Protection Bureau and data from the U.S. Census Bureau.

Medical debt disproportionately impacts those who are already struggling to make ends meet, according to Berneta Haynes, a staff attorney at the National Consumer Law Center, a legal nonprofit that focuses on consumer issues for working-class Americans.

“Medical debt comes along and makes all that worse,” Haynes said. Such debt hurts patient’s credit scores, which in turn affects a patient’s ability to obtain employment, housing and loans — such as for a car.

Patients sometimes try to reduce treatment in order to keep medical costs affordable, such as taking fewer medications than recommended by a doctor, only for the problem to persist and worsen, Haynes said. The patient then has to spend even more on costlier treatment as their health continues to decline.

“It ends up becoming this horrible feedback loop,” she said.

Populous states make up some of the the highest levels of medical debt ― Texas with $14.6 billion, Florida with $8.2 billion and California with $7.5 billion. Virginia is the country’s 12th most populous state but ranks ninth in medical debt, according to the report.

In prevalence, South Carolina ranks second with nearly 23% of state residents having medical debt only surpassed by West Virginia, where one out of four residents has medical debt. West Virginia is the nation’s fourth-poorest state and South Carolina is the No. 10, according to U.S. Census data.

Some health systems garnish wages and tax returns, place liens on homes and personal property or even seize bank accounts in response to unpaid medical debt, according to Haynes.

“We have even seen debt collection practices that involve civil arrest warrants against patients who fail to show up when they’ve been sued about a medical debt,” Haynes said.

Sentara Healthcare and Bon Secours do not use such methods, according to emails from representatives.

Hospitals in areas with higher incomes spend less on charity care, while those that serve more economically distressed communities have to write off more debt as patients simply cannot afford the bills, according to Haynes.

However, Medicaid expansion has helped patients and hospitals avoid these outcomes, she said.

“Before Medicaid expansion in the Commonwealth of Virginia, the number of applicants (for financial assistance) increased each year,” the Sentara statement said. “Starting in 2019, the number of applicants has shrunk due to Medicaid expansion.”

Sentara helped about 67,300 patients with $288 million worth of financial assistance and medical bill adjustments between April 1, 2021 and March 30, 2022, according to company data.

Most of those who sought financial assistance from Sentara prior to the 2019 Medicaid expansion were patients who were uninsured or underinsured, according to Sentara. Since the expansion, they have seen a lower number of uninsured patients.

Nationwide, those with health insurance are less likely to have medical debt, 14.6%, and have a lower average of medical debt, $10,570, compared with Americans having no health insurance — nearly 28% have medical debt and the average value is $18,150.

Sentara also covers costs for certain patients who would have absolutely no way to pay back the system. Between 2016 and 2021, Sentara provided $1.5 billion in care that it was not compensated for, according to the statement from the health system.

Like Sentara, Bon Secours will provide care to patients regardless of their ability to pay.

“We offer financial counselors and patient advocacy representatives to help patients estimate the cost of their care and understand their medical bills before scheduled services and after they are billed,” said Emma Swann, a spokesperson for the not-for-profit health system.

Sentara also provides such services and free care is also available to those 200% below the federal poverty level and less than $50,000 in assets. Virginians can also apply for help with paying for medical bills to the Virginia Department of Social Services depending on their eligibility for certain financial aid.