Fewer people with health insurance report having problems paying medical debt, a new Kaiser Family Foundation/New York Times survey finds. While 53 percent among the uninsured face problems paying medical bills, 20 percent who have insurance—both traditional employer-sponsored plans and individual insurance—report having trouble paying medical bills.
People with insurance who face problem medical bills also report a wide range of consequences and sacrifices during the past year as a result, including delaying vacations or major household purchases (77%), spending less on food, clothing and basic household items (75%), using up most or all their savings (63%), taking an extra job or working more hours (42%), increasing their credit card debt (38%), borrowing money from family or friends (37%), changing their living situation (14%), and seeking the aid of a charity (11%). These shares generally are as large as or larger than the shares among uninsured people with problem medical bills.
Overall, 62 percent of those who had medical bill problems say the bills were incurred by someone who had health coverage at the time (most often through an employer). Of those who were insured when the bills were incurred, three-quarters (75%) say that the amount they had to pay for their insurance copays, deductibles, or coinsurance was more than they could afford.
People with health insurance who have problems with medical bills also report skipping or putting off other health care in the past year because of the cost, such as postponing dental care (62%), skipping doctor-recommended tests or treatments (43%), or not filling a prescription (41%). In general, people with medical bill problems are two to three times as likely to report each of these problems as those without problems paying medical bills.
This highlights one of the key problems with the prevailing approach health economists and policymakers have taken to reduce the nation's spending on health care—trying to force people to use less of it by making it expensive. That's the rationale behind one of the most controversial—and now delayed—provisions of Obamacare, the so-called "Cadillac" tax. Take these generous plans, with low deductibles and co-pays away, and people will go to the doctor less.
Which is great for people who are in good health. But not every health problem is minor enough that skipping a visit to the doctor is possible. It doesn't have to be a catastrophic illness or injury—as this study demonstrates—to land a person in a bad financial situation because of medical bills. Something like a slip and fall resulting in a broken bone, or a hospital stay account for 66 percent of the insured people who are facing bills they can't pay. The other 33 percent have chronic conditions to manage.
That there are fewer uninsured is a great thing, and Obamacare took us a big step forward toward getting more people better access to health care. But the goal of ending medical bankruptcies hasn't been achieved by it. The combination of stagnated wages with greater cost-sharing (the euphemism for higher patient spending) means that problem isn't going away. Not until we get to the next round of healthcare reform, which will need to make health care affordable to everybody.