- Few patients are confident they can afford an expensive medical bill, as high out-of-pocket healthcare costs continue to be a cause for patient concern, according to a report from the Commonwealth Fund.
This report was informed by a survey the Commonwealth Fund conducts each year asking patients about the affordability of their healthcare costs.
Each year, the survey asks whether patients are confident they can afford their medical bills should they fall seriously ill. In 2018, 62.4 percent of patients said they were confident they could afford their healthcare costs in a dire situation. This is down from an all-time high of 70 percent of patients saying such in 2015.
Only about half of individuals who make under 250 percent of the federal poverty level (nearly $30,000 for an individual) said they could afford their healthcare costs. This is 20 percentage points lower than the number of high-income adults who said the same thing.
Also adversely affected by healthcare costs were young adults, individuals ages 50 to 64, women, and individuals with health problems. Each of these demographics saw serious declines in confidence to pay patient financial responsibility within the past two years.
Comfort with rising healthcare costs increased when patients had health payer coverage, especially for those with employer-sponsored healthcare. Fifty-five percent of patients with employer-sponsored coverage expressed confidence their health plan would assist them in times of health crisis. Only 31 percent of patients on the individual market and 41 percent of patients with Medicaid said the same.
These decreases in confidence levels stem from overall increases in healthcare costs and patient financial responsibility, the report noted. Nearly one-quarter of patients said their healthcare costs – which include prescription drug costs – have become harder to afford. Sixty-six percent of patients said there was no change in affordability, while only 8 percent said healthcare became easier to afford.
Patients with higher deductibles – about $1,000 – said their care was harder to afford than those with low deductibles or no deductible at all. Additionally, Medicare beneficiaries or those with no payer coverage said care was unaffordable at a higher rate than other patients.
Overwhelmingly, patients accessing coverage via the individual market said their healthcare has become more difficult to afford, with 34 percent of individual market beneficiaries reporting such.
Patients also reported concerns should an unexpected health crisis arise, the report noted.
Forty-six percent of patients said they would not be able to pay an unexpected $1,000 medical bill within 30 days. More vulnerable populations, including women, people of color, uninsured patients, Medicare and Medicaid beneficiaries, and those making less than 250 percent of the poverty level, were least likely to afford unexpected medical bills.
High healthcare costs serve as a major everyday concern for patients, with medical costs serving as one of patients’ top four biggest financial concerns. Fourteen percent of patients said healthcare was their biggest cost concern after mortgage or rent, student loans, and retirement.
Those who ranked healthcare as their biggest financial burden were likely those without healthcare coverage or who were enrolled in high-deductible health plans.
These results indicate that comprehensive healthcare coverage is difficult to attain for many. Although the Affordable Care Act (ACA) closed some health payer coverage gaps, much work remains, the report authors noted.
“As this survey suggests, the ACA’s reforms did not fully resolve the individual market’s relatively higher costs for all those enrolled, compared to employer coverage or Medicaid,” the report stated. “Moreover, recent actions by Congress and the Trump administration, including the repeal of the individual mandate penalty and loosened restrictions on plans that don’t comply with the ACA, are expected to exacerbate those costs for many.”
Congress should assess a number of bipartisan legislative actions that could make comprehensive health coverage access more attainable, the report authors noted. States may also create their own programs to create more affordable and effective healthcare.
This report comes as the government examines patient access to care amidst high healthcare costs. Recent reports have found small but notable increases in the uninsured rate, with 25.7 percent of low-income patients reporting no insurance in March 2018. Only 20.9 percent of that population reported no insurance in 2016.
HHS has begun work to address some patient healthcare cost concerns. As many patients grapple with high out-of-pocket costs for prescription drugs and other treatments, the Administration has begun work to identify strategies to reduce those costs.
In a speech about drug pricing late last week, President Trump called for better price transparency on the part of drug manufacturers. HHS also released a companion blue print calling for suggestions for reducing out-of-pocket drug costs for patients.
However, those actions only address one component of high patient healthcare costs. Patients also face high costs for healthcare access, medical devices, and insurance coverage. Going forward, health payer policymakers should implement strategies to make all elements of care more affordable, allowing patients to obtain insurance and treatments at a manageable cost.