By John Tozzi

Tango Walker estimates her family owes more than $28,000 in medical debt. Her five active kids often got banged up playing sports and needed minor surgery or physical therapy. She still owes money for an $1,800 custom knee brace her daughter, now a college junior on a basketball scholarship, got after tearing her ACL in 10th grade.

Walker, who has a master’s degree in educational leadership and is working toward a doctorate, recently started a job at the Children’s Advocacy Center at the University of Missouri at St. Louis. Even with insurance, she struggles to afford care. Last year she was surprised to learn her wages had been garnished with no notice for a surgery bill she didn’t know about.

She says she’s never been offered the financial assistance she later learned is often available, even though nonprofit hospitals are required by law to publicize charity-care policies. Walker, who’s Black, sees a double standard. “I’ve witnessed how White people are spoken to and how things are explained to them as opposed to how I’ve been spoken to and how things have been explained to me,” she says.

Walker’s debt is part of an enormous burden of $140 billion in past-due medical bills reported on U.S. credit files. But that burden isn’t evenly distributed: It disproportionately falls on Black Americans. Census data show that 28% of Black households have medical debt, compared with 17% of White households.

The gap is even wider in certain parts of the country. In St. Louis County, where Walker lives, people living in communities of color are almost four times as likely to have medical debt in collections than people living in predominantly White communities, according to data compiled by the Urban Institute.