For years, surveys have shown that the high cost of health care is a burden on American families and that health care costs influence decisions about insurance coverage and seeking care. These costs and the prospect of unexpected medical bills are also among the top financial concerns of adults and their families, and recent polls show that reducing out-of-pocket health care costs is the public's top health care priority. Health care affordability is also one of the top issues voters want to hear about from presidential candidates during the 2024 election. This post summarizes the results of a recent poll on how the public feels about health care costs. Key findings include:
- About half of U.S. adults say they have trouble paying for health care costs, and one in four say they or a family member had trouble paying for health care in the past 12 months. Young adults, people with lower incomes, adults in poor or poor health, and the uninsured are the most likely to report problems paying for health care in the past year.
- The cost of health care services can cause some people to put off getting them. One in four adults say they have skipped or delayed getting needed health care in the past 12 months because of the cost. Notably, six in 10 uninsured adults (61%) say they have foregone needed care because of cost.
- The cost of prescription drugs prevents some people from getting a prescription. About one in five adults (21%) say they have not used a prescription because of the cost, and about the same number say they prefer over-the-counter alternatives. About one in ten adults say they have halved or skipped pills in the past year because of cost.
- Those with health insurance are not immune to the burden of health care costs. About half (48%) of insured adults worry that they can't afford the monthly premium for health insurance, and a large share of adults with employer-sponsored insurance (ESI) and those using the Marketplace rate their insurance as "satisfactory" or "poor" when it comes to the monthly premium and the cost of doctor visits.
- Medical debt is a burden for a significant portion of Americans. About four in ten adults (41%) report having debt for medical or dental bills, including debt owed to credit cards, collection agencies, family and friends, banks and other creditors for health care expenses, with a disproportionate share of black and Hispanic adults, women, parents, low-income and uninsured adults saying they have medical debt.
- A significant proportion of adults still say they are worried about whether they will be able to pay for medical expenses such as unexpected bills, the cost of medical services (including costs not covered by insurance such as copayments and deductibles), the cost of prescription drugs, and long-term care services for themselves or a family member. About three in four adults say they are "very" or "somewhat" concerned about being able to pay unexpected medical bills (74%) or the cost of medical services (73%) for themselves and their family. In addition, about half of adults would not be able to pay an unexpected $500 medical bill in full without going into debt.
Difficulties in paying medical expenses
Many U.S. adults have difficulty paying for health care. While this is most often reported by low-income and uninsured adults, those with health insurance and those with higher incomes are not immune to high health care costs. About half of U.S. adults say it is very or somewhat difficult for them to pay for health care costs (47%). Among those under age 65, uninsured adults are much more likely to say they have difficulty paying for health care (85%) than those with health insurance (47%). In addition, at least six in 10 black (60%) and Hispanic (65%) adults say they have difficulty paying for health care services, compared with four in 10 white adults (39%). Adults from households with annual incomes of less than $40,000 are more than three times as likely as adults from households with incomes of more than $90,000 to say they have difficulty paying for health care costs (69% vs. 21%).
When asked about problems paying for health care in the past year, one in four adults say they or a family member had problems paying for health care, including three in ten adults under age 50 and those with lower incomes (less than $40,000). Affordability of health care is a particular problem for those who need it most: one-third of adults who characterize their physical health as "fair" or "poor" say they or a family member had trouble paying for health care in the past 12 months. Among uninsured adults, half (49%) say they or someone in their family has had trouble paying for health care, including 51% of uninsured adults who say they are in fair or poor health.
The cost of care can also cause some adults to skip or delay seeking services. A quarter of adults say they have skipped or delayed getting needed health care services in the past 12 months because of cost. The cost of health care may also have a disproportionate impact on different populations; for example, women are more likely than men to say they have skipped or delayed getting needed health care services because of cost (28% vs. 21%). Adults age 65 and older, most of whom are eligible for Medicare, are much less likely than younger age groups to say they have not received the health care they need because of cost.
One in four immigrant adults (22%) say they have missed or delayed treatment in the past year, with the rate rising to a third (36%) among those who are uninsured. Seven in 10 (69%) immigrant adults who skipped or delayed care (15% of all immigrant adults) say they did so because of the cost or lack of health insurance. (Source: Immigrant Survey 2023: April-June 2023)
Six in 10 uninsured adults (61%) say they have missed or delayed getting the health care services they need because of cost. Health insurance, however, does not provide ironclad protection, as one in five adults with insurance (21%) still say they do not get the health care services they need because of cost.
The March 2022 survey also looked at what types of health care adults are most likely to put off and found that dental services are the most common type of health care people put off or skip, with 35% of adults saying they have put them off in the past year because of cost. They are followed by vision services (25%), doctor's office visits (24%), mental health services (18%), hospital services (14%) and hearing services including hearing aids (10%).
2022 report found that people who already have medical or dental debt are disproportionately likely to delay or skip medical care. Half (51%) of adults who currently have debt from medical or dental bills say the cost of services has been a barrier to getting a medical exam or treatment that was recommended by a doctor in the past year.
Expenses for prescription drugs
For many American adults, prescription drugs are part of their daily care. More than one in four (28%) adults say it is "somewhat" or "very difficult" for them to pay for prescription drugs. It is especially difficult to pay for prescription drugs for those adults who take four or more prescription drugs (37%) and those who live in households with annual incomes of less than $40,000 (40%). Black and Hispanic adults are also more likely than whites to say they have difficulty paying for prescription drugs.
The high cost of prescription drugs is also causing some people to cut back on their medications in a variety of ways. About one in five adults (21%) say they have not used a prescription in the past 12 months because of cost. A similar share (21%) say they took an over-the-counter medication instead of getting a prescription, and that share rises to one-third of Hispanic adults (32%) and more than one in four adults (27%) with an annual household income of less than $40,000. About one in 10 adults say they have cut their pills in half or skipped a medication in the past 12 months because of cost.
Health insurance cost ratings
Overall, most insured adults rate their health insurance as "excellent" or "good" when it comes to the amount they have to pay for prescriptions (61%), the amount they have to pay to see a doctor (53%), and the amount they pay monthly for coverage (54%). However, at least three in ten rate their insurance as "fair" or "poor" on each of these measures, and affordability scores vary by type of insurance.
Adults with private, employer-sponsored or Marketplace insurance are more likely than those with Medicare or Medicaid to rate their insurance negatively when it comes to monthly premiums, the amount they have to pay out of pocket to see a doctor, and prescription co-pays. About one in four adults with Medicare negatively rate their insurance when it comes to the amount they have to pay each month for premiums and prescription drug costs, and one in five negatively rate their insurance when it comes to the cost of doctor visits.
Medicaid participants are less likely than participants in other types of insurance to give their insurance negative ratings on these affordability measures (most states do not charge monthly premiums for Medicaid and surcharges for covered services, where they apply, must be nominal).
Debt to health care
In June 2022, we released an analysis of the Health Debt Study, which was a companion piece to Health News and NPR's investigative journalism on health care debt, " Diagnosing Debt ." That project revealed that health care debt is a widespread problem in the U.S. and that 41% of U.S. adults currently have some type of medical or dental bill debt for their own or someone else's care, including about a quarter of adults (24%) who say they have past due medical or dental bills or are unable to pay them, and one in five (21%) who have bills they eventually pay directly to a provider. One in six (17%) report owing money to a bank, collection agency or other creditor for loans taken out to pay medical or dental bills, while a similar proportion say they have medical debt for bills they put on a credit card and pay over time (17%). One in 10 report owing a family member or friend money borrowed to pay medical or dental bills.
While four in ten American adults have some type of medical debt, a disproportionate share of low-income, uninsured, black and Hispanic adults, women, and parents report current medical or dental bill debt.
Vulnerability and concerns about health care and long-term care costs
According to the February 2024 Health Tracking Poll, unexpected medical bills and the cost of health care services top the list of people's financial concerns. About three-quarters of the population - and a similar share of insured adults under age 65 - said they are at least somewhat concerned about paying for unexpected medical bills (74%) or the cost of medical services (73%) for themselves and their family. Just over half (55%) said they were "very" or "somewhat" concerned about whether they could afford prescription drug costs, and about half (48%) of insured adults said they were concerned about whether they could pay the monthly health insurance premium.
Worry about health care costs pervades most adults, regardless of their financial situation. Among adults who report having difficulty paying their monthly bills, more than eight in 10 say they are worried about the cost of health care (86%) or unexpected medical bills (83%). Among those who say they can afford to pay their bills, nearly eight in 10 say they worry about whether they can afford unexpected medical bills (84%) or medical services (83%). And even among those adults who say they can afford to pay bills with money left over, six in 10 still say they are "very" or "somewhat concerned" about being able to afford unexpected medical bills (62%) or the cost of medical services (60%) for themselves and their family.
Many U.S. adults may be one unexpected medical bill away from going into debt. About half of U.S. adults say they would not be able to pay an unexpected $500 medical bill out of their own money. Among them, one in five (19%) would not have been able to pay it at all, 5% would have borrowed money from a bank, lender, friend or relative to cover the cost, and one in five (21%) would have gone into credit card debt to pay the bill. Women, low-income, black and Hispanic adults are more likely than their peers to say they would not be able to pay such a bill.
Older adults are also concerned about the cost of long-term care and support services. Nearly six in ten (57%) adults aged 65 and over say they are at least "somewhat concerned" about paying for a nursing or assisted living home if they needed one, and half say they are worried about paying for care services such as paid caregivers or aides. These concerns are also relevant for people aged 50 to 64, with more than seven in ten respondents saying they would feel worried about paying for a care home (73%) and paid carers or aides (72%) if they needed these services.