Having affordable health insurance doesn’t always protect you from medical bills, as many consumers are shocked to learn. A new survey by the Commonwealth Fund reveals persistent coverage gaps and challenges in accessing affordable and timely healthcare, even for those with insurance.
The Commonwealth Fund's Biennial Health Insurance Survey assessed the experiences of adults aged 18 to 64 regarding their health insurance coverage. The findings indicate that approximately 20% of respondents experienced a lapse in insurance coverage during the year.
At the same time, nearly 23% of those with insurance were underinsured, meaning their plans involved high out-of-pocket costs that hindered their ability to afford necessary care.
A significant portion of the underinsured, about 66%, were covered through employer-based health plans. The survey also found that 14% had individual or marketplace plans, while 11% were enrolled in Medicaid.
The financial strain of high medical costs led over half of the underinsured to go without recommended treatments or prescriptions. Alarmingly, up to one-third of individuals with chronic conditions like heart failure and diabetes reported not filling prescriptions due to cost concerns.
The survey highlights the financial burden of medical debt, with over one-third of working-age adults who were uninsured or underinsured currently repaying medical or dental debt. Nearly half of these individuals owe $2,000 or more, and 21% carry debts exceeding $5,000. Hospital care was frequently cited as the primary source of this debt.
The repercussions of delaying or skipping care due to cost are severe, with 41% of those who postponed necessary care reporting worsened health conditions. This issue is particularly acute among individuals with lower incomes and those in poor health.
Recommendations
The report’s authors make several recommendations. They said expanding Medicaid eligibility in the ten states that have yet to do so could provide coverage to 1.5 million uninsured individuals. Addressing the fragmented nature of the U.S. health insurance system, which includes various sources such as employers, Medicaid, Medicare, and ACA marketplaces, is crucial to closing coverage gaps.
To alleviate the financial burden on consumers, the report recommends permanently extending enhanced marketplace premium tax credits, set to expire in 2025. Without these credits, the authors say annual premium costs could increase by an average of $705, potentially leaving 4 million people without coverage.
Additional policy options include removing medical debt from credit reports, enforcing stricter hospital billing practices, and adjusting premiums and cost-sharing based on income to make employer plans more affordable for lower-wage workers.