Americans’ Challenges with Health Care Costs
As the COVID-19 pandemic has dragged on and much of the national health care discussion has focused on hospital capacity, health care worker burnout, COVID-19 vaccination, and other measures to protect public health, the high cost of health care continues to be a burden on U.S. families. As KFF polling has found for many years, health care costs factor into decisions about insurance coverage and care seeking, and rank as a top financial worry. This data note summarizes recent KFF polling on the public’s experiences with health care costs. Main takeaways include:
- Many U.S. adults have difficulty affording various health care and dental costs. These difficulties are comparable to – and in many cases higher than – the shares who have difficulty affording other household costs, such as rent, transportation, and food. Furthermore, substantial shares of adults older than 65 report difficulty paying for various aspects of health care, especially services not generally covered by Medicare, such as hearing services, dental and prescription drug costs.
- The cost of health care often prevents people from getting needed care or filling prescriptions. Half of U.S. adults say they put off or skipped some sort of health care or dental care in the past year because of the cost. Three in ten (29%) also report not taking their medicines as prescribed at some point in the past year because of the cost.
- High health care costs disproportionately affect uninsured adults, Black and Hispanic adults, and those with lower incomes. Larger shares of U.S. adults in each of these groups report difficulty affording various types of care and delaying or forgoing medical care due to the cost.
- However, those who are covered by health insurance are not immune to the burden of health care costs. Nearly half (46%) of insured adults report difficulty affording their out-of-pocket costs, and one in four (27%) report difficulty affording their deductible.
- Difficulty paying medical bills can have significant consequences for U.S. families. In March 2019, about one-fourth of U.S. adults (26%) reported that they or a household member have had problems paying medical bills in the past year, and about half of this group (12% of all adults) said the bills had a major impact on their family. Medical bill problems also disproportionately affect those without health insurance, those with lower household incomes, and adults in households where they or a member of their household has a serious health condition.
Difficulty Affording Medical Costs
Health care costs top the list of expenses that people report difficulty affording. Substantial shares of adults in the U.S. report difficulty paying for various aspects of health care including nearly half who report having difficulty paying for dental care (46%) and a similar share of insured adults who report difficulty affording out-of-pocket costs not covered by their insurance (46%). These shares are substantially higher than the shares who report difficulty affording other household expenses such as rent or mortgage, gasoline, monthly utilities, or food and groceries. In addition to these costs, one-third report difficult paying for hearing or vision care (33%), while about one-quarter say the same about their prescription drugs (26%). Among the insured, about one-quarter (27%) say their monthly premium is difficult to afford. Those with lower incomes, Black and Hispanic adults are more likely to report difficulty affording some medical costs. See Appendix table A.1 for breaks by socioeconomic and health status.
Affording dental, hearing, and vision care is also an issue among adults 65 and older as those benefits are not generally covered by Medicare.1 See the October 2021 Health Tracking Poll for a deeper dive into health care costs and challenges among older adults.
The cost of care can also lead some adults to skip or delay seeking services. Half of adults (51%) report they have delayed or gone without certain medical care during the past year due to cost. Dental services are the most common type of medical care that people report delaying or skipping, with 39% of adults saying they have put it off in the past year due to cost. This is followed by vision services (28%), visits to a doctor’s offices (24%), mental health care (17%), hospital services (13%), and hearing aids (9%).
About six in ten Black and Hispanic adults (58% each) report delaying or skipping at least one type of medical care in the past year due to cost, compared to half (49%) of White adults. Similarly, about six in ten (63%) adults with household incomes under $40,000 and 55% of those with incomes between $40,000 and $89,999 report delaying some sort of care due to cost, compared to three in ten (31%) of those in hoseholds making $90,000 or more annually. See Apendix table A.2 for additional breaks by socioeconomic and health status.
Besides differences by income and race or ethnicity, a KFF report from 2019 found that people without health insurance were disproportionately likely to put off or skip medical care or take over-the-counter medicines instead of prescription drugs due to costs. Three-fourths of adults 18-64 (76%) without health insurance reported this, compared to half (52%) of adults with health insurance.
Insurance does not offer ironclad protection, however. Among people with employer-sponsored health insurance, KFF research in 2018 found that workers in higher deductible plans were more likely to report problems paying medical bills and skipping or delaying care due to cost compared to those with lower deductibles. See this KFF/LA Times Survey Of Adults With Employer-Sponsored Insurance for a more in depth look.
Prescription Drug Costs
For many U.S. adults, prescription drugs are another component of their routine care. Among those currently taking prescription drugs, one in four say they have difficulty affording their cost, including at least one third (33%) who take four or more prescription drugs, those in households with annual incomes under $40,000 (32%) and Hispanic adults (40%).
The high cost of prescription drugs also leads some people to cut back on their medications in various ways. About three in ten (29%) U.S. adults say they have not taken their medicines as prescribed at some point in the past year because of the cost. This includes about one in five who say they took an over-the counter drug instead (22%), one in six who report that they haven’t filled a prescription (16%), and 13% who say they have cut their pills in half or skipped a dose of a prescribed medicine due to cost.
Problems Paying Medical Bills, and Their Consequences
Health care costs also impact some American households after an individual receives care. A KFF survey from March 2019 found that about one-fourth of U.S. adults (26%) said they or a household member have had problems paying medical bills in the past year, and half of this group saying the bills had a major impact on their family (48% of those who had medical bill problems, or 12% of all adults). The share reporting their household has had problems paying medical bills has remained steady between about 25% and 30% for the past decade.
Adults in households with incomes under $40,000, those without health insurance coverage, and those in households where someone has a chronic condition are more likely than their counterparts to report negative impacts from their inability to pay for medical bills. Adults in households with incomes under $40,000 are nearly four times as likely to report problems paying medical bills as those who have annual incomes of $90,000 or more (38% vs. 10%). Nearly half (45%) of uninsured adults ages 18-64 report issues paying medical bills, and one in four (25%) say it has had a major impact on them and their families. Among those under age 65 with health insurance, one in four report issues paying medical bills, and 12% say it has had a major impact on their lives. In addition, one-third of adults in households with a serious medical condition report problems paying medical bills, compared to one in five in households without such a condition.
In 2019, those who reported problems paying for medical bills indicated cutting costs in other areas to pay for them. Most commonly, 16% of all adults say they had problems paying medical bills that led them to put off vacations or major household purchases (16%) and a similar share reported bill problems that led them to cut spending on basic household items (15%). Slightly fewer say they have used up all or most of their savings (12%) due to medical bills, taken an extra job or worked more hours (11%), increased their credit card debt (9%), borrowed money from friends or family (8%), or taken money out of long-term savings accounts (8%) in order to pay medical bills.