Knoxville’s Black community endured deeply rooted racism. Now there is medical debt

KNOXVILLE, Tenn. — When Dr. H.M. Green opened his new medical office building on East Vine Avenue in 1922, Black residents of this city on the Tennessee River could be seen only in the basement of Knoxville General Hospital. They were barred from the city’s other three medical centers.

Green, one of America’s leading Black physicians, spent his life working to end health inequities like this. He installed an X-ray machine, an operating room, and a private infirmary in his building to serve Black patients. On the first floor was a pharmacy.

Today the Green Medical Arts Building has been replaced by a tangle of freeways that were built after the city’s Black business district was bulldozed in a midcentury urban renewal project.

But the health gaps Green labored to narrow still divide this community. And if segregation is less apparent in medical offices today, its legacy lives on in crushing medical debt that disproportionately burdens this city’s Black community.

In and around Knoxville, residents of predominantly Black neighborhoods are more than twice as likely as those in largely white neighborhoods to owe money for medical bills, Urban Institute credit bureau data shows, one of the widest racial disparities in the country.

That tracks with a disturbing national trend. Health care debt in the U.S. now affects more than 100 million people, a KHN-NPR investigation found. But the toll has been especially high on Black communities: 56% of Black adults owe money for a medical or dental bill, compared with 37% of white adults, according to a nationwide KFF poll conducted for this project.

The explanation for that startling disparity is deeply rooted. Decades of discrimination in housing, employment, and health care blocked generations of Black families from building wealth — savings and assets that are increasingly critical to accessing America’s high-priced medical system.

Against that backdrop, patients suffer. People with debt avoid seeking care and become sicker with treatable chronic conditions like diabetes or multiple sclerosis. Worse still, hospitals and doctors sometimes won’t see patients with medical debt — even those in the middle of treatment.

“African Americans don’t seek health care until we are really, really sick, and then it costs more,” said Tabace Burns, a former emergency room nurse in Knoxville. Burns, who is also a leader in her church, said she routinely helps members of her congregation find medical care they should have sought earlier.

Nationwide, Black adults who have had health care debt are twice as likely as white adults with such debt to say they’ve been denied care because they owe money, the KFF poll found. Many Black Americans also ration their care out of fear of cost.

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