Problems Americans Have with the Cost of Health Care

As lawmakers talk about the future of the country's health care system and their plans to replace and repeal the Affordable Care Act, a big part of the discussion is how to change or get rid of the health insurance marketplaces that were set up by the ACA so that people who could get financial help could compare plans and buy insurance. Some people see this as an important source of coverage, but the vast majority of Americans with insurance get it from somewhere else, like their employer, Medicaid, or Medicare. Lowering the cost of health care for Americans is what the public wants lawmakers to focus on. Two new Kaiser Health Tracking Polls look at what people think about health care costs, including their ability to pay for premiums and deductibles, and how they feel about them right now. Most people don't have a problem paying for care, but there are large groups that do, and even more are worried about how they will be able to pay for care in the future. Here are some of the most important results: • About a third of adults with health insurance say they have trouble paying their premiums and other cost sharing, and 43% of those adults say they have trouble paying their deductible. All of these percentages have gone up since 2015. • Two-tenths of Americans (29%) say they have trouble paying their medical bills. For some, these issues have real effects. For instance, 73% of people who are having trouble paying their medical bills say they are spending less on food, clothes, and basic household items. • Some Americans say they have put off or skipped care because of costs in the past year, including 27% who say they put off or postponed getting the health care they needed, 23% who say they skipped a recommended medical test or treatment, and 21% who say they have not filled a prescription for a medicine. • Even for people who may not have had trouble paying medical bills or affording care, there is still a problem. • Uninsured people, people with low incomes, and people who aren't in good health are more likely than their peers to worry about health care and have trouble paying for it. Women and people of racial minority groups are also more likely than their peers to report these problems. Lawmakers Care Most About The Public's Health Care Costs A Kaiser Health Tracking Poll done in December found that Democrats, independents, and Republicans have different ideas about what lawmakers should do about the Affordable Care Act, or Obamacare. On the other hand, Americans are less divided on their concerns about the rising cost of health care for individuals. Most Americans, no matter what party they belong to, think that lowering the cost of health care for individuals should be a "top priority" for President Trump and Congress. They also put it at the top of their list of health care priorities. Also, more than half of Americans agree that the price of prescription drugs should go down. This includes two-thirds of Democrats (67%) and about six in ten independents (61%) and Republicans (55%). Figure 1: Majority of Americans, Regardless of Party, Say Limiting Amount Individuals Pay for Health Care Should Be Top Priority Not Able To Pay For Medical Care A lot of people think that lawmakers should make lowering the costs of health care and prescription drugs a top priority. However, a lot of people who have health insurance say it's hard for them to pay their premiums, deductibles, and other cost-sharing costs like copays for doctor visits and prescription drugs. About six out of ten adults with health insurance say it is easy for them to pay their premiums and cost-sharing costs. The other third say it is hard for them to pay those costs. Fifteen percent of people say it is easy to pay their deductibles, while forty-three percent say it is hard. Shares of people who say they have trouble paying for these kinds of medical costs have gone up since 2015: from 27% to 37% for premiums, from 34% to 43% for deductibles, and from 24% to 31% for copays for doctor visits and prescription drugs. Premiums, deductibles, and other types of cost sharing are going up in the market for employer-sponsored insurance, which is in line with these trends. Figure 2: More Insured Americans Now Report Difficulty Affording Health Care Failures To Pay Medical Bills And What Happens After That A little over a third of U.S. adults (29%) say they or a family member had trouble paying medical bills in the last year. Most of those who had trouble (58%) say the bills had a big effect on their family, which is 17% of all Americans. For the past ten years, the percentage of people who say their family has had trouble paying medical bills has stayed between 25 and 30 percent. Figure 3: Most of Those Who Struggled to Pay Medical Bills Report Major Impacts on Their Family People who have had trouble paying their medical bills in the past year say they have dealt with those problems in a variety of ways. For example, 73% of people who are having trouble paying their medical bills say they have cut back on spending on food, clothing, or basic household items or put off vacations or big household purchases. Also, 61% of those people say they have used up all or most of their savings, taken on extra work, or worked more hours to pay the bills. A lot of people who are having trouble paying their medical bills are also adding to their credit card debt (37%), taking money out of retirement or other long-term savings accounts (31%), and a quarter of those people say they have even moved to pay the bills. Figure 4: Those with Problems Paying Medical Bills Report Engaging in a Variety of Actions to Pay off Bills Large Shares Say They Have Deferred Care Because Of The Cost Some Americans say they or a family member put off or skipped some kind of health care in the last year because of the cost. This is because they were worried about how much it would cost. Most often, these people don't go to the dentist (32%), rely on home remedies or over-thecounter drugs instead of seeing a doctor (29%), and put off or delay getting the health care they needed (27%). About one in five also say they have skipped a medical test or treatment because it was too expensive (23%), or they have not filled a prescription for medicine (21%). Only about 18% of people say they have skipped doses or cut pills in half, and 12 % say they had trouble getting mental health care because of the cost. Figure 5: Some Americans Report Putting Off or Postponing Care Due to Costs A Lot Of People In The U.S. Worry About High Health Care Prices Kaiser polls have also asked Americans how worried they are about a range of economic and health-related issues. The results show that Americans are least worried about their income not keeping up with prices and most worried about their health care. A third of Americans are "very worried" that their income isn't keeping up with prices. This is closely followed by a quarter who are "very worried" that they won't be able to afford the medical care they think they need (25%), will lose their health insurance (22%), or won't be able to afford their prescription drugs (21%). About half of them are somewhat or seriously concerned that they won't be able to pay for the medical care they need. Figure 6: Cost Concerns, Including Health Care Costs, Top List of Worries Having Trouble Paying A $500 Medical Bill That Wasn't Expected People can't always afford medical bills that come up out of the blue, and 46% of Americans say they would have a hard time paying a $500 medical bill that came up out of the blue. One fifth (19%) say they wouldn't be able to pay the bill at all, and another 7% say they would have to borrow money from a bank, a payday lender, or family or friends to do so. Twenty percent say they would put the bill on a credit card and pay it off over time. About half of Americans (47%) say they could pay the $500 bill right away. About a third of people who don't have health insurance and 35% of people who make less than $500 a month say they wouldn't be able to pay it at all. Also, 40% of people who say their health is fair or poor say they wouldn't be able to pay a $500 bill that came up out of the blue. Figure 7: Uninsured and Lower-Income Individuals More Likely to Say They Would Struggle to Pay an Unexpected Medical Bill Troubles And Troubles Over Time Even though the national economy is better and the Affordable Care Act (ACA) has been put into place, there hasn't been much change in the percentage of people who say they have trouble paying their medical bills, put off care because of cost, or worry about being able to afford care. This may be because premiums and deductibles keep going up. There Is A Lot Of Difference Between Demographic Groups In The Problems And Worries People Report Not surprisingly, people with less money, no health insurance, or worse health are more likely to say they have trouble paying for health care and that the problem bothers them. For example, people who are in fair or poor health (52%), don't have health insurance (41%), and make less money (42%), are more likely to say they have trouble paying their medical bills. Also, about half of people who are fair to poor health say they are "very" worried about being able to pay for the medical care they need. Figure 8: Uninsured, Lower-Income Individuals, and Those in Poorer Health Are More Likely to Report Issues with Health Care Costs Although having health insurance can help protect you from high health care costs in the long run, people with less money or who are not in great health are more likely to say they have trouble paying for things like premiums, deductibles, and other cost sharing. About 60% of people with a household income of $40,000 or less say it is hard for them to pay their deductibles, 53% say it is hard for them to pay their premiums, and 46% say it is hard for them to pay other cost sharing. These percentages are much higher than those of people with higher incomes.