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Survey Confirms (Again) that US Health Insurance Makes Us Sicker & Poorer

October 27, 2023

Summary: A Commonwealth Fund survey thoroughly documents that US health insurance of all types poses widespread financial barriers to care, and thus leaves us sicker. Not news, but essential to repeatedly document. The only solution: comprehensive universal public coverage.

Paying for It: How Health Care Costs and Medical Debt Are Making Americans Sicker and Poorer
Findings from 2023 Health Care Affordability Survey
The Commonwealth Fund
October 26, 2023
By Sara R. Collins, Shreya Roy, Relebohile Masitha

Highlights [HJM * bolded summaries]

  • Large shares of insured working-age adults surveyed said it was very or somewhat difficult to afford their health care: 43 percent of those with employer coverage, 57 percent with marketplace or individual-market plans, 45 percent with Medicaid, and 51 and percent with Medicare. *43-57% of insured working-age adults find health care difficult to afford.
  • Many insured adults said they or a family member had delayed or skipped needed health care or prescription drugs because they couldn’t afford it in the past 12 months: 29 percent of those with employer coverage, 37 percent covered by marketplace or individual-market plans, 39 percent enrolled in Medicaid, and 42 percent with Medicare.* Over 12 months, 29-42% of insured adults or family delay or skip needed care due to unaffordability. This is higher for poor families, and reaches 64% for uninsured (see figure below).
  • Cost-driven delays in getting care or in missed care made people sicker. Fifty-four percent of people with employer coverage who reported delaying or forgoing care because of costs said a health problem of theirs or a family member got worse because of it, as did 61 percent in marketplace or individual-market plans, 60 percent with Medicaid, and 63 percent with Medicare. * 54-63% of those delaying or skipping care got sicker as a result.
  • Insurance coverage didn’t prevent people from incurring medical debt. Thirty percent of adults with employer coverage were paying off debt from medical or dental care, as were 33 percent of those in marketplace or individual-market plans, 21 percent with Medicaid, and 33 percent with Medicare. * 21-33% of adults are paying off medical debt.
  • Medical debt is leading many people to delay or avoid getting care or filling prescriptions: more than one-third (34%) of people with medical debt in employer plans, 39 percent in marketplace or individual-market plans, 31 percent in Medicaid, and 32 percent in Medicare.* 31-39% of those with medical debt delay or skip care as a result.

Comment by: Jim Kahn

This survey powerfully quantifies the failure of our insurance system to assure financial access to care. The findings aren’t entirely new (eg, see a similar survey by KFF), but they’re still shocking.

Which raises the question: What’s the purpose of US health insurance?

For me, the answer is clearer with each report released and each year passed: the fragmented health insurance system is designed to benefit powerful interest groups: insurers, pharma, and large providers.

Who are the losers? All of us needing medical services that – even with insurance – are often financially out of reach.

Dozens of other countries have solved the health insurance challenge. Universal lifelong coverage with identical comprehensive benefits, and without opportunity for profiteering. Far lower costs, and far better overall health outcomes.

Embarrassing and painful survey results like this will disappear only once we adopt single payer insurance.

About the Commentator, Jim Kahn

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Jim (James G.) Kahn, MD, MPH (editor) is an Emeritus Professor of Health Policy, Epidemiology, and Global Health at the University of California, San Francisco. His work focuses on the cost and effectiveness of prevention and treatment interventions in low and middle income countries, and on single payer economics in the U.S. He has studied, advocated, and educated on single payer since the 1994 campaign for Prop 186 in California, including two years as chair of Physicians for a National Health Program California.

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