The cost of health care affects every aspect of the U.S. health care system. It dominates political discussions on health care, impacts decisions about insurance coverage, and ranks at the top of things Americans worry about. It also plays a significant role in the patient experience from decisions on whether or not to get care to the impact of medical bills after receiving care. This data note summarizes the most recent Kaiser Family Foundation polling on the public’s experiences with and worries about health care costs. Main takeaways include:
  • Health care costs dominate public and personal discussions on health care. Americans consistently put health care costs at the top of their list when it comes to health care issues they want the government to address and for political candidates to talk about and recent KFF polling indicates health care costs now occupy a tier of their own on the public’s list of pressing health care issues. Health care costs also top the list of household expenses the public worries about affording.
  • Some insured adults report difficulty affording the routine costs of health insurance. While majorities of those with health insurance report that it is easy (either “very easy” or “somewhat easy” for them to afford to pay the routine costs of health insurance like premiums and deductibles, some insured adults (at least one-fourth) say it is difficult for them to afford these routine costs. In fact, one-third (34 percent) of insured adults say it is either “very difficult” or “somewhat difficult” for them to afford to pay their deductible.

    Costs can be prohibitive to Americans seeking or adhering to health or dental care. Half of U.S. adults in the past year say they or a family member delayed or skipped care — or relied on an alternative treatment — because of costs.

  • Health care costs stop people from getting needed care or filling prescriptions. Half of U.S. adults say they or a family member put off or skipped some sort of health care or dental care or relied on an alternative treatment in the past year because of the cost, and about one in eight say their medical condition got worse as a result. Three in ten of all adults (29 percent) also report not taking their medicines as prescribed at some point in the past year because of the cost.
  • Difficulty paying medical bills can have significant consequences for U.S. families. About one-fourth of U.S. adults (26 percent) say they or a household member have had problems paying medical bills in the past year, and about half of this group (12 percent of all Americans) say the bills had a major impact on their family. Medical bill problems also disproportionately affect sicker populations like individuals living in households with a serious medical condition.
  • Individuals with employer-sponsored insurance coverage are not immune to problems with health care costs. Many problems associated with the cost of health care coverage and services in this country are frequently attributed to the share of the population who are uninsured or buy their own coverage. Yet, KFF polling finds that even individuals with employer-sponsored insurance, especially those in high deductible plans, have difficulty affording their health care or health insurance, or report problems paying medical bills.
  • Some populations experience the most difficulty with affording the cost of their health care and health insurance. Individuals living in households where someone has a serious medical condition, the uninsured, and those with lower-incomes are more likely to struggle with medical bills and report putting off care because of cost.

Cost Issues Dominate Political and Public Discussions of Health Care

Americans have consistently put health care costs at the top of their list when it comes to health care issues they want the government to address and for political candidates to talk about. Prior to the passage of the 2010 Affordable Care Act, politicians spoke frequently about health care during elections with equal attention paid to “health care costs” as “access to coverage.” For example, leading up to the 2008 presidential election, a KFF Health Tracking Poll found that “reducing the cost of health care and insurance” (41 percent) was the top health care issue chosen by voters from a list of possible health care issues, but it was closely followed by “expanding health coverage for the uninsured” (31 percent). Since the implementation of the ACA, health care costs now occupy a tier of their own on the public’s list of pressing health care issues. For example, leading up to the 2018 general election, KFF found at least twice as many voters said they wanted hear candidates talk about health care costs (27 percent) as any other health care issue such as increasing access or decreasing the number of uninsured people (11 percent) or universal coverage (8 percent).

Figure 1: Leading Up To The 2008 And 2018 Elections, Addressing Health Care Costs And Coverage Seen As The Top Priorities For Voters

Outside of elections, health care costs top the list of household expenses Americans worry about affording. About half of the public, regardless of socioeconomic status or health condition, say they are either “very worried” or “somewhat worried” about being able to afford unexpected medical bills or their health insurance deductible (see Tables A.1 and A.2).

Figure 2: Large Majority Are Worried About Being Able To Afford Surprise Medical Bills For Them And Their Family

When asked about the most important feature in their plan, people with employer coverage are about twice as likely to cite cost-related concerns as coverage-related ones. The opposite was true 15 years ago.

Among those with employer-sponsored health coverage, twice as many say cost-related concerns are the “most important” feature to them when choosing a health plan compared to coverage-related concerns. This is a flip in priorities from the 2003 survey which found a larger share saying the most important feature to them was coverage-related, such as having a range of benefits or choice of providers.

Figure 3: Shift In Importance Placed On Cost Factors Versus Coverage Factors In Health Insurance From 2003 To 2018

Some Americans Report Difficulty Affording Routine Costs of Health Coverage

One reason why costs dominate discussions about health care may be due to the significant share of Americans, even with health coverage, who say it is difficult to afford the routine costs of health insurance, such as their premiums, deductibles, and other cost sharing expenses (co-pays for doctor visits and prescription drugs).

The most recent KFF Health Tracking Poll finds that at least one-fourth of insured adults reporting it is difficult to afford to pay their deductible (34 percent), the cost of health insurance each month (28 percent), or their co-pays for doctor visits and prescription drugs (24 percent). These trends correspond with the ongoing trend of rising premiums, deductibles, and other types of cost sharing in the employer-sponsored insurance market.1

Figure 4: Some Insured Americans Report Difficulty Affording Health Care

Difficulty Affording Prescriptions

For many Americans, prescription drugs are another component of their routine care. Among those currently taking prescription drugs (62 percent of adults), about one-fourth (24 percent) and a similar share of seniors (23 percent) say it is difficult to afford their prescription drugs, including about one in ten saying it is “very difficult.” Certain groups are much more likely to report difficulty affording medication, including those who spend $100 or more a month on their prescriptions (58 percent), those who report being in fair or poor health (49 percent), those who take four or more prescription drugs (35 percent), and those earning less than $40,000 annually (35 percent) (see Tables A.3 and A.4).

Figure 5: Who Has Difficulty Affording Their Prescription Drugs?

Three in ten adults ages 50 to 64 report having difficulty affording their prescription medicines (30 percent) compared to about one-fourth of those ages 65 and over with Medicare (23 percent) and one-fifth of those under the age of 50 (21 percent), who take fewer drugs on a regular basis. This group, adults ages 50 to 64, is not yet eligible for Medicare but is more likely to be taking more prescription medicines than other non-Medicare eligible populations.

Large Shares Report Putting Off Care Due To Cost

Beyond the routine costs of health coverage, health care costs also dictate when people decide to seek out care. About half of U.S. adults say they or a family member put off or skipped some sort of health care or dental care in the past year because of the cost. Most common among these are relying on home remedies or over-the-counter drugs instead of going to see a doctor (31 percent), skipping dental care (30 percent), and putting off or postponing getting health care they needed (26 percent). About one in five also report they have skipped a recommended medical test or treatment (21 percent) while fewer say they had problems getting mental health care because of costs (12 percent). About one in eight say their medical condition got worse because they delayed their care or relied on alternative treatments due to costs.

Figure 6: Half Of Adults Report Putting Off Care Due To Costs; Some Say Their Conditions Got Worse As A Result Of Skipping Care

Three In Ten Report Not Taking Their Medications AS PRESCRIBED Due to Cost

In addition to putting off care, about three in ten of all adults (29 percent) report not taking their medicines as prescribed at some point in the past year because of the cost. This includes about one in five who report that they haven’t filled a prescription (19 percent of total) or took an over-the counter drug instead (18 percent of total), and about one in ten who say they have cut pills in half or skipped a dose. In addition, three in ten (29 percent) of those who report not taking their medicines as prescribed say their condition got worse as a result of not taking their prescription as recommended (eight percent of total).

Figure 7: Three In Ten Say They Haven’t Taken Their Medicine As Prescribed Due To Costs

The Experiences of the Uninsured and Those with Serious Medical Conditions

While the ACA resulted in more than 16 million uninsured adults getting health insurance, the uninsured population still faces significant struggles in their ability to access care. Three-fourths of adults 18-64 (76 percent) who do not have health insurance say they or a family have postponed or put off care due to costs. The most common experiences reported by the uninsured include relying on home remedies or OTC drugs (57 percent), postponing needed care (50 percent), or skipping dental care or checkups (47 percent). One-fourth say their medical condition got worse because they delayed their care or relied on alternative treatments due to costs.

Households with Serious Medical Conditions
This survey includes self-reports and family member in household measures of five serious medical conditions: cancer, stroke, heart disease, diabetes, or a serious mental health illness. One-fourth of adults (26 percent) ages 18-64 say they, themselves, are receiving medical treatment for either diabetes, heart disease, stroke, cancer, or a serious mental health illness such as depression, bipolar disease, or schizophrenia while a similar share (28 percent) say the same about a family member in their household. Overall, four in ten (38 percent) say either they or someone in their household is receiving treatment for one or more of these serious medical conditions. See table A.5 to see the self-reported and family member measures for each of the serious medical conditions included in this classification.

Putting off care due to costs is even more prevalent in households with someone with a serious medical condition, with nearly two-thirds (64 percent) saying they or a family member put off or skipped some sort of health care in the past year because of the cost. About four in ten of 18-64-year-olds who are living in a household with someone (including themselves) with a serious medical condition say they have skipped dental care or checkups (41 percent), relied on home remedies or over-the-counter drugs instead of going to a doctor (40 percent) due to cost, or say they have postponed needed care (35 percent). About one-fourth have skipped a recommended medical test or treatment (27 percent) because of the cost while one-fifth (19 percent) say they have had problems getting mental health care due to cost. In addition, one-fourth (23 percent) of those living in a household with a serious medical condition say they or their family member’s condition got worse as a result of not getting the recommended care (see Tables A.6 and A.7). Click here to learn more about the affordability issues among the sick.

Figure 8: Majorities Of Uninsured And Those In Households With Serious Medical Conditions Report Putting Off Care Due To Costs

Problems Paying Medical Bills, and Their Consequences

Health care costs also impact some American households after an individual receives care with about one-fourth of U.S. adults (26 percent) saying they or a household member have had problems paying medical bills in the past year, and half say the bills had a major impact on their family (48 percent of those who had medical bill problems, or 12 percent of all Americans). The share reporting their household has had problems paying medical bills has remained steady between about 25 and 30 percent for the past decade (Table A.8).

Figure 9: Nearly Half Of Those Who Struggled To Pay Medical Bills Report Major Impacts On Their Family

Ongoing difficulty paying for medical bills also affects the sickest populations the most. Adults, 18-64 years old, who live in a household where someone has a serious medical condition are more likely than those living in households without a serious medical condition to report problems paying medical bills. Overall, 29 percent of all adults ages 18-64 say they or someone in their household had problems paying medical bills in the past year. This share reporting problems paying medical bills is almost twice as high among people in households with a serious medical condition compared to those without such a condition (39 percent versus 22 percent). One in five (21 percent) adults, 18-64, who live in a household where someone has a serious medical condition say problems paying medical bills had a “major impact” on them and their family.

Those who report problems paying medical bills in the past year report a number of different responses to those challenges with the most common being putting off vacations or major household purchases (16 percent) or cutting spending on household items (15 percent). Slightly fewer (about one in ten) say they have used up all or most of their savings (12 percent), taken an extra job or worked more hours (11 percent), increased their credit card debt (9 percent), borrowed money (8 percent), or taken money out of long-term savings accounts (8 percent).

Figure 10: About One In Six Say They Have Put Off Vacations Or Household Purchases, Cut Spending To Pay Off Medical Bills

Employer-Sponsored Health Insurance Plans

Many problems associated with the cost of health care coverage and services in this country are frequently attributed to the share of the population who are uninsured or buy their own coverage. KFF polling has previously reported that majorities of these groups report being either “very worried” or “somewhat worried” about their out-of-pocket costs increasing so high they will not be able to get the health care they need. What is frequently missing from the discussions of health care costs is the problems facing those who get their health coverage through their employer, which is where nearly half of adults 18-64 get their coverage.2 Previous KFF polling has also found that significant shares of individuals with employer-sponsored coverage (34 percent) would not be able to pay an unexpected medical bill of $500.

Figure 11: About One-Third Of Individuals With ESI Say They Would Not Be Able To Pay An Unexpected $500 Medical Bill

In addition, a recent Kaiser Family Foundation analysis found that in the past decade, the average health insurance deductible for covered workers increased by 212 percent with one in four covered employees now having a single-person deductible of $2,000 or more.3 Similarly, a KFF/L.A. Times poll found that one in five people with employer-sponsored health coverage say they have plans with the highest deductible amounts (at least $3000 for an individual or $5000 for a family). Half (49 percent) of individuals with the highest deductible ESI plans say they have had difficulty affording their health care, health insurance, or had problems paying medical bills in the past year. Significant shares of those with lower deductibles – about four in ten – also say they have had similar difficulties, compared to one-fourth (27 percent) of individuals with ESI plans without a deductible.

Figure 12: Workers With Higher Deductible Health Insurance Plans Report Health Care Affordability Challenges

Having health coverage does not mean that workers are getting the care they think they need as about half of individuals with employer-sponsored insurance say they or a family member have skipped or postponed getting health care or prescription drugs in the past 12 months because of cost. This is even higher among employees with higher deductibles with six in ten of those with a deductible of at least $1500 for an individual or $3000 for a family say they have skipped or postponed care.

Figure 13: High Deductibles Associated With Skipping Or Postponing Care Due To Cost

A majority of individuals enrolled in health plans with the highest deductibles (at least $3000 for an individual or $5000 for a family) say they currently have easily accessible savings less than the amount of the deductible (56 percent) while four in ten (42 percent) say they have savings that could cover the amount of their deductible. Overall, about four in ten (44 percent) of those in plans with a deductible of at least $1500 for an individual or $3000 for a family say they do not have savings to cover the amount of their deductible.

Figure 14: Over Half Of Those In Highest Deductible Plans Report Personal Savings Less Than Amount Of Their Deductible

Health care is already a prominent feature in the 2020 Democratic presidential primary and similar to 2018, we expect there to be a segment of voters who say health care is the top issue they want to hear the 2020 candidates discuss on the campaign trail. This data note indicates that increasing emphasis on health care as an election issue may be indicative of the public’s experiences with and increasing worries about health care costs.

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