South Dakota has the highest percentage of adults with medical debt, with roughly 17.66% to 17.7% of its population affected. While South Dakota often leads in the percentage of adults holding debt, other southern states like Mississippi, North Carolina, and West Virginia also report high rates. Overall, the South and rural areas in the U.S. report the highest burden.
Top 10 States with Highest Medical Debt Rates
There isn't one single #1 state; it depends on the ranking source, but Hawaii, Massachusetts, and New Hampshire consistently appear at the top for overall healthcare performance, with Hawaii leading for outcomes (life expectancy, low uninsured) in U.S. News, Massachusetts for access/affordability in Commonwealth Fund reports, and New Hampshire often ranking high in metrics like access and quality in WalletHub's analysis.
The report found that the California state government carries more debt than any other state with $497 billion in liability. The findings stem from 2023, the most recent year for which complete data was available, according to the Reason Foundation, a think tank with offices in Washington, D.C., and Los Angeles.
According to the Steno Health study, the top five states with the highest healthcare spending per person are:
The two countries had similar healthcare systems before Canada changed its system in the 1960s and 1970s. The United States spends much more money on healthcare than Canada, on both a per-capita basis and as a percentage of GDP.
The state governments with the lowest per capita debt at the end of 2023 were Tennessee, Utah, Nebraska, Idaho, South Dakota, Oklahoma, and Indiana, each with less than $3,000 in debt per resident.
Across 13 indictors measured, the availability of medical resources and timely access to medical services in Canada was generally below that of the average OECD country. In 2023, Canada ranked 27th (of 30) for the relative availability of doctors and 25th (of 30) for hospital beds dedicated to physical care.
There isn't one single "best" state, as rankings vary by methodology (e.g., overall health, hospital quality, specific specialties), but Massachusetts, New Hampshire, and Minnesota consistently appear at the top for overall hospital quality and access, alongside states like Colorado, Utah, and Rhode Island in various recent analyses from sources like U.S. News & World Report, World Population Review, and Advisory Board}. Massachusetts boasts renowned hospitals like Mass General and Brigham and Women's https://www.usnews.com/news/best-states/rankings/health-care/healthcare-quality/hospital-quality, while Minnesota is home to the Mayo Clinic.
If you can't afford healthcare in America, you risk significant medical debt and worse health outcomes, but you can get emergency stabilization regardless of ability to pay, and can seek help through Medicaid, CHIP, Marketplace subsidies, community health centers, or catastrophic plans, with options varying by state and income. Delaying care due to costs often leads to poorer health, while options like public clinics offer sliding-scale fees, and government programs provide free or low-cost coverage for eligible individuals.
Even those with health insurance often face gaps in coverage or high out-of-pocket costs, deductibles, co-payments, and coinsurance can be prohibitively expensive, making it difficult for many people to afford necessary medical care and leading to the accumulation of medical debt.
Annual totals are based on data from April of each year. Inflation adjusted to the 2023 calendar year. As of April 2024, the five countries owning the most US debt are Japan ($1.1 trillion), China ($749.0 billion), the United Kingdom ($690.2 billion), Luxembourg ($373.5 billion), and Canada ($328.7 billion).
2. Who are the creditors of this debt? The debt is made up of government bonds held by individuals and financial institutions, mostly Canadian (around two-thirds of Canadian government securities are held by Canadian investors, such as insurance companies, pension funds, and financial institutions).
Based on recent studies (2024-2025), Texas, Florida, Louisiana, Nevada, and South Carolina are frequently cited as the most financially distressed U.S. states, showing high rates of debt searches, credit issues, and accounts in forbearance/distress, while Hawaii, Vermont, and Alaska often rank as the least distressed. These rankings rely on metrics like credit scores, bankruptcy filings, and consumer financial health indicators.
Mississippi is consistently ranked as the cheapest state to live in the U.S., primarily due to extremely low housing costs (significantly below the national average), low transportation expenses, and minimal property taxes, although it has lower average incomes, notes Extra Space Storage, Money | HowStuffWorks, Forbes, and World Population Review. Other very affordable states often listed include West Virginia, Oklahoma, Alabama, and Kansas, offering low housing and general living expenses.
Nine U.S. states currently have no state income tax on earned income: Alaska, Florida, Nevada, New Hampshire, South Dakota, Tennessee, Texas, Washington, and Wyoming, though some nuances exist, like Washington's new capital gains tax and New Hampshire's phase-out of its interest/dividend tax. These states often balance their budgets with higher sales, property, or excise taxes.
New Jersey and Illinois consistently rank as having the highest effective property tax rates, followed by Connecticut, New Hampshire, and Texas, though exact percentages vary slightly by source and year, with NJ often around 2.2-2.4% and IL near 1.8-2.3% of home value. These states rely heavily on property taxes, sometimes due to a lack of state income tax, to fund local services, resulting in substantial tax bills for homeowners.