For privately insured patients, surprise medical bills can arise from either having to pay a high deductible, or from “balance billing.” Typically, health plans negotiate payments to in-network providers. Out-of-network providers may directly bill privately insured patients the difference between the typical in-network health plan payment and the full charge, also known as “balance bills”. In these cases, patients can be liable for the balance bill in addition to any deductible, coinsurance, or copay under the health plan.

The No Surprises Act prohibits many of these balance bills starting in 2022. Privately insured patients (including those with employer-based coverage, non-group plans, and grandfathered plans) are protected from certain surprise balance bills. The surprise balance billing protections require private health plans to cover out-of-network claims and apply in-network cost sharing (deductibles, copayments) for certain covered benefits. The law prohibits certain providers, hospitals, and air ambulance from surprise balance billing patients for out-of-network care, unless the patient consents ahead of time.

The new protections require plans and providers to take the patients out of many of the most common payment disputes. Though it is possible that patients still get balance bills, including because of plan or provider billing mistakes, the bill is not covered under the new law (for example, ground ambulance rides, non-covered services, patient consents to out-of-network care costs), or the health plan denies the claim completely as not covered by the plan.

The patient might get balanced bills, for instance, if the patient’s plan incorrectly processes a claim or applies out-of-network cost-sharing amount when the NSA prohibits it. A patient could get billed more than they ought to be, for example, if the plan does not recognize that a claim is subject to the No Surprises Act, or because of a billing oversight. Patients can appeal these mistakes using the plan’s internal claims and appeals procedure. Under the federal law, the patient has the right to appeal a health plan denial (called an adverse benefit determination or “ABD”). ABDs also include plan decisions to apply the incorrect cost-sharing amount. Once the adverse benefit determination has been made, the health plan must give the patient at least 180 days to file an internal appeal. For post-service claims, the plan must then complete the internal appeal no later than 60 days after it is filed. If the plan upholds its denial, the patient has a new right under the NSA to ask for an independent external appeal for NSA compliance issues. Federal regulations provide several examples for when NSA-related decisions can be reviewed by an external reviewer, including a decision about whether a specific claim involves an item or service that is covered by the NSA as a surprise bill.

For patients who receive a surprise bill when they should not, what follows may be more complicated. To correct the situation, patients would first need to recognize that the plan’s decision was incorrect and that the provider bill is subject to the No Surprises Act. KFF polling finds the vast majority of Americans (78%) know little or nothing about the new consumer protections law, so the effectiveness of self-advocacy by consumers could be limited if problems arise. Under current law, any health plan ABDs must include contact information for state consumer assistance programs (CAPs) and notice that such programs (in states where they exist) can help people file an appeal. Consumers could reach out to CAPs to get an assessment of whether the bill they received is valid. Additionally, as part of the No Surprises Act, the Centers for Medicare and Medicaid Services (CMS) has established resources for patients to seek review of their medical bills (through this website: https://www.cms.gov/medical-bill-rights/help/submit-a-complaint or by calling the No Surprises Help Desk at 1-800-985-3059 which is available 24/7 and through holidays). This no-wrong-door complaints system is available for consumers who are concerned their plan may have incorrectly denied or covered a surprise medical bill.

Meanwhile, however, if a plan incorrectly denies or covers a surprise bill and the patient does not recognize the mistake in order to be able to either appeal or ask for a state or federal review, the patient might get stuck with the bill.

While patients appeal, there is no federal rule preventing providers from trying to collect the outstanding bill. For incorrect bills, if the patient appeals, the out-of-network provider might be able to bill the patient for the full charge while the appeal is underway. Patients who are unable to pay the outstanding bill may be referred to collection agencies. Though the Consumer Finance Protection Bureau (CFPB) has outlined additional guidelines restricting coercive practices from collection agencies. KFF polling has found that 41% of adults have health care debt according to a broader definition, which includes health care debt on credit cards or owed to family members. KFF analysis of a census survey suggests Americans may owe at least $220 Billion in medical debt. People with medical debt report cutting spending on food, clothing, and other household items, spending down their savings to pay for medical bills, borrowing money from friends or family members, or taking on additional debts. Medical debt may make it difficult for patients to get loans for daily living like housing or car.

Later, if the patient prevails on the appeal, the health plan would need to reprocess the claim, this time following the No Surprises Act rules, and the out-of-network provider would then be required to refund the patient for any amount collected in excess of the applicable in-network cost sharing amount.

Under the Affordable Care Act and the No Surprises Act, federal agencies can impose penalties on health plans and providers for incorrectly billing patients. For plans who incorrectly process claims, they can be charged up to $100 per day per affected beneficiary under federal law. State regulators may have additional authority and enforcement tools they can use to address billing problems. On the provider side, the penalty for incorrect billing is up to $10,000 per violation. That is, if a provider sends 200 incorrect bills, the provider could be penalized $2 million. But for these penalties to happen, the patient would have to successfully lodge a complaint with federal regulators and the regulators would need to investigate and enforce.

Through October 2023, about 11,000 patient complaints have been filed through the federal feedback portal. The federal government has said 248 complaints involved a violation and resulted in $3 million in monetary relief paid to consumers or providers. At this point, it is unclear whether the federal government has issued penalties to providers or health plans for incorrect billing practices.

Discussion

Most patients do not know about the new surprise billing protections and likely also do not know of resources available to seek recourse for incorrect medical bills. It’s advisable to ask about the cost ahead of time, when possible. Additionally, when patients get a large, unexpected bill, a good first step is to call the health plan. New federal resources allow patients to submit complaints and get a response from the federal government. The federal process does not provide a determination or help the consumer fight a bill with the payer. Patients may have little recourse, however, if their plan does not cover certain items or services, or if their surprise balance bill is not protected under federal law.

Plans and providers can now arbitrate disagreements over payments for out-of-network care via the No Surprises Act independent dispute resolution. Most payment determinations through the arbitration process have been in favor of the providers’ asking price. Yet most of the lawsuits against the No Surprises Act are also being brought by providers. The federal government recently proposed several changes with the goal of making the IDR process more efficient and increasing early communication between the parties. In the midst of the legal disputes over the dispute resolution process for payment rates, patients are required to be held harmless for surprise, out-of-network balance bills.

Patients are not supposed to get surprise balance bills, unless there’s a mistake or the surprise bill is not protected. In these situations, patients have some recourses, though they are only helpful if people know about them.

In Medicaid, states are required to cover all screening services as well as any services “necessary… to correct or ameliorate” a child’s physical or mental health condition under Medicaid’s Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit (see Box 1). Many of these screening services along with immunizations are provided at well-child visits. These visits are a key part of comprehensive preventive health services designed to keep children healthy and to identify and treat health conditions in a timely manner. Various studies have also shown that children who forego their well-child visits have an increased chance of going to the emergency room or being hospitalized. Well-child visits are recommended once a year for children ages three to 21 and multiple times a year for children under age three according to the Bright Futures/American Academy of Pediatrics (AAP) periodicity schedule.

A recent Centers for Medicare and Medicaid Services (CMS) analysis shows that half of children under age 19 received a Medicaid or CHIP funded well-child visit in 2020. The onset of the pandemic in 2020 had a substantial impact on health and health care service utilization, but research has shown that many Medicaid-covered children were not receiving recommended screenings and services even before the pandemic. This issue brief examines well-child visit rates overall and for selected characteristics before and after the pandemic began and discusses recent state and federal policy changes that could impact children’s preventive care. The analysis uses Medicaid claims data which track the services enrollees use and may differ from survey data. In future years, claims data will be used to monitor adherence to recommended screenings. Key findings include:

• More than half (54%) of children under age 21 enrolled in Medicaid or CHIP received a well-child visit in 2019, but the share fell to 48% in 2020, the start of the COVID-19 pandemic.
• Despite having the highest well-child visit rates compared to other ethnic and racial groups, Hispanic and Asian children enrolled in Medicaid or CHIP saw the largest percentage point declines in well-child visit rates from 2019 to 2020.
• Children over age three enrolled in Medicaid or CHIP have lower rates of well-child visits and experienced larger declines in well-child visits during the pandemic than children under age three.
• Well-child visit rates are lower for Medicaid/CHIP children in rural areas, but rates in urban areas declined more during the pandemic.

How did use of well-child visits change during the pandemic?

More than half (54%) of children under 21 enrolled in Medicaid or CHIP received a well-child visit in 2019, but the share fell to 48% in 2020, the first year of the COVID-19 pandemic (Figure 1). Rates examined here use Medicaid claims data which differ substantially from survey data (see Box 2). While the vast majority of children in the analysis (91% in 2019 and 88% in 2020) used a least one Medicaid service, including preventive visits, sick visits, filling prescriptions, or hospital or emergency department visits, well-child visit rates remained low and are substantially below the CMS goal of at least 80%. One recent analysis found that 4 in 10 children enrolled in Medicaid or CHIP experienced at least one challenge when accessing health care. Barriers to Medicaid/CHIP children receiving needed care can include lack of transportation, language barriers, disabilities, and parents having difficulty finding childcare or taking time off for an appointment as well as the availability of and distance to primary care providers. Some states have seen a loss in Medicaid pediatric providers, and one recent story reported that families with Medicaid in California were traveling long distances and experiencing long wait times for primary care appointments. Data have also shown slight declines in the share of kindergarten children up to date on their routine vaccinations since the COVID-19 pandemic, which may, in part, be associated with the decline in well-child visits. The national measles, mumps, and rubella (MMR) vaccination rate is below the goal of at least 95%, and some states are now seeing measle outbreaks among children.

Despite having the highest well-child visit rates compared to other ethnic and racial groups, Hispanic and Asian children enrolled in Medicaid or CHIP saw the largest percentage point declines in well-child visit rates from 2019 to 2020 (Figure 2). Prior to the pandemic in 2019, about half or more of children across most racial and ethnic groups had a well-child visit, with rates highest for Hispanic (60%) and Asian (57%) children. The rate for American Indian and Alaska Native (AIAN) children lagged behind at just over one in three (36%), although this may reflect that some services received from Indian Health Service providers not being captured in the analysis (see Methods). Between 2019 and 2020, the well-child visit rate fell for all racial and ethnic groups. Hispanic and Asian children experienced the largest percentage point declines in well-child rates (9 percentage points for both groups), but they still had higher rates compared to other groups as of 2020. Black, Native Hawaiian, and Other Pacific Islander (NHOPI), and AIAN children also experienced larger percentage point declines in their well-child visit rates compared with White children, and AIAN children had the largest relative decline on account of their lower starting rate. As of 2020, rates remained lowest for NHOPI (42%) and AIAN children (29%). Twenty-two states, including some states that are home to larger shares of AIAN and NHOPI children, were excluded from the race/ethnicity analysis due to data quality issues (see Methods).

Children ages three and older have lower rates of well-child visits and experienced larger declines in well-child visits during the pandemic than children under age three (Figure 2). Well-child visit rates are highest when children are young because multiple well-child visits are recommended for children under age three. Although children under three have highest rates of a single well-child visit within the year, it is unknown whether the rates of adherence to recommended well-child screenings are higher or lower than that of other groups because this analysis only accounts for one well-child visit in a year. Well-child visit rates steadily decrease as children get older with the exception of the 10-14 age group, where somewhat higher rates may reflect school vaccination requirements.

Well-child visit rates are lower in rural areas than urban ones, but urban areas had larger declines during the first year of the pandemic (Figure 2). The share of Medicaid/CHIP children living in rural areas with a well-child visit declined from 47% in 2019 to 43% in 2020 while the share for urban areas fell from 56% in 2019 to 49% in 2020, narrowing the gap between Medicaid/CHIP well-child visit rates in rural and urban areas. Note that 18% of children in the analysis lived in a rural area, and three states were excluded from the geographic area analysis due to data quality issues (see Methods). This analysis also examined changes for children by eligibility group, managed care status, sex, and presence of a chronic condition; data are not shown but well-child visit rates for Medicaid/CHIP children declined across all groups from 2019 to 2020.

What to watch?

Well-child visit rates for Medicaid/CHIP children overall fall below the goal rate, with larger gaps for AIAN, Black and NHOPI children as well as older children and children living in rural areas, highlighting the importance of outreach and other targeted initiatives to address disparities. Addressing access barriers and developing community partnerships have been shown to increase well-child visit rates and reduce disparities. It will be important to track, as data become available, the extent to which well-child visit rates as well as vaccination rates (often administered at well-child visits) rebounded during the pandemic recovery and where gaps remain.

Recent state and federal actions could help promote access, quality and coverage for children that could increase well-child visit rates. The Bipartisan Safer Communities Act included a number of Medicaid/CHIP provisions to ensure access to comprehensive health services and strengthen state implementation of the EPSDT benefit. CMS also released an updated school-based services claiming guide, and states have taken action to expand Medicaid coverage of school-based care in recent years. In 2024, it became mandatory for states to report the Child Core Set, a set of physical and mental health quality measures, with the goal of improving health outcomes for children. In addition, as of January 2024, all states are now required to provide 12-month continuous eligibility for Medicaid and CHIP children, which could help stabilize coverage and help children remain connected to care. Three states also recently received approval to extend continuous eligibility for children in Medicaid for multiple years, which could help children maintain coverage beyond one year. In the recently released FY 2025 budget, the Biden Administration proposes establishing the option for states to provide continuous eligibility in Medicaid and CHIP for children from birth to age six or for 36 month periods for children under 19.

Lastly, millions of children are losing Medicaid coverage during the unwinding of the continuous enrollment provision, which could have implications for access. Data up to March 2024 show that children’s net Medicaid enrollment has declined by over 4 million. In some cases, children dropped from Medicaid may have transitioned to other coverage, but they may also become uninsured, despite in many cases remaining eligible for Medicaid or CHIP. While people of color are more likely to be covered by Medicaid, data on disenrollment patterns by race and ethnicity are limited. KFF analysis shows individuals without insurance coverage have lower access to care and are more likely to delay or forgo care due to costs. A loss of coverage or gaps in coverage can be especially problematic for young children who are recommended to receive frequent screenings and check-ups.

During the three years of the pandemic, states maintained coverage for people enrolled in Medicaid. As a result of this continuous enrollment provision, the number of people enrolled in Medicaid increased. The result – in combination with enhanced premium subsidies in the Affordable Care Act marketplace – is that the number of people who were uninsured decreased and the uninsured rate dropped to historic lows. However, despite these improvements in coverage, 25.6 million nonelderly people remained uninsured in 2022 (Figure 1), and six in ten of the uninsured people are eligible for Medicaid (6.4 million or 25%) or subsidized plans (35%) in the Marketplace but are not enrolled in these programs. Among the remaining uninsured, 6% fall into the “coverage gap” because they live in one of the 10 states that have not adopted the Medicaid expansion. People in the coverage gap have incomes too high to qualify for Medicaid in their state, but too low (below 100% of the poverty level) to qualify for subsidies in the Marketplaces. States began the process of unwinding continuous enrollment in the spring/summer of 2023 and have disenrolled millions of people from Medicaid, likely increasing the number of people who are uninsured.

This issue brief examines the characteristics of the nonelderly uninsured population that is eligible for Medicaid or CHIP using the most recent available national survey data from 2022, which is before the end of Medicaid continuous enrollment, and the most recent eligibility levels for Medicaid (from 2023). Even with declines in the uninsured, the characteristics of the uninsured but eligible for Medicaid remained fairly stable from the prior year.

Who are the people who are uninsured and eligible for Medicaid and CHIP?

Among the 6.4 million nonelderly people who are uninsured and eligible for Medicaid or CHIP (referred to as people who are uninsured and eligible for the rest of this brief), most are adults. Two-thirds of people who are uninsured and eligible, 4.2 million, are adults and one-third, 2.2 million, are children (Figure 2). Adults include those eligible for the program through the Medicaid expansion and individuals who qualify under pre-ACA rules but are not enrolled.

Across all people who are uninsured and eligible, over six in ten are people of color and nearly seven in ten live in working families (Figure 2). Nonelderly Hispanic people account for 36.0% of those who are uninsured and eligible, and Black people account for another 13.9%. While just under three in ten (29.6%) of people who are uninsured and eligible are in families with no workers, over half (54.6%) are in families with one or more full-time workers. Both full- and part-time low-wage workers are less likely to report having an offer of coverage from their employer than higher wage workers, and among those with an offer of coverage, are more likely to report the coverage offered is too expensive.

Over three-quarters of the 6.4 million people who are uninsured and eligible (5.2 million people) reside in expansion states, which have more people living in them and have higher Medicaid income eligibility for adults than non-expansion states (Figure 2). The remaining 1.2 million people are in states that have not expanded Medicaid but are eligible for Medicaid or CHIP under traditional (not ACA expansion) pathways. Most of the people who are uninsured and eligible in expansion states are adults, while children make up the majority of uninsured and eligible people in non-expansion states (Figure 2). All states have opted to set eligibility thresholds for children in Medicaid and CHIP at higher levels, in most states above 200% of poverty. In Medicaid expansion states, eligibility for adults was expanded to 138% of poverty ($20,783 for an individual and $35,632 for a family of three in 2024) and extended to adults without children. In non-expansion states, eligibility is limited for adults, often to below half of the federal poverty level, and generally only available for parents of dependent children. The differences in eligibility for adults across expansion and non-expansion states drives the variation in the shares of children and adults who are uninsured but eligible for Medicaid and CHIP for these states.

What are key issues to watch?

Medicaid continuous enrollment contributed to a decline in the number of people uninsured overall as well as the number of uninsured individuals who are eligible for Medicaid but not enrolled. However, since the end of continuous enrollment on March 31, 2023, states have disenrolled millions of people. Although national survey data that will show changes in coverage is lagged, the unwinding of continuous enrollment is expected to increase the number of people who are uninsured, including among those who are still eligible for Medicaid and those who are eligible for subsidies in the Marketplace. Some people who are disenrolled from Medicaid for procedural or paperwork reasons, even though they are still eligible for Medicaid, may struggle to re-enroll and may remain uninsured. Even as the number of people who are uninsured increases, the characteristics of those who are eligible for Medicaid but uninsured may remain relatively stable. Understanding these characteristics can help inform outreach efforts as well as policy changes that can mitigate coverage losses by making it easier for people who are eligible to obtain or retain Medicaid coverage.

Medicare provides health insurance coverage to 66 million adults, including 59 million adults ages 65 and older and more than 7 million adults under age 65 with disabilities. While the vast majority (91%) of Medicare beneficiaries give their Medicare coverage an overall positive rating, health care cost-related problems are not uncommon. Medicare beneficiaries contribute to the cost of their health care coverage through monthly premium payments, deductibles, and other cost-sharing requirements. Additionally, people on Medicare may face additional premiums for Medicare Part D prescription drug coverage and supplemental insurance. Further, there is no limit on out-of-pocket spending for beneficiaries in traditional Medicare, and beneficiaries often incur out-of-pocket costs for services not covered under traditional Medicare, such as dental, hearing, and vision services. Medicare Advantage plans have a cap on out-of-pocket costs and typically offer reduced cost-sharing for no premium, but enrollees can still have substantial expenses.

In 2022, the Consumer Price Index (CPI) for all Urban Consumers, a closely tracked measure of price inflation, increased to its highest annual rate since 1981, which translated to higher costs for housing, food, transportation, and other household expenditures, including health care costs. The inflation rate has come down since then, but prices for many household expenses are still substantially higher than they were previously. In this analysis, we assess the financial burden of health care spending among households where all members are covered by Medicare (referred to as Medicare households) compared to households where no members are covered by Medicare (referred to as non-Medicare households), based on data from the 2022 Consumer Expenditure Survey. We also assess trends in household spending and the financial burden of health care spending over the 10-year period from 2013 to 2022. (See Methods for details on the analysis.)

The health spending burden was twice as large among Medicare households than non-Medicare households in 2022

Average health-related expenses accounted for 13.6% of Medicare households’ total spending in 2022 compared to 6.5% for non-Medicare households.

Medicare households spent more on health care than non-Medicare households in 2022, both as an annual dollar amount and as a share of total household spending. Medicare households spent an average of $7,000 on health care, accounting for 13.6% of their total household spending ($51,800), while non-Medicare households spent $4,900 on their health care, accounting for 6.5% of their total household spending ($74,100) (Figure 1). Health care expenses include health insurance premiums, medical services (e.g., hospital and physician services), prescription drugs, and medical supplies (e.g., crutches, eyeglasses, hearing aids).

The larger burden of health care spending among Medicare households than non-Medicare households is a function of both lower average total household spending for Medicare households than non-Medicare households and higher health care use, which results in higher health care spending by Medicare households.

Across all household spending categories, housing accounted for the largest share of total spending for both Medicare and non-Medicare households (35.3% for Medicare households and 32.5% for non-Medicare households). Across other major categories of household spending – transportation, food, and other expenses such as education and clothing – Medicare households devoted a smaller share of their household spending (and less in dollar terms) to these items than non-Medicare households. This may be a function of both smaller average family sizes in Medicare households than non-Medicare households (1.4 vs. 2.6 people), as well as lower median household income ($31,700 vs $76,600).

In 2022, nearly 3 in 10 Medicare households spent 20% or more of their total household spending on health-related expenses, compared to 7% of non-Medicare households

Consistent with the higher average health care spending burden among Medicare households compared to non-Medicare households, a larger share of Medicare households than non-Medicare households spent 20% or more of their total household spending on health-related expenses than non-Medicare households – nearly 3 in 10 (29%) Medicare households versus 7% of non-Medicare households. Nearly three out of four Medicare households (74%) spent 10% percent or more of their total household spending on health expenses, compared to a quarter (25%) of non-Medicare households (Figure 2).

Health care spending by Medicare households increased by 53% between 2013 and 2022, but health care as a share of total household spending changed very little over these years

In 2022, Medicare households spent an average of $7,000 on health care—$2,400 or 53% higher than the amount spent on health care in 2013 ($4,600) (Figure 3). With total household spending by Medicare households growing at nearly the same rate as the growth in health care spending over these years, health care as a share of total household spending was nearly the same in 2022 (13.6%) as in 2013 (13.5%).

Similarly, non-Medicare households also spent more on health care in 2022 ($4,900) than in 2013 ($2,800), a 71% ($2,100) increase. Health care as a share of total household spending for non-Medicare households was somewhat higher in 2022 (6.5%) than in 2013 (5.4%).

Focusing on household spending trends between 2019 and 2022 shows the dual effects of the COVID-19 pandemic and price inflation.

Between 2019 and 2020, spending by Medicare households on food and transportation fell, likely reflecting stay-at-home policies established at the outset of the COVID-19 pandemic, and total household spending declined somewhat (Figure 4). By contrast, between 2021 and 2022, total household spending increased substantially, reflecting increases in all categories of household spending, as price inflation hit its highest level since 1981 in 2022. This was true for both Medicare households and non-Medicare households.

Discussion

The health care spending burden was twice as large for Medicare households than for non-Medicare households in 2022, measured by average health care spending as a share of total household spending, and a larger share of Medicare households spent at least 20% of their household budgets on health care than non-Medicare households. Of note, this analysis underestimates the health care spending burden for households that incur long-term care facility costs because the Consumer Expenditure Survey does not include people who reside in facilities. This exclusion is more likely to affect the spending burden estimates for Medicare households than non-Medicare households since spending on long-term care facilities is a significant share of average out-of-pocket health care costs for people with Medicare.

With health care use increasing with age and with most Medicare beneficiaries living on relatively low incomes and modest financial assets to draw upon in retirement, it’s not unexpected that health care is a bigger cost burden for Medicare households. This cost burden has important implications for policy debates, including the level of cost-sharing and premiums in Medicare. Policies aimed at improving financial protections for Medicare beneficiaries have been proposed in recent years. The Inflation Reduction Act of 2022 includes several provisions that lower prescription drug costs for people with Medicare, including a cap on Medicare beneficiaries’ out-of-pocket spending under the Medicare Part D benefit; a limit on insulin cost sharing to $35 a month in Medicare Part B and Part D; and expanded eligibility for full Part D Low-Income Subsidies. Policy makers have also considered other proposals that would improve the affordability of health care for Medicare beneficiaries, such as expanding income eligibility thresholds for the Medicare Savings Programs to enable more people to qualify for these financial supports, and adding an out-of-pocket cap on cost sharing for benefits covered under traditional Medicare. Adopting such changes, however, would require additional federal spending.

As rates of childhood vaccination decline and with measles on the rise again, a KFF Health Misinformation Tracking Poll, fielded in late February, examines the extent to which adults have heard and believe misinformation about the measles vaccine. The poll also examines the public’s views of the U.S. government and social media companies’ role in moderating false health claims online.

While most of the public—including parents—haven’t heard misinformation about the measles vaccine, many are uncertain about the validity of one specific false claim. About one in five adults (18%, including 19% of parents of children under age 18) say they have heard or read the claim, “Getting the measles vaccine is more dangerous than becoming infected with measles.”

A relatively small share leans towards believing the claim is true. Regardless of whether they have heard the claim, a fifth of adults (19%), including one quarter of parents (25%), say the claim is “definitely” or “probably” true. Six percent of U.S. adults—including about one in ten (9%) parents—say they have heard the claim and think it is probably or definitely true.

Across partisans, levels of educational attainment, and race and ethnicity, fewer than five percent of adults say that the claim is “definitely true,” meaning that there are few ardent believers in this piece of misinformation. However, independents (37%) and Republicans (21%) are less likely than Democrats (59%) to be certain that the claim is “definitely false.” Those without a college degree (29%) are also less likely to say that the claim is false than those with a college degree (55%).

Large Shares Support Social Media Companies in Restricting Health Misinformation at the Expense of Certain Freedoms

Later this March, the Supreme Court will hear arguments in three important cases related to misinformation on social media that will have implications for how the U.S. government and social media companies interact with users and can moderate information.

Two-thirds (68%) of the public views the spread of health misinformation on social media as a bigger problem than censorship of speech on social media platforms (31%). This sentiment is in turn reflected in opinions about what kind of action social media companies should take to curb the spread of false health claims.

Large shares of the public support social media companies in tamping down on misinformation even at the expense of certain freedoms. About two-thirds (66%) of adults overall say, “Social media companies should restrict false health information, even if it limits people from freely publishing or accessing information,” while one-third instead say “People’s freedom to publish and access health information should be protected, even if it means false information can also be published.”

The public is more divided about whether the U.S. government should take action. Nearly six in ten adults overall (57%) say, “The U.S. government should require social media companies to take steps to restrict false health information, even if it limits people from freely publishing or accessing information,” while about four in ten (42%) say “People’s freedom to publish and access health information should be protected, even if it means false information can also be published.”

There are partisan divisions on both these questions, with Democrats more likely than independents or Republicans to favor both the government and social media companies taking action to restrict false health information. Notably, however, majorities of Democrats (82%), independents (57%), and Republicans (56%) say that social media companies should take steps to restrict health misinformation even if it limits certain freedoms.

The Health Misinformation Tracking Poll is part of a new KFF program area focused on identifying and monitoring health misinformation and trust in the United States, emphasizing communities that are most adversely affected by misinformation, including people of color, immigrants, and rural communities.

Designed and analyzed by public opinion researchers at KFF, the poll was conducted from February 20-28, 2024, online and by telephone among a nationally representative sample of 1,316 U.S. adults including 283 parents. Interviews were conducted in English and in Spanish. The margin of sampling error is plus or minus 3 percentage points for the full sample and 7 percentage points for the sample of parents. For results based on other subgroups, the margin of sampling error may be higher.

About half (47%) of immigrant adults in the U.S. have limited English proficiency (LEP), meaning that they speak English less than very well. Immigrants with LEP come from diverse backgrounds and speak a variety of languages. The top five languages spoken by people with LEP include Spanish (63%), Chinese (7%), Vietnamese (3%), Arabic (2%), and Tagalog (2%), while the remaining roughly quarter (23%) of people with LEP speak other languages. Having LEP can impact individuals’ daily lives and access to health coverage and care. Below are five key facts about immigrants with LEP drawing on the 2023 KFF/LA Times Survey of Immigrants.

About half (53%) of immigrants with LEP say they have faced language barriers in a variety of interactions, including accessing health care.

About three in ten immigrants with LEP report that difficulty speaking or understanding English has ever made it hard for them to get health care services (31%), receive services in a store or restaurants (30%), or get or keep a job (29%) (Figure 1). A quarter say it has made it hard to apply for government financial assistance for food, housing, or health coverage, and about one in five (22%) cite difficulty reporting a crime or getting help from the police. These difficulties are more pronounced among lower income immigrants with LEP. Among immigrants who are parents with LEP (52% of all immigrant parents), about one in four (24%) report difficulties communicating with their child’s school.

Immigrants with LEP (21%) are twice as likely to be uninsured as immigrants who are English proficient (10%).

Immigrants with LEP are twice as likely as English proficient immigrants (defined as speaking English exclusively/very well) to be uninsured (21% vs 10%) (Figure 2), and parents with LEP are about three times as likely to say they have a child who is uninsured compared to English proficient immigrant parents (14% vs. 5%).This pattern reflects lower rates of private coverage among immigrants with LEP due to disproportionate employment in lower income jobs that are less likely to offer employer-based insurance. While Medicaid helps fill some of this gap, some may also face linguistic and other barriers to enrollment even if they are eligible for coverage.

Immigrants with LEP face greater barriers to accessing health care and report worse health compared to their English proficient counterparts.

Reflecting their higher uninsured rates and other barriers, immigrants with LEP are somewhat less likely than those who are English proficient to say they have a usual source of care other than the emergency room (77% vs 84%), have a trusted health care provider (68% vs. 80%) and to have seen a health care provider within the past year (74% vs. 80%). However, they are twice as likely as their English proficient immigrants to report fair or poor health status (28% vs. 14%). Community health centers (CHCs) play a particularly important role serving immigrants with LEP, with about four in ten (39%) saying that they usually rely on a CHC for care, reflecting CHCs’ role serving uninsured populations and their provision of linguistically and culturally appropriate services.

About half (55%) of immigrant workers with LEP report experiencing discrimination at work.

While immigrants with LEP are as likely as their English proficient peers to be employed (64% vs 67%), they are more likely to be in hourly jobs (60% vs. 45%) and less likely to receive a salary (21% vs 42%) (Figure 4). Reflecting these patterns, they are more likely to have lower incomes, with 55% having household incomes of less than $40,000 per year compared with 28% of English proficient immigrants. Half (55%) of immigrant workers with LEP report experiences with discrimination at work, such as being given fewer opportunities for advancement compared to people born in the U.S. doing the same job (38%), getting paid less (34%),not getting paid for all hours they worked (25%), being given undesirable work shifts or having less control over their hours than people born in the U.S. doing the same work (21%), or being harassed or threatened by someone at their work because they are an immigrant (14%).

About six in ten immigrants with LEP say they lack sufficient information about U.S. immigration policy (58%) and are unsure about public charge rules (62%).

About six in ten immigrants with LEP (58%) say they do not have enough information about U.S. immigration policy to understand how it affects them and their family compared with 34% of English proficient immigrants (Figure 5). Immigrants with LEP primarily get their information on immigration policy from a search engine such as Google (30%), a U.S. government website (26%), or an attorney or other professional (24%). They are less likely than English proficient immigrants to seek information from an internet search engine and more likely to rely on an attorney or other professional and other sources of information such as news media, social media, and family and friends. Information gaps among immigrants with LEP extend to public charge rules, with 62% saying they are unsure about whether using government programs to help pay for health care, housing, or food will decrease their chances of being approved for a green card compared with 55% of those who are English proficient, and another 17% incorrectly believing this to be the case.

KFF takes a new look at the continued impact of the Hyde Amendment, the federal ban on payment for abortion services, in the wake of the Supreme Court’s Dobbs decision. At a moment when all eyes are on states that have banned abortion, the Hyde Amendment remains a barrier to abortion care for people with low incomes in states where abortion is legal but the state restricts Medicaid coverage to the narrow exceptions allowed under Hyde.

Today, the policy limits abortion coverage in 19 states and the District of Columbia where abortion isn’t banned. The policy potentially affects 5.5 million women ages 15 to 49 who reside in those states and are covered by Medicaid.

Since 1977, the Hyde Amendment has banned the use of federal funds for abortion, allowing exceptions to pay for terminating pregnancies that endanger the life of the pregnant person or that result from rape or incest.  This policy has limited abortion coverage for millions of pregnant people on Medicaid, as well others who rely on federal programs such as Medicare, TRICARE, and the federal Employee Health Benefit Program for their coverage.

This longstanding federal funding ban has had a disproportionate effect on women with low incomes and women of color who are covered by Medicaid at higher rates and are more likely to seek abortion care because of persistent systemic barriers to care and contraceptive access. Some states choose to pay for abortions for their Medicaid enrollees in other instances but use their own state revenues, not federal funds, to cover the service.

For more information about the federal programs affected by the Hyde Amendment, the impact of the law on access to abortion services, and the potential effect if the law were to be repealed, check out the brief, “The Hyde Amendment and Coverage for Abortion Services Under Medicaid in the Post-Roe Era.”

Adult children of immigrants make up a disproportionately large share of physicians, surgeons and other health care practitioners in the U.S. — just one reflection of their comparatively high employment, educational attainment and income levels, according to a new KFF analysis.

The analysis of 2023 Current Population Survey data shows that U.S.-born nonelderly adults whose parents were both born outside the U.S. comprise 13% of physicians, surgeons, and other health care practitioners. That amounts to more than twice their share of the working age population (6%). 

The data show that the adult children of immigrants have higher educational attainment compared to their peers with U.S.-born parents. Forty-five percent of nonelderly adult children of immigrants hold a bachelor’s degree or higher, compared to 40% of adults with at least one U.S.-born parent. 

Adult children of immigrants also are somewhat more likely to have higher incomes, with 39% living in households with an annual income of $90,000 or more. In comparison, about one in three (36%) of nonelderly adults with at least one U.S.-born parent live in higher income households.Other key findings include: 

• Three in four (76%) nonelderly adult children of immigrants are employed, accounting for 6% of the nonelderly adult workforce, similar to their share of the nonelderly adult population (6%). The rate is higher among adult children of immigrants between the ages of 25 and 64, who are less likely to be students, with 81% of this group working compared to 78% of their peers with at least one U.S.-born parent. 
•  Nonelderly adult children of immigrants are less likely than those with U.S.-born parents to have private health coverage (67% vs. 76%) and more likely to be uninsured (13% vs. 8%). Their higher uninsured rate may reflect that they are more likely to be working in some industries like construction, food services, and transportation, which may be less likely to offer health coverage.

The full analysis, “The Role of Adult Children of Immigrants in the U.S. Health Care Workforce”, is available at kff.org.