Lawmakers will leave Washington this week for the holidays but will not extend expiring Affordable Care Act (ACA) tax subsidies. Millions of people will face significant spikes in health care costs if these benefits end on January 1. Recent KFF polls and data compilations provide context for health care cost burdens, highlighting the importance of meaningful access to affordable, high-quality insurance.
Millions of people already struggle with health care affordability:
- Nearly half of adults say it’s difficult to afford medical care. Among those under 65, uninsured adults (82%) are more likely to have trouble affording care than adults with health insurance (42%).
- Health care costs can result in some people not getting the care they need. About one-third (36%) of adults have skipped or postponed care in the past year due to affordability issues. Here, too, the uninsured bear a heavy burden. They are more likely than the insured to forego care (75%), but those with insurance are still stuck: About 4 in 10 insured adults (37%) report postponing care.
- High prescription drug costs are also a barrier to care. Last year, one-third of adults (33%) took at least one step to save money on prescription drugs, such as skipping prescriptions (21%), taking over-the-counter medications (23%) and cutting pills in half or skipping doses (15%).
Cost barriers can have serious consequences, leading to delays in care and perpetuating medical debt:
- Delays in care can lead to worsening health conditions. Nearly one in five adults (18%) has experienced a worsening of their health due to cost-related delays in care. In addition to being more likely to skip care in the first place, the uninsured are also more likely to suffer as a result. They are twice as likely as those with insurance to say their health has worsened as a result of skipping or delaying care (42% vs. 20%).
- Health care debt is a burden that burdens a large portion of Americans. About 4 in 10 adults (41%) will be in debt for medical bills in 2022, with the uninsured more likely than the insured to be affected (62% vs. 44%).
- Many adults are on the verge of falling into medical debt. Half of adults (50%) say they would not be able to pay an unexpected medical bill of $500. These include 19% who simply cannot afford to pay; 5% who will borrow money from a bank, payday lender, friends or family; and 21% who will take on credit card debt to pay their bills.
- Medical debt exacerbates delays in care. People with medical debt are disproportionately likely to delay or skip medical care. Half (51%) of adults with medical debt say the cost prevented them from getting medical tests or treatments recommended by their doctors in the past year.
Health care cost issues are widespread:
- Health insurance premiums and out-of-pocket costs raise financial concerns. While health insurance provides some financial protection, premiums and out-of-pocket costs can still create a financial burden for many people. Nearly 4 in 10 (38%) insured adults under age 65 are concerned about being able to afford their monthly health insurance premiums, and among marketplace plans, 55% rate their coverage as “fair” or “poor” in terms of monthly premium amount and out-of-pocket doctor visits.
- People also worry about future medical costs. More than 6 in 10 adults (62%) say paying for health care services is their top financial concern. For seniors, the cost of long-term care is a particular concern: Nearly six in 10 (57%) are anxious about affording a nursing home or assisted living facility. These rates are higher than those worried about housing (51%), transportation (50%), utilities (49%) and food (48%).
Congress must act now
As KFF research and polling show, many Americans are already struggling with health care costs. Allowing tax credits that improve the affordability of marketplace plans to expire will only make the situation worse. Without these subsidies, premiums for more than 22 million people could rise by an average of 75%, while people in rural areas could see premiums rise by 90%.
Some people may be able to find alternative coverage, but at least 4 million people won't.
Some people may be able to find alternative insurance, but at least 4 million people cannot. The resulting hardship and loss of insurance coverage will mean reduced access to care and worsened health outcomes, as well as higher Medicare costs because more people will enter the program with higher acuity than otherwise.
Medicare Rights continues to urge lawmakers to immediately extend the enhanced credit. The health and economic security of millions of Americans hang in the balance.
Read KFF's brief: The health care cost challenges facing Americans.
