High Healthcare Costs Bar Care Access Despite Insurance Status

Having health insurance coverage isn’t enough to attenuate high healthcare costs and their impacts on patient access to care, according to a new Commonwealth Fund report.

Anywhere from 43 to 57 percent of the 6,121 respondents to the Commonwealth Fund Health Care Affordability Survey said it was challenging to afford their medical care this year. That shakes out to 43 percent of people with employer-sponsored healthcare, 57 percent with marketplace or individual-market plans, 45 percent with Medicaid, and 51 percent with Medicare.

Despite the slight variation based on insurance type, the researchers said it’s notable that sizeable portions of people—even those with employer-sponsored health plans—find healthcare costs untenable. Of course, the uninsured were the most likely to say they had trouble with healthcare costs (76 percent), but the Commonwealth Fund indicated that these figures are surprisingly high for those with insurance.

“While having health insurance is always better than not having it, the survey findings challenge the implicit assumption that health insurance in the United States buys affordable access to care,” the researchers wrote in the report. “Difficulties affording care are experienced by people in employer, marketplace, and individual-market plans as well as people enrolled in Medicaid and Medicare.”

Medical debt, too, was common among all respondents, with 32 percent saying they have some kind of medical or dental debt. Uninsured people were the most likely to say they have medical debt (41 percent), but those with different types of insurance were not far behind.

Among those with employer health plans, 30 percent reported medical debt. That figure was 33 percent for those with marketplace health plans, 21 percent for Medicaid, and 33 percent for Medicare, the survey showed.

Most people have medical or dental debt that adds up to between $500 and $2,000, but for some people, debt balloons upwards of $5,000 (22 percent of respondents). The most common source of medical debt is hospital care, followed by doctor’s office visits, emergency departments, dental care, and disease management, either for a new or ongoing health condition.

And these high healthcare costs come with consequences, the survey furthered.

In total, 38 percent of survey respondents said they delayed or skipped treatment or prescriptions that they needed because they couldn’t afford it. This was most common among those without insurance coverage (64 percent) but not exactly uncommon among those with insurance (29 percent for employer-sponsored coverage, 37 percent for marketplace plans, 39 percent for Medicaid, and 42 percent for Medicare).

There were also income-based differences at play. Low-income people with employer-sponsored health insurance, for example, were apt to skip care due to costs.

As a result of cost barriers and delayed healthcare, health status and well-being got worse over time. More than half (57 percent) of patients who skipped care due to cost said their health problem got worse as a result, with 54 percent of those with employer health plans, 61 percent of those with marketplace plans, 60 percent of Medicaid enrollees, and 63 percent of Medicare enrollees saying as much.

The high cost of healthcare affects more than just healthcare access, the data added. More than three-quarters of respondents said their medical debt causes them anxiety or worry, while others are facing consequences like cutting back on food or certain utilities (39 percent), using up part or all of their savings (37 percent), or receiving a lower credit rating (36 percent).

About a third of all patients are working on paying off these debts, with this being more common among uninsured and low-income people with employer-sponsored coverage. Two-thirds make their payments directly to their providers, while others pay a collection agency or financial institution.

These findings indicate many paths forward to ensuring healthcare affordability and access, the researchers said. Policy changes to protect consumers from being financially ruined by medical debt and to stem healthcare cost growth would be effective in helping patients with all insurance types, the team recommended.