THURSDAY, Nov. 21, 2024 (HealthDay News) — Health care expenses in the United States rank among the highest globally, and a staggering 1 in 4 adults who have health coverage are struggling with substantial out-of-pocket expenses, according to a comprehensive new survey.
The in-depth survey, conducted by the Commonwealth Fund, a prominent health-care think tank, reveals that while a majority of individuals rely on employer-sponsored insurance, many of these policies fall short in providing timely or affordable access to essential medical services.
This lack of accessible care translates to numerous Americans unable to fill vital prescriptions and neglecting ongoing medical treatments, contributing to the worsening of health conditions that ultimately require more intensive and costly interventions.
“Millions of families across the U.S. can’t afford the care they need, including many who are managing chronic conditions like diabetes and heart disease,” emphasized Dr. Joseph Betancourt, a primary care physician and president of the Commonwealth Fund.
“I routinely see patients facing unexpected costs that prevent them from getting essential care to stay well and avoid illness,” he remarked in a release from the Commonwealth Fund. “At the end of the day, these financial barriers ripple through our health care system, driving up costs — with preventable hospitalizations being just one of many costly consequences.”
The Commonwealth Fund surveyed a representative sample of adults aged 18 to 64 years from March to June, diving into their health insurance experiences.
The survey indicated that approximately 20% faced periods of lacking insurance over the past year, while 23% of insured respondents were enrolled in plans with prohibitive out-of-pocket expenses that made accessing care financially burdensome.
In total, over half of the respondents (57%) reported that financial constraints prompted them to forgo necessary medical care, and nearly half of them (44%) were grappling with medical debt.
Alarmingly, about one-third of individuals with chronic conditions, including diabetes and heart failure, reported that they could not afford to fill essential prescriptions.
“The Affordable Care Act has covered 23 million people and cut the uninsured rate in half,” shared study lead author Sara Collins, a senior scholar at the Commonwealth Fund. “But high costs are a serious problem for many Americans, regardless of the kind of insurance they have.”
The findings revealed that 66% of underinsured individuals possessed employer-sponsored health insurance; 14% were enrolled in individual plans or those obtained through the healthcare marketplace; and 11% relied on Medicaid, a government program designed to assist low-income individuals and those with disabilities.
Even when insured, costs can escalate quickly.
More than one-third of respondents aged 19 or older, who were uninsured or underinsured, reported being in the process of repaying medical or dental debt, with nearly half of these individuals owing $2,000 or more; 21% reported debts of $5,000 or greater.
Approximately half of adults carrying medical debt incurred it while receiving treatment for ongoing health conditions.
Two in 5 adults who postponed or avoided care due to costs indicated that their health deteriorated as a direct consequence of their financial hardships. The impact was notably harsher for lower-income respondents.
“Ensuring that all Americans have access to affordable, comprehensive coverage is critical not only to people’s health and economic security but also for a resilient health care system,” Betancourt stressed.
The study highlighted that 10 states have not expanded Medicaid eligibility under the Affordable Care Act, leaving around 1.5 million individuals uninsured. In addition to advocating for a federal fallback option to extend coverage to these individuals, the report proposed several strategies to enhance healthcare accessibility.
Recommendations include permanently extending tax credits for purchasing insurance on the health care marketplace, which were initially enacted during the pandemic but are set to expire next year. Without these credits, annual premium costs on the marketplace are projected to surge by an average of $705, potentially affecting 4 million individuals at risk of losing coverage.
Other policy recommendations proposed included:
Implementing rigorous requirements on hospitals to prevent patients from accumulating overwhelming medical debt and removing medical debt from credit reports; reducing deductibles and out-of-pocket costs in marketplace plans; ensuring employer-provided coverage becomes more affordable and comprehensive for low-wage workers; allowing states to maintain 12 months of continuous Medicaid eligibility for adults as has been established for children to avert coverage lapses.
“Congress, employers, insurers, and health care providers all play a role in lowering costs and making care more affordable so families can avoid debt and get the care they need to stay healthy,” Collins concluded.
The survey, which utilized both phone and online methods, encompassed 8,201 adults aged 19 or older.
More information
For further details regarding Americans’ healthcare costs, visit the U.S. Centers for Medicare & Medicaid Services.
SOURCE: Commonwealth Fund, news release, Nov. 21, 2024
How do financial barriers, such as high out-of-pocket costs and medical debt, impact health outcomes for Americans with chronic conditions?
**Interview with Dr. Joseph Betancourt on Recent Findings about U.S. Health Care Expenses**
**Interviewer:** Thank you for joining us today, Dr. Joseph Betancourt, President of the Commonwealth Fund. Your organization recently published a survey that highlights some alarming statistics about health care costs in the U.S. Can you summarize the key findings?
**Dr. Betancourt:** Thank you for having me. Our survey revealed that healthcare expenses in the United States are among the highest in the world, and shockingly, about 1 in 4 adults with health coverage are struggling with significant out-of-pocket costs. This financial burden many face often prevents them from accessing timely and necessary medical services.
**Interviewer:** That’s concerning. What do you believe are the primary reasons behind these high costs and the struggles people are experiencing?
**Dr. Betancourt:** Several factors contribute to this issue. First, many individuals rely on employer-sponsored insurance, which can sometimes provide inadequate coverage, especially when it comes to high deductibles or co-pays. Additionally, we see that nearly 20% of respondents experienced periods without insurance over the past year. The result is that many forgo necessary treatments or medications — for instance, about one-third of people with chronic health conditions reported being unable to afford essential prescriptions.
**Interviewer:** The implications sound serious, especially for those with chronic conditions. Can you elaborate on how these financial barriers affect health outcomes?
**Dr. Betancourt:** Certainly. Financial constraints lead to delayed care, which often deteriorates health. Our survey found that nearly 40% of adults who avoided necessary healthcare reported that doing so had a direct negative impact on their health. This not only exacerbates individual health problems but ultimately drives up overall healthcare costs due to preventable hospitalizations and more complex medical needs.
**Interviewer:** The survey also mentioned medical debt. What did your findings reveal about this issue?
**Dr. Betancourt:** Many Americans are falling into medical debt despite being insured. In fact, around 44% of respondents reported struggling with medical debt, with a significant number owing thousands of dollars. This is especially concerning because half of those who incurred this debt did so while receiving treatment for ongoing conditions, indicating that even with insurance, many still face overwhelming financial barriers.
**Interviewer:** Given these findings, what do you believe are the next steps necessary for improving access to affordable health care in the U.S.?
**Dr. Betancourt:** It’s crucial that we advocate for comprehensive healthcare reform to ensure that all Americans can access affordable coverage. We also need to expand Medicaid in the states that have yet to do so and consider policies that address the high costs associated with healthcare. Ultimately, having a resilient health care system that prioritizes people’s health and economic security is fundamental.
**Interviewer:** Thank you, Dr. Betancourt, for sharing your insights today. Your work at the Commonwealth Fund is vital in addressing these pressing health care issues.
**Dr. Betancourt:** Thank you for having me. It’s important that we continue to raise awareness about these challenges and work towards solutions that benefit all Americans.