NOT POOR, BUT STILL BURDENED
ciently to maintain its margins, Budzinski said. The system lowered its cost per unit of services by 4% for the seven months that ended in January.
Peter Cunningham, a senior fellow with the Center for Studying Health System Change who has studied household medical debt, said the results, though not surprising, underscored the toll on households from the nation’s steadily climbing healthcare costs.
“The way that healthcare costs have been rising and the fact that workers have been absorbing a higher share of the costs in the form of higher deductibles and copays, a lot of people who think they are well covered are not as well covered” as they might think, said Cunningham, who also is co-director of quantitative research for the Washingtonbased health policy center.
High-deductible health plans have grown more common among those insured by an employer. Last year, 17% of workers were enrolled in such plans compared with 4% six years earlier, according to the Kaiser Family Foundation. Meanwhile, workers covered by health plans with deductibles of $2,000 or more increased to 12% from 3% during the same period.
Cunningham said households with low and moderate incomes with less cushion to absorb unexpected bills struggle most with medical debts.
One in 5 individuals in poverty were in families that had medical bills they could not pay at all, the CDC data show, though the figures did not distinguish between insured and uninsured. The same was true for those with income slightly above the federal poverty threshold. As household income climbed, financial difficulty from medical bills declined. Roughly 1 in 17 individuals, or 6%, with incomes at or above 200% of the poverty threshold were in families that could not pay medical bills.
Research published by Cunningham in Incurred more than $2,000 out- of- pocket Uninsured Near- poor
Poor Public insurance
Not poor Private insurance Incurred less than $2,000 out- of- pocket December found 1 in 3 nonelderly individuals in families with low and moderate incomes struggled with medical bills. Among the insured with low and moderate incomes, the percentage remained high, at 27% to 28%.
The research was based on a nationally representative telephone survey in 2010. Surveys conducted in 2010, after the Great Recession drove unemployment upward, and 2007, prior to the economic downturn, found little change in households struggling with medical debt.
With financial distress came other troubles, including collection agencies and borrowing to pay off medical bills, the research found. Some withdrew savings. Others struggled to pay for necessities.
Cunningham said those with medical bills were also more likely to put off medical care out of concern for the cost.
Like Cunningham, Patricia Herman, a research scientist at the Center for Health Outcomes and Pharmacoeconomics
The CDC estimates that millions of households with incomes more than twice the federal poverty level ($44,700
for a family of four) are burdened by medical expenses Research at the University of Arizona College of Pharmacy, said she did not find the CDC results surprising. Herman and colleagues studied 2008 survey data on insurance coverage and medical debt in Arizona and found insured households were as likely as the uninsured to struggle with medical bills. Herman praised the CDC report for highlighting an issue she described as “almost a secret.”
“It’s amazing to me that it’s so prevalent and devastating” but so little studied, Herman said.
Indeed, the Arizona research found medical debt mattered more than whether someone was insured when it came to who would be most likely to delay or skip needed medical care, Herman said. Early results of subsequent research suggest health plans with coinsurance leave households particularly vulnerable to medical debt, she said. Households can plan for co-payments and deductibles, but the cost from co-insurance can depend on the medical care needed when someone unexpectedly becomes ill or injured.
Dr. David Himmelstein, a professor of public health at the City University of New York, said the fault lies not only with the outof-pocket fees such as deductibles but coverage and reimbursement limits that also shift more cost to households.
Himmelstein is an advocate for a singlepayer health system and co-founder of Physicians for a National Health Program, and he co-authored a 2009 study that found medical debt contributed to 62% of U.S. bankruptcies. In an earlier study, Himmelstein and colleagues surveyed more than 1,700 bankruptcy filers and found among those for whom medical bills were a significant factor, 75% were covered by insurance when they fell ill.