Survey: Medical costs burdening 2 out of every 5 Americans

A survey by the Commonwealth Fund shows that despite record high insurance coverage, medical debt is burdening two out of every five Americans, due to large deductibles and other cost sharing requirements.

The survey found that 46% of working-age adults skipped or delayed care because of cost in the last year, and 42% struggled to pay medical bills or were paying off medical debt. The study reports that this is likely to get worse after the public health emergency ends, as it will likely result in about 16 million people losing coverage with many becoming uninsured.

Growing costs in hospital inpatient and outpatient services are a leading cause of Americans’ financial struggles, according to the survey.

Forty-three percent of working-age adults are inadequately insured, including people who are uninsured (9%), had a gap in coverage over the past year (11%), or are underinsured (23%). More than one-quarter (29%) of continuously insured people with employer coverage and 44% of those with coverage purchased in the individual market or marketplaces are underinsured because of high out-of-pocket costs and deductibles, relative to their income.

According to the survey, high out-of-pocket maximums are leaving people with considerable cost exposure. Almost half (49%) of people surveyed said they would be unable to pay for an unexpected $1,000 medical bill within 30 days, including 68% of adults with low income, 69% of Black adults, and 63% of Latinx/Hispanic adults. Up to one-quarter of people with chronic health problems like diabetes said that out-of-pocket costs for prescription drugs had caused them to skip doses or not fill a prescription at all.

People who were uninsured for a year or longer were disproportionately young, Latinx/Hispanic, poor, sicker, and living in the South.

When asked to name their health policy priorities, lower health care costs were top of the list. Sixty-eight percent of Democrats, 55% of independents, and 46% of Republicans said President Biden and Congress should make health care costs a top priority in the coming year.

The study notes that in order to keep Americans covered, Congress could make permanent the enhanced marketplace plan subsidies extended for three years under the Inflation Reduction Act of 2022. The Commonwealth Fund survey shows that premium costs figure heavily in consumers’ decisions to enroll and stay enrolled in marketplace plans.

Congress also could provide a path to coverage for Medicaid-eligible people in states that have yet to expand the program; this could reduce the number of uninsured people in those states by an estimated 1.9 million.

To help protect consumers from medical debt, Congress could ban short-term plans and other coverage that doesn’t comply with the benefit requirements of the Affordable Care Act. It also could rein in deductibles and out-of-pocket costs in marketplace plans. In addition, states could use rate regulation to limit growth in premiums and cost sharing, as Rhode Island has, according to the report.