As lawmakers debate the future of the country’s health care system and outline plans to repeal and replace the Affordable Care Act, much of the current debate surrounds how to change or eliminate the health insurance marketplaces developed under the ACA where individuals eligible for financial assistance could compare plans and purchase insurance. While this is an important source of coverage for some, the vast majority of Americans with insurance have coverage from other sources, such as an employer, Medicaid or Medicare, and the public’s top priority for lawmakers is reducing what Americans pay for health care. Two recent Kaiser Health Tracking Polls take stock of the public’s current experience with and worries about health care costs, including their ability to afford premiums and deductibles. For the most part, the majority of the public does not have difficulty paying for care, but significant minorities do, and even more worry about their ability to afford care in the future. Some of the key findings include:

• Four in ten (43 percent) adults with health insurance say they have difficulty affording their deductible, and roughly a third say they have trouble affording their premiums and other cost sharing; all shares have increased since 2015.
• Three in ten (29 percent) Americans report problems paying medical bills, and these problems come with real consequences for some. For example, among those reporting problems paying medical bills, seven in ten (73 percent) report cutting back spending on food, clothing, or basic household items.
• Challenges affording care also result in some Americans saying they have delayed or skipped care due to costs in the past year, including 27 percent who say they have put off or postponed getting health care they needed, 23 percent who say they have skipped a recommended medical test or treatment, and 21 percent who say they have not filled a prescription for a medicine.
• Even for those who may not have had difficulty affording care or paying medical bills, there is still a widespread worry about being able to afford needed health care services, with half of the public expressing worry about this.
• Health care-related worries and problems paying for care are particularly prevalent among the uninsured, individuals with lower incomes, and those in poorer health; but women and members of racial minority groups are also more likely than their peers to report these issues.

Health Care Costs Are Public’s Top Priority For Lawmakers

While Democrats, independents, and Republicans are divided on what they want lawmakers to do when it comes to the Affordable Care Act, known commonly as Obamacare, according to a Kaiser Health Tracking Poll conducted in December, Americans are less polarized on their worries about the cost of health care for individuals. A majority of Americans, regardless of party identification, think lowering the amount individuals pay for health care should be a “top priority” for President Trump and Congress and rank it at the top of the list of health care priorities. In addition, more than half of Americans say the same about lowering the cost of prescription drugs, including two-thirds (67 percent) of Democrats, and about six in ten independents (61 percent) and Republicans (55 percent).

Figure 1: Majority of Americans, Regardless of Party, Say Limiting Amount Individuals Pay for Health Care Should Be Top Priority

Difficulty Paying For Health Care

As large shares of the public say that lowering people’s health care and prescription drug costs should be a top priority for lawmakers, sizeable shares of those with health insurance say that affording their premiums, deductibles, and other cost sharing expenses (copays for doctor visits and prescription drugs) is difficult for them. Specifically, about six in ten adults with health insurance say it is easy for them to afford to pay their premiums and cost sharing expenses, while about a third report difficulty covering those expenses. When it comes to affording their deductibles, four in ten say it is difficult (43 percent) compared to half who say it is easy.

The shares saying they have a difficult time affording these types of medical costs has increased since 2015; from 27 percent to 37 percent for premiums, 34 percent to 43 percent for deductibles, and from 24 percent to 31 percent for copays for doctor visits and prescription drugs. 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 2: More Insured Americans Now Report Difficulty Affording Health Care

Problems Paying Medical Bills, And Their Consequences

About three in ten U.S. adults (29 percent) say they or a household member have had problems paying medical bills in the past year, and most who have had trouble say the bills had a major impact on their family (58 percent of those who had medical bill problems, or 17 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.

Figure 3: Most of Those Who Struggled to Pay Medical Bills Report Major Impacts on Their Family

Those who report problems paying medical bills in the past year report a number of different responses to those challenges. For example, among those reporting problems paying medical bills, seven in ten report cutting back spending on food, clothing, or basic household items (73 percent) or putting off vacations or major household purchases (71 percent), and about six in ten say they have used up all or most of their savings (61 percent) or taken an extra job or worked more hours (58 percent) in order to pay the bills. Sizeable shares of those with problems paying medical bills also report increasing credit card debt (37 percent) or taking money out of retirement or other long-term savings accounts (31 percent), and a quarter say they have even changed their living situation in order to be able to pay the bills.

Figure 4: Those with Problems Paying Medical Bills Report Engaging in a Variety of Actions to Pay off Bills

Large Shares Report Putting off Care due to Cost

Concerns about the cost of care also result in some Americans saying they or a family member put off or skipped some sort of health care in the past year because of the cost. Most common among these are skipping dental care (32 percent), relying on home remedies or over-the-counter drugs instead of going to see a doctor (29 percent), and putting off or postponing getting health care they needed (27 percent). About one in five also report they have skipped a recommended medical test or treatment (23 percent) or not filled a prescription for a medicine (21 percent) due to costs. Fewer, about one in eight, say they have cut pills in half or skipped doses (16 percent) or had problems getting mental health care (12 percent) due to costs.

Figure 5: Some Americans Report Putting Off or Postponing Care Due to Costs

Many Americans Worry About the Cost of their Health Care

Kaiser polls have also asked Americans how worried they are about a number of health-related concerns and economic issues, and find that worries about health care fall just below concerns about their income not keeping up with prices. About one-third of Americans say they are “very worried” about their income not keeping up with prices, followed closely by about one-fourth who are “very worried” about not being able to afford health care services they think they need (25 percent), losing their health insurance (22 percent), or not being able to afford prescription drugs (21 percent). Overall, half are at least somewhat worried that they won’t be able to afford needed health care services.

Figure 6: Cost Concerns, Including Health Care Costs, Top List of Worries

Trouble Paying an Unexpected $500 Medical Bill

Unexpected medical bills can catch people off guard without a way to pay for the expense and nearly half (45 percent) of Americans say they would have difficulty paying a surprise medical bill of $500. About one in five (19 percent) say they would not be able to pay the bill at all and another 7 percent say they would have to borrow money from a bank, payday lender, or friends or family to pay the bill, while 20 percent say they would put it on a credit card and pay it off over time. Half of Americans (47 percent) say they could pay the $500 bill in full right away. Among the uninsured and those with lower incomes, about a third of each group say they would not be able to pay a $500 bill at all (31 percent and 35 percent, respectively). In addition, four in ten of those who report being in fair or poor health say they wouldn’t be able to pay an unexpected bill of $500.

Figure 7: Uninsured and Lower-Income Individuals More Likely to Say They Would Struggle to Pay an Unexpected Medical Bill

Problems and Worries Over Time

Despite an improved national economic situation and implementation of the ACA, there has been little movement in the share of the public that reports problems paying medical bills, putting off care due to cost, or worries about affording care, potentially reflecting continually rising premiums and deductibles.

Large Variation in Reports of Problems and Worries Across Demographic Groups

Not surprisingly, people who are lower-income, uninsured, or who are in poorer health are more likely to report that they have difficulty affording health care and that the issue concerns them. For example, problems paying medical bills are more commonly reported by those in fair or poor health (52 percent), the uninsured (41 percent), and those with lower incomes (42 percent). And, about half of those in fair or poor health say they are “very” worried about being able to afford health care services they need.

Figure 8: Uninsured, Lower-Income Individuals, and Those in Poorer Health Are More Likely to Report Issues with Health Care Costs

While having health insurance ultimately helps protect against high health care costs, those with health insurance who are lower income or in poor or fair health are more likely to say that they have difficulty affording expenses like premiums, deductibles, and other cost sharing. Among those with health insurance, about six in ten people with an annual household income of $40,000 or less say it is difficult for them to afford their deductibles (59 percent) and about half say it is difficult to afford their premiums (53 percent) and other cost sharing (46 percent), shares that are much higher than their upper-income counterparts.

In some cases, there are also differences in problems paying and worrying about health care costs across other demographic groups such as gender, racial and ethnic groups, and for those with ongoing health conditions or pre-existing health conditions. See Table 2 and Table 3 for full results across different demographic groups.