Medical Debt and Hunger-Coping Economic Tradeoffs Among Charitable Food Assistance Clients

Objective: Medical debt is a long-term hardship, typically unplanned, and difficult to resolve. Hunger-coping economic tradeoffs (e.g., choosing between food or another basic need) are smaller financial constraints related to implementing short-term strategies to resolve cash shortages. This study examined associations between long-term financial constraint (medical debt) and engagement in short-term financial strategies (hunger-coping economic tradeoffs) among charitable food assistance (CFA) recipients. Methods: Survey data were collected in 10 Houston-area and 10 Atlanta-area food pantries in 2022. Hunger-coping economic tradeoff experiences were based on affirmative responses to whether anyone in the household ever had to choose between food and five basic needs. Covariate-adjusted logistic regression models were used to assess the relationship between medical debt (defined as unpaid medical bills) and each hunger-coping tradeoff. Results: Among 999 participants (mean age, 55 years), 41% reported medical debt. Participants with medical debt had greater odds of having to choose between paying for food or (1) childcare (AOR = 1.92, 95% CI 1.37–2.69, p < 0.001), (2) utilities (AOR = 2.05, 95% CI 1.59–2.64, p < 0.001), (3) rent/mortgage (AOR = 2.34, 95% CI 1.75–3.14, p < 0.001), (4) transportation/gas (AOR = 2.81, 95% CI 2.05–3.85, p < 0.001), and (5) education (AOR = 2.18, 95% CI 1.42–3.34, p < 0.001). Conclusions: Long-term hardship (i.e., medical debt) was associated with CFA recipients reporting engaging in short-term financial strategies (i.e., hunger-coping economic tradeoffs) to make ends meet. These findings highlight the need to screen CFA recipients for medical debt, economic hardship, and financial management skills, with food pantries serving as key referral points.