Polling Data Note: Beyond the ACA, the Affordability of Insurance Has Been Deteriorating Since 2015

The debate about the future of the Affordable Care Act and its individual insurance marketplaces may be taking the focus off the affordability challenges facing the broader population, most of whom get their health coverage through employers, Medicare or Medicaid.

New survey findings from the Kaiser Family Foundation show that health care has become somewhat less affordable even among those with health insurance. Since 2015, larger shares of people with health insurance say they have a difficult time affording their health care costs: from 27 percent to 37 percent for premiums, 34 percent to 43 percent for deductibles, and from 24 percent to 31 percent for copays and prescription drugs.

Other findings include:

• About three in 10 adults (29%) report someone in their household has had problems paying medical bills in the past year, often with real consequences. For example, among those reporting problems paying medical bills, seven in 10 (73%) report cutting back spending on food, clothing, or basic household items, while about six in 10 report using up all or most of their savings (61%) or taking an extra job or working more hours (58%) to pay their bills.

• Concerns about cost are also affecting whether and when some people seek health care. For example, a quarter (27%) of the public says that they or a family member living in their household put off or delayed getting health care they needed in the past year due to costs, and nearly as many say they skipped a recommended medical test or treatment (23%) or did not fill a prescription (21%).

• Nearly half of Americans (45%) say they would have difficulty paying an unexpected $500 medical bill. This includes those who say they wouldn’t be able to pay it at all (19%), those who would put it on a credit card and pay it off over time (20%) and those who would have to borrow money from a bank, payday lender, family or friends (7%). Among the uninsured and those with lower incomes, more than three in ten say they would not be able to pay a $500 bill at all.

• Significant shares of the public say they are “very worried” about not being able to afford health care services they think they need (25%), losing their health insurance (22%), or not being able to afford prescription drugs (21%). Overall, half say they are at least somewhat worried that they won’t be able to afford needed health care services.

The data note draws on previously unreported data from Kaiser Health Tracking Polls conducted in December and February. Designed and analyzed by public opinion researchers at the Kaiser Family Foundation, the polls were conducted from December 13-19, 2016 and February 13-19, 2017 among nationally representative random digit dial telephone samples of 1,204 and 1,160 adults, respectively. Interviews were conducted in English and Spanish by landline and cell phone. The margin of sampling error is plus or minus 3 percentage points for the full samples. For results based on subgroups, the margin of sampling error may be higher.