The Kaiser Family Foundation (KFF) has published a new survey on the impact of health care debt in America.
By Al Norman
Politicians like to talk about how many Americans have health insurance. But what we don’t discuss is how many Americans — with and without health coverage — still go into serious health care debt.
The Kaiser Family Foundation (KFF) has published a new survey on the impact of health care debt in America. They define this debt broadly as “any money owed due to medical or dental bills for their own — or someone else’s — medical or dental care, including any bills owed to a provider, a bank, collection agency, a credit card or any debt owed to a family member or friend.”
One in 10 adults in America have medical debt of over $250, and we collectively owe at least $195 billion in medical debt. The new KFF poll found that 57 percent of adults surveyed have experienced medical debt within the past 5 years. Medical debt is a problem facing not just the uninsured. Over four in ten adults with health insurance also report current medical debt.
To pay off these medical debts, consumers take on more debt — in the form of bank loans, credit card debt, or borrowing from friends. Women, Black and Hispanic adults, parents, and low-income consumers areespecially likely to incur debt. “Adults with lower levels of education and income were more likely than those with higher education and higher income to say they have current health care debt due to medical or dental bills,” the KFF reports.
Nearly half of women (48 percent) report they have debt due to medical or dental bills, compared to about a third of men (34 percent). At least half of Black (56 percent) and Hispanic (50 percent) adults say they have debt due to medical or dental bills, compared to fewer White adults (37 percent).
More than half (52 percent) of people between the ages of 30 and 49 say they have current debt, and more than 1 in 5 elders age 65 and over (22 percent) said they currently owe money due to medical or dental bills. Medicare is touted as insurance that covers most seniors, but the Medicare benefit package still has major gaps, such as lack of dental care, “that can leave beneficiaries with substantial out-of-pocket costs,” according to KFF.
Half of adults with debt (49 percent) say dental bills caused some of their debt. Dental insurance typically has annual limits on coverage. 60 percent of the people who say dental bills are part of their debt — actually had dental insurance at the time. “One of the most common types of bills leading to debt for older adults is dental care, likely because traditional Medicare does not provide dental coverage (though some beneficiaries in private Medicare Advantage plans do have dental coverage, with the scope varying widely). By contrast, older adults are less likely than their younger counterparts to say their health care debt resulted from lab fees, doctor visits, or emergency care,” KFF says.
Not surprisingly, nearly half of adults (47 percent) in the twelve states that have not expanded their Medicaid program under the Affordable Care Act, say they have current debt, compared to 39 percent in states that have expanded Medicaid.
Unexpected bills are a major cause of debt. Seven in ten adults with health care debt (72 percent) say a one-time or short-term medical expense, such as a single hospital visit or treatment for an accident, threw them into medical debt. Lab and diagnostic tests, and doctor’s visits, are common sources of health care debt. Half of adults (50 percent) with debt say bills from emergency care caused their debt: those one-time acute medical events which can cause pile up health care bills.
About half of those surveyed admit that they would be unable to pay even a $500 unexpected medical bill without borrowing money. About 1 in 3 consumers owe less than $1,000 — yet almost 1 in 5 people with health care debt believe they will never be able to pay off the amount they owe. Low-income consumers, and people of color, were more likely to experience pressure from collection agencies, have been denied further health care, and have had difficulty buying a car or renting a home.
Six in 10 adults (63 percent) with health care debt say they cut back spending on food, clothing, and basic household items. Nearly half (48 percent) used up all, or most of, their savings. 40 percent took on an extra job or worked more hours, and 37 percent skipped or delayed paying other bills to pay off health care debt. 1 out of 7 consumers with health care debt say a health care provider denied them further care due to unpaid bills.
Adults with health care debt were twice as likely to say they, or someone in their family, had to postpone or skip getting care because of the cost. “Health care costs are a top concern for U.S. adults, and many — even those without debt — make decisions about whether to seek care based on how much it costs and whether they can afford it,” KFF notes.
“This survey finds that those with health care debt are more likely to report delaying or skipping medical care due to costs, though significant shares of those without medical debt also say they or someone in their household has done these things as well.” 64 percent of those with health care debt say they, or someone in their family, has put off health care they needed due to costs in the past 12 months, vs. 28 percent families without debt.
Elected officials tell us health care insurance is almost universal, now that we have the Affordable Care Act. But this KFF survey reveals that with health insurance, what is not covered can be as critical as what iscovered. KFF says debt “left some individuals feeling as if they could not provide a good life for their families, or with a general sense that they will never be able to extricate themselves from debt.” As health care costs continue to surge, this medical debt is not a healthy state of affairs for our nation.
Al Norman worked in the elderly home care field in Massachusetts for nearly 40 years. He has been writing editorials for 50+ for almost the same period of time.