A new study in the Journal of the American Medical Association reveals that Americans now have over $140 billion in unpaid medical bills owed to collection agencies. The figure is nearly twice as high as the most recent data from several years ago. But the country’s total medical debt is even higher, as the $140 billion does not include bills owed directly to health providers or credit card debt from medical expenses. Republican-run states that chose not to expand Medicaid through the Affordable Care Act had the highest debts.