Affordable Health Care in Jeopardy for Millions

Lawmakers are set to leave Washington this week for the holidays, without extending the expiring Affordable Care Act (ACA) tax subsidies. With millions of people facing dramatic health care cost spikes if those credits end January 1, a recent KFF polling and data compilation offers context on health care cost burdens, underscoring the importance of meaningful access to affordable, high-quality coverage.

Millions already struggle with health care affordability:

Nearly half of adults say it is difficult to afford their health care costs. Among those under age 65, uninsured adults are much more likely to have trouble affording care (82%) than those with health insurance coverage (42%).

The cost of health care can lead some people to go without needed care. About one-third (36%) of all adults skipped or postponed care in the past year due to affordability concerns. Here too, the uninsured bore a heavy burden. They were more likely to forgo care (75%) than their insured counterparts, but those with coverage still struggled: About four in ten insured adults (37%) reported putting off care. 

High prescription drug costs are also barriers to care. In the past year, one-third of all adults (33%) took at least one measure to save costs on prescription drugs, such as not picking up their prescribed medication (21%), taking over-the-counter drugs instead (23%), and cutting pills in half or skipping doses (15%).

Cost barriers have serious consequences that perpetuate care delays and medical debt:

Care delays worsen health. Nearly one in five adults (18%) experienced worse health due to cost-related care delays. In addition to being more likely to skip care in the first place, the uninsured were also more likely to suffer as a result. They were twice as likely as those with coverage to say their health worsened because of skipped or postponed care (42% vs. 20%).

Health care debt is a burden for a large share of Americans. In 2022, about four in ten adults (41%) had debt due to medical bills, with the uninsured more likely to be affected than those with coverage (62% vs. 44%).

Many adults are close to falling into medical debt. Half of adults (50%) say they would not be able to pay a $500 unexpected medical bill. This includes 19% who would not be able to pay it at all; 5% who would borrow the money from a bank, payday lender, friends or family; and 21% who would incur credit card debt to pay the bill.

Medical debt amplifies care delays. People with medical debt are disproportionately likely to put off or skip medical care. Half (51%) of all adults experiencing medical debt said that in the past year, cost has prevented them from getting a medical test or treatment that was recommended by a doctor.

Health care cost concerns are widespread:

Health insurance premiums and out-of-pocket costs drive financial worries. While health insurance provides some financial protection, premiums and out-of-pocket costs can still present a financial burden for many. Almost four in ten insured adults under the age of 65 (38%) worry about affording their monthly health insurance premium, and 55% of adults with Marketplace coverage rate their insurance as “fair” or “poor” when it comes to their monthly premium amounts and how much they pay out of pocket to see a doctor.

People are also worried about future health care costs. More than six in ten adults (62%) say paying for health care services is a top financial worry. Among older adults, the cost of long-term care is a particular concern: Almost six in ten (57%) have anxiety about affording a nursing home or assisted living facility. These are larger shares than those who are worried about affording housing (51%), transportation (50%), utilities (49%), and food (48%).

Congress Must Act Now

As the KFF research and polling make clear, many Americans are already struggling with health care costs. Allowing tax credits that improve Marketplace plan affordability to expire will only worsen the landscape. Without these subsidies in place, more than 22 million people could see their premiums rise by 75% on average, while people in rural areas could see a 90% increase. 

Some may be able to find other insurance, but at least 4 million people will not. The resulting hardships and coverage losses would mean reduced access to care and worse health outcomes, as well as higher Medicare costs, as more people would enter the program with higher acuity than they would have otherwise.

Medicare Rights continues to urge lawmakers to extend the enhanced credits without delay. The health and economic security of millions of Americans is hanging in the balance.

Read the KFF brief, Americans’ Challenges with Health Care Costs.