Over 60 million still face medical-related financial difficulties

The Commonwealth Fund
January 15, 2015
The Rise in Health Care Coverage and Affordability Since Health Reform
Took Effect
By Sara R. Collins, Petra W. Rasmussen, Michelle M. Doty, and Sophie Beutel

Abstract

New results from the Commonwealth Fund Biennial Health Insurance Survey,
2014, indicate that the Affordable Care Act's subsidized insurance
options and consumer protections reduced the number of uninsured
working-age adults from an estimated 37 million people, or 20 percent of
the population, in 2010 to 29 million, or 16 percent, by the second half
of 2014. Conducted from July to December 2014, for the first time since
it began in 2001, the survey finds declines in the number of people who
report cost-related access problems and medical-related financial
difficulties. The number of adults who did not get needed health care
because of cost declined from 80 million people, or 43 percent, in 2012
to 66 million, or 36 percent, in 2014. The number of adults who reported
problems paying their medical bills declined from an estimated 75
million people in 2012 to 64 million people in 2014.

Conclusion

For the first time since it was launched in 2001, the Commonwealth Fund
Biennial Health Insurance Survey has found significant declines in the
number and share of U.S. adults who lack health insurance. The survey
also finds evidence to suggest that the coverage gains are allowing
working-age adults to get the health care they need while reducing their
level of financial burden because of medical bills and debt.

But, while there were minor improvements reported by insured adults in
cost-related access and medical bill problems, rates of these problems
remain high, especially among adults with low incomes. Prior
Commonwealth Fund survey results have found that the increasing size and
prevalence of high deductibles and copayments in private health plans,
including employer-based plans, is leading many people with low and
moderate incomes to avoid or delay needed health care. Excessive
cost-sharing for Americans across all insurance types could jeopardize
improvements in access to care and medical bill burdens documented in
the survey.

States' decisions to reject the Medicaid expansion have left large
numbers of the poorest Americans in the country without health
insurance. Since the survey was fielded in July, one additional state
has expanded its program, seven others are in discussions to move to
forward, and still others may follow their lead this year.

http://www.commonwealthfund.org/~/media/files/publications/issue-brief/2015/jan/1800_collins_biennial_survey_brief.pdf

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Comment by Don McCanne

The media reports on the new Commonwealth Fund study are celebrating the
reduction in the numbers who remain uninsured and the reductions in the
financial consequences of being uninsured, supposedly proving that the
Affordable Care Act is working. What is difficult to celebrate is
confirmation that there are still 66 million people who did not get
needed health care because of cost, and there are 64 million people who
still reported problems paying their medical bills.

Rather than celebrating a modest improvement in the statistics we should
be be using this report to condemn the gross inadequacies of the
Affordable Care Act that leave in place the financial barriers that have
negatively impacted over 60 million people, and have the potential to
have the same negative impact on tens of millions more should they incur
a need to access the health care system.

For those who say, "But this is working," it is not working for the vast
majority for whom our prior system fell cruelly short. Continuing this
highly flawed experiment constitutes unethical experimentation when we
know that a single payer system with full prepaid financing will remove
the financial barriers and hardships that are perpetuated by the
Affordable Care Act.

When you have a forest fire, you don't pull out the candle snuffers; you
call in the tankers. Likewise, when our health care financing system is
leaving tens of millions broke and without adequate care, you don't
tweak what we have; you mobilize a powerful system that actually would
work - an improved and expanded Medicare for all.