Medical debt.
Despite progress made to ensure Americans have access to health insurance through the Affordable Care Act, a coverage gap remains, and health plans do not always guarantee affordable or timely access to care.
This is according to the Commonwealth Fund’s 2024 Biennial Health Insurance Survey, which found 1 in 5 respondents have been uninsured at some point during the past year and nearly a quarter have been underinsured, or enrolled in plans with high out-of-pocket costs that make it difficult to afford care. Among the underinsured, two-thirds had coverage through an employer, 14% had individual or marketplace plans, and 11% were enrolled in Medicaid.
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More than half of respondents said they have skipped recommended care because of costs, according to the survey. Up to one-third of respondents with a chronic condition such as heart failure or diabetes, said they didn’t fill prescriptions due to cost.
In addition, 44% said they have medical debt that causes them to delay necessary care. Nearly half of adults with medical debt owe $2,000 or more and 21% have debt of $5,000 or more. Hospital care was the most frequently cited source of debt.
Forty-one percent of adults who skipped or delayed needed care because of cost said their health problem has worsened as a result.
Federal and state policy action could help, said Commonwealth Fund. Policymakers should consider expanding Medicaid, addressing fragmented coverage and targeting high health care costs, said the firm. Policy options that could bring better coverage to more people include permanently extending enhanced marketplace premium tax credits introduced during the COVID pandemic that are set to expire in 2025. Without these credits, annual premium costs for consumers in marketplace plans will spike by an average of $705, and an estimated 4 million could lose coverage, said Commonwealth Fund.
In addition, removing medical debt from credit reports, lowering deductibles and out-of-pocket costs in marketplace plans, and establishing a federal fallback option, could help close coverage gaps and ensure people can access care.
“As a primary care physician, I routinely see patients facing unexpected costs that prevent them from getting essential care to stay well and avoid illness,” said Commonwealth Fund President Joseph R. Betancourt, M.D. “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. 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 strong health care system.”
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