More than a quarter of Americans say they or their families were saddled with medical debt in 2025, including many with health insurance, according to a new Urban Institute study.

Why it matters: The findings are an indicator of just how unaffordable care has become — and how having insurance is no longer a buffer against expensive medical bills.

The big picture: Medical debt plagues higher proportions of the uninsured. But just 7.9% of Americans went without coverage last year.

• A growing number of Americans with workplace coverage or individual policies are finding they can't afford deductibles, copays or other out-of-network costs.
• That's helping stoke affordability concerns just weeks before the midterm elections.

Case in point: Medical debt has taken center stage in what's turned into a surprisingly competitive Senate race right in the heart of Trump country.

• Sen. Roger Marshall (R-Kan.) filed lawsuits against more than 700 patients with outstanding medical bills throughout his career as an obstetrician-gynecologist, the New York Times reported last month.
• His race against Democrat Adam Hamilton has tightened considerably since the report, and the Cook Political Report recently called it a toss-up.
• Hamilton has featured one of the patients Marshall sued in a campaign ad, in which she recalls how she was arrested in front of her young daughter while pregnant for missing a $50 payment.
• That prompted a lawyer for Marshall to send a cease-and-desist warning. Marshall's camp says the ad is defamatory and that the patient was in fact arrested for failing to appear in court for a variety of debts.

By the numbers: 26.6% of Americans reported they or their family members owed medical debt as of December, the Urban Institute found in a survey of more than 10,000 adults.

• Medical debt was most common among adults 45 to 54, those who are Black, Hispanic, or in racial groups other than white or Asian, and those with incomes 100%–200% of the federal poverty level.
• 17.6% of seniors eligible for Medicare coverage reported that they or a family member owed medical debt.
• More than half of adults with medical debt reported owing $1,000 or more, and 15.5% owed $5,000 or more.
• More than 4 in 10 adults with disabilities had medical debt, as did 42% of those who reported being in fair or poor health.

Zoom in: More than half of those saddled with debt owe money to hospitals.

• The second most common debt was for care by specialist doctors, followed by debt owed to dental care providers.

What we're watching: Affordability challenges are poised to get worse, not better.

• Republicans' cuts to federal Medicaid spending and the expiration of enhanced Affordable Care Act tax subsidies are expected to increase the uninsured rate. Other individual market enrollees will face higher premium costs.
• Meanwhile, employers are staring down yet another year of high medical cost growth, much of which will likely get passed on to workers via higher premium or out-of-pocket obligations.
• Concern over medical debt is going viral, with some social media influencers urging their followers to refuse to pay large bills, or to ask for itemized versions and whether they qualify for financial assistance, the Wall Street Journal reported.

CDC is moving ahead with a previously shelved controversial hepatitis B vaccine study (Rolling Stone)

Our take: Director Erica Schwartz's office moved to allocate new funds for a clinical trial in Guinea-Bissau that had been put on hold amid ethics concerns, raising fresh questions about her independence from Health Secretary Robert F. Kennedy Jr.

FDA says it will complete safety review of abortion pill in March (NBC News)

Our take: The FDA, in a court filing, said a final report on mifepristone's safety will come months after the midterm elections. That could raise the stakes for Heidi Overton, President Trump's pick to lead the agency, who previously described medication abortion as dangerous and sidestepped questions about the pill during a confirmation hearing last month.

Michigan's attorney general sues Blue Cross, alleging illegal monopoly (Detroit Free Press)

Our take: A significant state case raises antitrust questions about the Blue Cross Blue Shield network at a time of rising premiums, service reductions and more medical debt.