Insured and Uninsured Alike Report Difficulty Paying Medical Bills

While the prevalence of problems paying medical bills may be greater in certain groups compared with others, almost anyone can experience difficulty paying medical bills, according to the results of a survey from Kaiser Family Foundation/New York Times. Having health insurance does provide some financial protection against medical bills, but even individuals with insurance can still be vulnerable to medical bills that cannot be paid, according to the report.

Kaiser Family Foundation and New York Times surveyed 1204 adults between the ages of 18 and 64 years who reported that they or someone in their household had problems paying a medical bill in the last 12 months, as well as 1371 adults of the same age who did not report having problems.

Insurance status does have a strong association with a person’s ability to pay for their medical bills: 53% of the uninsured had trouble paying medical bills compared with roughly one-fifth of people with insurance (employer, 19%; Medicaid, 18%; and self-purchased, 22%).

People with lower or moderate income, women, adults younger than 30 years, people with children in the household, and Blacks and Hispanics were all more likely to report experiencing problems paying medical bills.

“Certain groups are more vulnerable, including individuals and families with lower incomes and limited financial assets, people with chronic medical conditions and disabilities, the uninsured, and people insured by plans with high deductibles,” according to the report. “Even so, people are not immune who have higher incomes, who are insured, or who are otherwise in good health and then experience unexpected health problems.”

Two-thirds of those who had trouble paying their medical bills said the bills were a result of a one-time or short-term medical expense, such as a hospital stay or an accident. Nearly an equal percent say they are no longer receiving the treatment that led to their bills and 46% said the illness or injury occurred more than 1 year ago.

Insurance does minimize the impact. People with insurance are less likely to report having bills of $10,000 or more compared with the uninsured (8% vs 21%). Overall, 13% of people reported that they have medical bills adding up to $10,000, while 31% said the total amount they had trouble paying was $5000 or more.

People struggling with medical bills aren’t only feeling the pressure from large bills of thousands of dollars. The survey found that many people are having trouble paying smaller amounts: 24% of the insured and 22% of the uninsured say their medical bills are less than $1000. The difficulty of paying even small bills makes sense considering 61% of people who have had trouble paying their medical bills either just meet their basic expenses and 18% admitted they don’t even meet basic expenses.

Once people are faced with a large medical bill that they are struggling to pay, they often make adjustments to their lives to accommodate the new debt, such as putting off a vacation or a major household purchase (72%), cutting back spending on food, clothing, or basic household items (70%), taking an extra job or working more hours (41%), taking money out of retirement, college, or other long-term savings accounts (26%), or even changing their living situation (17%).

The poll responses show that in some cases, people with insurance who are having trouble paying medical bills are more likely to make sacrifices. Perhaps more importantly is the impact medical bills have on people’s ability to get needed healthcare. Nearly one-third of respondents said they had problems getting other care they needed as a direct result of their trouble to pay medical bills. Regardless of insurance status, people with medical bill problems reported delaying or skipping care over the past year at rates 2 to 3 times those of people who did not have problems paying medical bills.

“As the nation moves beyond the debate over the Affordable Care Act, issues of health care costs and affordability like those highlighted by this survey are likely to play a prominent role in health policy discussions,” the report concluded. “Information about the causes of medical debt and its impacts on people can play an important part in these discussions and help policymakers and others as they work on solutions to alleviate the burden of medical debt on American families.”