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Insured Americans Struggle to Afford Health Care

About half of Americans with health insurance find it difficult to pay their medical bills. This causes working adults and their family members to delay care, resulting in worsening health.

The Commonwealth Fund’s survey of 7,873 adults aged 19 to 64 conducted between April 18 and July 31, 2023, reveals that 51% of Americans find it very or somewhat difficult to afford their health care.

While three in four (76%) uninsured Americans say they cannot afford care, about half of those with insurance coverage also struggle: 43% of adults with employer coverage and 57% with marketplace or individual-market plans said it was difficult to afford their health care. So did 45% of people with Medicaid and 51% with Medicare.

Being in poor health exacerbates problems affording care, even for people covered by Medicare. Those under 65 who are eligible for the program have serious disabilities or health conditions that prevent them from working full-time, making them among the poorest and sickest people we surveyed.

Twenty-nine percent of those with employer coverage said they or their family members skipped needed health care or prescription drugs due to high costs in the past 12 months. This was also the case for 37% of respondents with marketplace or individual-market plans, 39% enrolled in Medicaid, and 42% with Medicare.

Large shares of insured adults who delayed or forewent health care because of costs said a health problem of theirs or a family member got worse because of it. Deteriorating health was reported by 54% of Americans with employer coverage, 61% of those in the marketplace or individual-market plans, 60% with Medicaid, and 63% with Medicare.

About 100 million Americans have debt because of medical or dental bills, and insurance coverage does not prevent people from incurring it, the Commonwealth Fund survey found.

One in three (30%) adults with employer coverage reported paying off debt from medical or dental care, as were 33% of those in marketplace or individual-market plans, 21% with Medicaid, and 33% with Medicare.

Half of adults said their debt stemmed from treatment for an ongoing chronic condition rather than unexpected health care events and emergency room visits.

A recent study published in JAMA found that the number of Americans with employer-sponsored insurance who struggle to afford health care has been increasing since 2000, with care becoming less affordable for women than men.

Lower incomes and higher healthcare needs among women could be driving the disparities, the authors noted, emphasizing the necessity for employers to redesign their benefits packages.

The survey shows that health costs are deterring many Americans from getting necessary care, with deleterious effects on their health. While having insurance is much better than going without it, many insured Americans still find health care unaffordable.


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