Americans are struggling with healthcare costs

For the survey, researchers interviewed a nationally representative sample of 7,873 adults ages 19 and older between April 18 and July 31, 2023. In total, the analysis included 6,121 respondents of working age between 19 and 64.

Overall, around half of the respondents said it was either somewhat or very difficult for them to afford their healthcare costs. These costs included insurance premiums, out-of-pocket costs, prescription and over-the-counter medication, home care, and more.

Uninsured respondents (76%) were the most likely to say they had difficulty with healthcare costs, but even those with insurance reported difficulties. Between 45% and 57% of insured respondents said they struggled with healthcare costs depending on what type of insurance they had. Insured individuals with lower incomes also had a more difficult time with healthcare costs. 

Almost 40% of respondents said they had skipped or delayed needed care or prescriptions in the past year due to high costs. Uninsured individuals had the highest rates of skipped or delayed care, but a significant portion of insured individuals also reported similar behavior.

Many people are also carrying medical debt. Among the respondents, around a third reported had either medical or dental debt they were paying off over time. A similar number of respondents (36%) of medical debt also said their debt had led them to skip or delay needed care.

Of the respondents with medical debt, 85% said it was $500 or more, and almost half said their debt was $2,000 or more. Over half of people's medical debt was for hospital care, while 37% was for a doctor's office visit and 35% was for emergency care.

For many people, healthcare costs are now taking up more of their monthly budgets. Almost 60% of respondents said their healthcare costs take up 10% or more of their household budget in an average month. In addition, around 25% of low-income adults with employer plans and adults in marketplace or individual-market plans said that healthcare costs took up over 25% of their monthly budget.

High healthcare costs have also impacted other aspects of people's lives. Around a third of all respondents reported difficulties paying for other living expenses, including household bills and food, due to healthcare costs. 

How to make healthcare more affordable.

As healthcare costs continue to rise, the Commonwealth Fund offered several potential policies that could make healthcare more affordable:

Increase consumer protections for medical debt

Currently, several states have passed legislation that bans aggression collection activities from collection agencies and hospitals. The Biden administration also recently announced new draft regulations that prohibit medical debt information from appearing on consumer credit reports.

Increase the Affordable Care Act's (ACA) minimum employer benefit standards

Currently, the ACA requires employers with 50 or more employees to provide insurance that covers at least 60% of covered healthcare costs on average. Employers who fail to meet that standard have to pay a penalty if an employee becomes eligible for a marketplace subsidy.

To reduce costs, Congress could increase the ACA's minimum standard, as well as broaden its enforcement.

Lower deductibles and out-of-pocket costs in marketplace plans

Extending cost-sharing reduction subsidies to middle-income individuals and changing the benchmark plan in the ACA marketplaces from silver to gold could save households $4.8 billion and reduce the number of uninsured individuals by around 1.5 million.

Expand the scope of Medicaid coverage

Medicaid coverage "varies substantially by state, and utilization limits can leave people unable to meet their needs without incurring out-of-pocket costs," the Commonwealth Fund writes. "States could adopt more optional services and Congress could increase the number of mandatory services."

Limit coverage losses as states redetermine Medicaid eligibility

States are currently redetermining Medicaid eligibility after the end of the COVID-19 public health emergency earlier this year, and health experts have estimated that around 15 million people could lose coverage over the next year.

States will need to ensure that people who are eligible for Medicaid receive alternative coverage and intervene as needed when people lose coverage for procedural reasons. (Goldman, Axios, 10/26; Collins et al., The Commonwealth Fund, 10/26)