A new law will protect people in Arizona from some of the harshest consequences of medical debt. Yet the policies of individual states can’t substitute for the US implementing a more humane system of universal health insurance coverage, say David U Himmelstein and colleagues
Americans are swimming in medical debt—or, more aptly, drowning in it. And, if the results of elections in Arizona on 8 November are any indication, they’re angry about it. Proposition 209,1 a ballot initiative on whether Arizona should place limits on debt collection for medical bills, garnered support from nearly three quarters of voters.2 That lopsided margin is particularly striking in a state whose government has long been controlled by Republicans and where the 2022 midterm election votes were almost evenly split between Republican and Democratic candidates.
The Arizona initiative continues the US trend of voters passing progressive health reform policies for an individual state that their Republican controlled legislatures had resisted. In the November election, for example, South Dakota became the latest jurisdiction to use a popular vote to expand Medicaid coverage for people on low incomes—following states such as Idaho, Missouri, Nebraska, and Utah. Like Arizona’s proposition 209, these votes suggest a mismatch between US politicians and many of their constituents.
US patients can incur medical debt either because they lack health insurance coverage (11.4% of Arizonans; 8.6% of Americans...
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