Survey Findings Paint Grim Picture of Health Care Affordability in the US

Half of working-aged adults in the United States report it is somewhat or very difficult to afford their health care costs, according to new data published by the Commonwealth Fund, and these financial pressures can lead them to delay or forgo care, resulting in worse downstream health outcomes.¹

The Commonwealth Fund’s first-ever Health Care Affordability Survey was fielded earlier this year (April 18-July 31) to 7873 adults 19 years and older who live in the United States. The aim was to assess health care affordability from 3 angles: whether costs are preventing Americans from accessing care, whether bills for care are leaving them burdened with medical debt, and how these pressures affect their lives. The researchers also conducted analyses among subgroups of the respondents: those who spent some or all of the past year uninsured, those with full-year coverage, and those who had Medicare coverage for the past year. Data were additionally segmented by source of insurance: employer, marketplace/individual, Medicaid, and Medicare.

The main analysis of adults aged 19 to 64 years (n = 6121) found that 51% reported it was somewhat or very difficult for their family to afford health care costs, which encompassed the costs of insurance premiums and out-of-pocket payments, prescription and OTC drugs, home care, long-term care, and care for dental, vision, and hearing. Unsurprisingly, those without insurance (76%) were most likely to say they struggled to afford the costs of care, but researchers noted that even those who had insurance all year still reported difficulty, ranging from 43% in those with employer-sponsored insurance to 57% in those with individual or marketplace plans.

Results also showed that about 2 in 5 respondents acknowledged that they or a family member delayed or avoided health care they needed (including prescription drugs) in the past year because they couldn’t afford it. Again, the proportion was highest among the uninsured (64%), but sizable amounts of those with employer, individual, Medicaid, and Medicare insurance also reported doing so (29%, 37%, 39%, and 42%, respectively). This barrier to care was not without consequences, as 57% of those who said they or a family member delayed or skipped necessary care agreed that their health problem got worse because of it.

The prospect of medical debt could be a significant driver of cost-related care avoidance: Almost one-third of the respondents reported having medical or dental bills they were paying off over time, and of those who did, 78% reported that it caused them anxiety and worry and 39% said they had to cut back on basic needs like food, heat, or rent to pay off this debt.

Another concerning sign was the proportion of respondents who reported they had considered dropping their health insurance due to costs in the past year, at 16% overall and 20% among those with incomes less than 200% of the federal poverty level.

In the analysis of Medicare beneficiaries only (n = 1978), 33% reported difficulty affording their health care costs, with respondents aged 19 to 64 years more likely to say so than those 65 years and older (51% vs 29%).² About half of all Medicare beneficiaries said that the costs of goods and services other than health care affected their ability to afford care, and about 1 in 4 said that health care costs made it harder for them to afford food and utility bills.

According to the report authors, these findings reinforce that health care affordability is not just a problem for the uninsured. They also point to several policy suggestions that could help alleviate this financial burden, including enhanced protections against medical debt, income-based adjustments to health benefits, and permanent extension of the enhanced marketplace premium subsidies.

“While having health insurance is always better than being uninsured, even people who have health insurance frequently cannot afford care,” lead author Sara Collins, PhD, senior scholar and vice president for health care coverage and access and tracking health system performance at the Commonwealth Fund, said in a statement.³ “We need policies that expand coverage and tackle the root causes of health care cost growth, particularly rising prices for health care services and prescription drugs.”

References

1. Collins SR, Roy S, Masitha R. Paying for it: how health care costs and medical debt are making Americans sicker and poorer. The Commonwealth Fund. October 26, 2023. Accessed October 26, 2023. https://www.commonwealthfund.org/publications/surveys/2023/oct/paying-for-it-costs-debt-americans-sicker-poorer-2023-affordability-survey

2. Jacobson G, Leonard F, Collins SR. Can Medicare beneficiaries afford their health care? The Commonwealth Fund. October 26, 2023. Accessed October 26, 2023. https://www.commonwealthfund.org/publications/2023/oct/can-medicare-beneficiaries-afford-their-health-care-2023-survey

3. New research: half of working-age Americans struggle to afford health care; nearly one-third saddled with medical debt. News release. The Commonwealth Fund. October 26, 2023. Accessed October 26, 2023. https://www.commonwealthfund.org/sites/default/files/2023-10/Collins_2023_AffordabilitySurveyTopline_PR_10-26-2023_v2.pdf