Healthcare affordability in the United States is at a crisis point. The latest findings from the Commonwealth Fund's 2023 Health Care Affordability Survey paint a bleak picture, highlighting the immense financial strain health costs place on Americans. Over half of those surveyed—more than 6,000 adults under 65—reported struggling to cover these expenses. This struggle transcends the uninsured; even those with coverage face significant financial hurdles.
The survey notably points out that 76% of uninsured respondents find it difficult to afford healthcare costs. Yet, insured Americans aren't faring much better. Among those with job-based insurance, 43% report difficulty, and the figure climbs to 57% for people on individual health insurance plans. The issue persists across different types of coverage, with those on Medicaid and Medicare also facing steep financial challenges.
"While the survey findings show that it's much better to have insurance than to go without, they also indicate that insurance frequently fails to provide affordable access to care for large segments of the U.S. population," stated Sara R. Collins, senior scholar at the Commonwealth Fund. Her remarks underscore a reality that many Americans live daily: having insurance isn’t synonymous with affordable healthcare.
One of the more troubling revelations from the survey is the extent to which Americans are delaying or skipping necessary medical care due to costs. A striking 36% of respondents admitted to putting off or forgoing essential healthcare services, including prescription medications, due to financial constraints. The result? Worsening health outcomes for many. A majority—57%—of those who avoided care due to cost reported their health deteriorated as a result. This troubling trend holds across all insurance types.
Dr. Joseph Betancourt, president of The Commonwealth Fund, emphasized the dire implications of the findings. "Almost every day, I see the challenges that patients face in regards to healthcare affordability," he said. The gravity of these challenges ranges from confusion and frustration to serious threats to health and well-being.
The survey also shed light on the broader financial impact of healthcare costs. Over half the respondents reported that healthcare expenses eat up 10% or more of their monthly household budget. This strain is so severe that 17% said healthcare costs account for a quarter or more of their budget, making it hard to afford basics like food, utilities, and housing. Inflation has only compounded these challenges, with 65% of respondents indicating that rising prices in other areas have affected their ability to pay for healthcare.
Even those with supposedly secure financial footing aren't spared. Lower-income workers with job-based insurance are, predictably, more likely to report difficulties, but even 30% of employees earning above 400% of the federal poverty level—around $58,000 per year—face similar struggles.
Medical debt is a pervasive issue. One-third of survey participants are currently paying off medical or dental bills over time. The burden is heaviest on the uninsured but remains significant even for those on Medicaid, which is designed to shield low-income individuals from such expenses. Interestingly, the survey suggests that traditional measures of medical debt might underestimate its true extent. While a substantial portion of debt ends up in collections, many Americans are directly paying their healthcare providers, which often doesn’t get reported on credit scores.
The primary drivers of medical debt are not surprising. Hospital care tops the list, with 54% of those in debt citing it as the main contributor. Close behind are office visits (37%) and emergency room care (35%). Dental bills also play a significant role, contributing to debt for 30% of respondents. Chronic conditions and routine medical expenses are nearly as culpable as emergencies in driving this debt.
Debt’s ramifications stretch beyond financial stress. An overwhelming number of respondents noted that medical debt induces anxiety and worry. More disturbingly, it forces people to make significant sacrifices. Nearly 40% of respondents reported cutting back on necessities like food, heating, or rent to pay medical bills. Others dip into savings or take on additional work to stay afloat.
Policy recommendations from the survey call for structural changes to better support Americans. Suggestions include automatically enrolling low-income individuals into Medicaid and extending Marketplace plan subsidies. While such measures could ease the burden in the long run, they don’t provide immediate relief for those currently grappling with healthcare costs.
The Biden administration's proposed federal regulations to prevent unpaid medical debt from affecting consumer credit reports is a move in the right direction. Nonetheless, more immediate, comprehensive measures are required.
The current state of healthcare in the U.S. forces a harsh reality upon its citizens—many are caught between neglecting their health and incurring insurmountable debt. This dichotomy is evident in the testimony of countless Americans, including those who seek care from Dr. Betancourt. As he poignantly puts it, "These affordability challenges are real. They're getting worse, and they're a clear and present danger to people's health and well-being." Addressing these challenges demands urgent action, lest the health of the nation continues to spiral downward, weighed down by the crushing burden of unpayable medical bills.
