Having health insurance doesn’t necessarily equal access to affordable healthcare.
That’s the takeaway from a new survey from the Commonwealth Fund that found people with insurance are almost as pressured by medical costs as uninsured individuals.
A significant number of working-age adults across multiple insurance types said it was difficult to afford care, including 43% of people covered by employers, 57% with Affordable Care Act marketplace plans, 45% with safety-net Medicaid coverage and 51% of adults on Medicare due to a disability or chronic condition.
That’s compared to 76% of uninsured individuals, a figure that — while concerning — is not surprising, according to Sara Collins, vice president for healthcare coverage at the Commonwealth Fund. Numerous studies have shown uninsured individuals have worse access to care than people with insurance.
“What is more surprising is the large share of adults across all coverage types that reported difficulty with costs,” Collins said during a media briefing on Wednesday.
The survey of almost 8,000 U.S. adults is the latest to illustrate the healthcare affordability crisis in the U.S., a crisis that is worsening as inflation spurs providers to charge higher prices for care, resulting in higher premiums for the majority of Americans covered in employer-sponsored plans.
Annual family premiums for employer-sponsored health insurance this year reached nearly $24,000, the biggest increase in over a decade, according to KFF.
Shrinking federal investment in health insurance programs coming out of the pandemic is also a concern for healthcare affordability moving forward. More generous subsidies in the ACA exchanges during the COVID-19 pandemic along with continuous Medicaid eligibility caused the U.S. uninsured rate to fall to a record low earlier this year.
However, ongoing Medicaid eligibility checks and eventual termination of the marketplace subsidies threaten to reverse that progress.
Having health insurance is better than not having it, Collins noted, but for many Americans, inadequate coverage results in delayed medical care, significant medical debt and worse downstream health. The survey — the Commonwealth Fund’s first to highlight healthcare affordability — shows how those problems affect not just uninsured individuals, but the roughly 90% of Americans with insurance as well.
Many insured adults said they or a member of their family was forced to skip medical care or couldn’t buy a prescription drug due to cost in the past year, according to the survey.
Nearly two-fifths of working-age adults are putting off or foregoing care due to cost
A majority of people who delayed care said the decision made them sicker down the line, regardless of insurance coverage.
High medical costs also threaten Americans’ financial health. Another byproduct of high healthcare costs is medical debt, which is a leading cause of bankruptcy in the U.S.
Rates of medical debt were largely stable across insurance types — ranging from 21% to 33%. That’s compared to 41% of uninsured individuals currently paying off medical debt, the Commonwealth Fund found.
More than a third of people said medical debt caused them to delay needed healthcare, dip into their savings, cut back on necessities like food or rent and receive a lower credit rating, also regardless of insurance.
“Insurance did not appear to protect people from the budget squeeze,” Collins said.
The findings reiterate the need for action to make healthcare more affordable, including lessening the burden of medical debt on Americans, according to the Commonwealth Fund.
The Biden administration in September said it planned to pass federal rules to stop unpaid medical bills from appearing on consumers’ credit scores. Those regulations, if enacted, could improve the financial health of the roughly 100 million Americans with medical debt, but are not a silver bullet, according to Collins.
“We really do need to see some federal changes to improve the protections people have from medical debt,” Collins said. Not allowing medical debt to appear on consumer credit reports “would go a long way, but doesn’t resolve the medical debt issue itself.”