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79 Million US Adults Have Medical Bill Problems Or Are Paying Off  
Medical Debt

The report finds that in 2007, nearly two-thirds of U.S. adults under  
age 65, or 116 million people, had medical bill problems or debt, went  
without needed care because of cost, were uninsured for a time, or  
were underinsured—insured but had high out-of-pocket medical expenses  
or deductibles relative to income. (Credit: Image courtesy of  
Commonwealth Fund)

ScienceDaily (Aug. 25, 2008) — The proportion of working-age Americans  
who have medical bill problems or who are paying off medical debt  
climbed from 34 percent to 41 percent between 2005 and 2007, bringing  
the total to 72 million, according to recent survey findings from The  
Commonwealth Fund. In addition, 7 million adults age 65 and over also  
had problems paying medical bills, for a total of 79 million adults  
with medical bill problems or medical debt.

In a new Commonwealth Fund report about the survey findings, Losing  
Ground: How the Loss of Adequate Health Insurance is Burdening Working  
Families, the authors describe how working-age adults are becoming  
more exposed to the rising costs of health care, either because they  
have lost insurance through their jobs or because they are paying more  
out of pocket for their health care. This combination of factors,  
along with sluggish growth in average family incomes, is contributing  
to problems with medical bills and cost-related delays in getting  
needed health care.

The report finds that in 2007, nearly two-thirds of U.S. adults under  
age 65, or 116 million people, had medical bill problems or debt, went  
without needed care because of cost, were uninsured for a time, or  
were underinsured—insured but had high out-of-pocket medical expenses  
or deductibles relative to income.

"We are seeing a perfect storm of negative economic trends threatening  
working families in the United States," said Sara Collins,  
Commonwealth Fund Assistant Vice President, and the study's lead  
author. "While gas and food prices are increasing and home values are  
declining, the rise in health care costs is surpassing income growth  
and fewer people have adequate insurance. As a result, working people  
are struggling to pay their bills and accruing medical debt."

While the increase in problems paying medical bills or carrying unpaid  
medical bills cuts across income brackets, low and moderate income  
families are burdened the most. The report finds that more than half  
of working-age adults earning less than $40,000 a year reported  
problems paying medical bills or being in debt due to medical  
expenses. Medical bill problems included not being able to pay bills,  
being contacted by a collection agency about an unpaid bill, and  
changing one's way of life in order to pay medical bills.

Those with medical bills and medical debt are increasingly facing  
serious financial problems and sometimes facing trade-offs among  
immediate life necessities. Thirty-nine percent of those with bill  
problems or debt say they have used up all of their savings to pay  
their health care bills; 29 percent are unable to pay for basic  
necessities like food, heat, or rent; and 30 percent took on credit  
card debt. Twenty-four percent of adults under age 65 with medical  
debt owe $4,000 or more and 12 percent owe $8,000 or more in unpaid  
medical expenses.

In a new Commonwealth Fund issue brief which accompanies the report,  
Seeing Red: The Growing Problem of Medical Debt and Bills, the authors  
explain that uninsured and underinsured adults are more at risk of  
having medical bill problems and medical debt than those with adequate  
insurance coverage. Three in five adults who are uninsured or  
underinsured face these challenges, more than double the rate of those  
who had adequate insurance all year (26 percent). Notably, adults 65  
years and older were far less likely to report medical bill problems  
or debt than younger adults because they are covered by Medicare and  
may also have supplemental private coverage, and in the case of low- 
income individuals, may have Medicaid. Just 19 percent of adults over  
65—half the rate for adults under 65 (41%)—reported any medical bill  
problems or debt.

"The current economic slowdown makes it even more urgent for a new  
Administration to make universal and affordable health insurance a  
high priority in 2009, to ensure that no American suffers financial  
hardship as a result of serious illness," said Commonwealth Fund  
President Karen Davis.

The report also finds that more working-age adults are delaying or  
avoiding needed medical care, such as skipping doses of medication or  
not filling prescriptions, because of health care costs. Forty-five  
percent of adults reported problems getting care because of costs in  
2007, a dramatic increase from 29 percent in 2001. Increasing numbers  
of adults are spending high proportions of their income on health  
care. One-third of U.S. working-age adults spent 10 percent or more of  
their income on out-of-pocket medical expenses and health insurance  
premiums in 2007, up from 21 percent in 2001.

The proportion of Americans who are uninsured continues to grow. More  
than one-quarter (28%) of U.S. adults ages 19 to 64, or an estimated  
50 million people, were uninsured for some time in 2007, compared with  
24 percent in 2001. But even having insurance coverage does not  
guarantee protection from medical bill problems and debt. The  
proportion of those who are underinsured increased from 9 percent to  
14 percent, or 25 million people, between 2003 and 2007. Sixty-one  
percent of those with medical bill problems or accumulated medical  
debt were insured at the time care was provided.

Other key survey findings include:

     * Among the medical bill problems reported in the survey: 28  
percent are paying off medical bills over time, up from 21 percent in  
2005, and 27 percent of adults under age 65 said they had problems  
paying or were unable to pay their bills in 2007, up from 23 percent  
in 2005.
     * More than half (53%) of insured working-age adults who have  
deductibles that represent 5 percent or more of their income reported  
medical bill burdens and debt; one-third of adults with lower  
deductibles face these kinds of difficulties.
     * While adults in families with incomes under $20,000 a year  
report the highest rates of lacking coverage during the year, more  
adults in moderate income families are going without insurance. In  
2007, 41 percent of adults in families earning between $20,000 and  
$40,000 a year reported a time uninsured during the year, up from 28  
percent in 2001.
     * Most people who were uninsured at any point in the last year  
are in working families. Of the estimated 50 million American adults  
who were uninsured in the last year, 58% were in families where at  
least one person was working full-time.
     * People who are uninsured or underinsured experience inefficient  
care; nearly half of adults (47%) under age 65 who had gaps in their  
health insurance or were underinsured reported they had experienced  
problems such as test results not being available on time, receiving  
duplicate medical tests, and delays in receiving results of abnormal  
test results; in contrast just 26 percent of adults who are adequately  
insured reported these inefficiencies.


Data come from the Commonwealth Fund Biennial Health Insurance Survey  
(2007), a national telephone survey conducted June 6 through October  
24, 2007 among a nationally representative sample of 3,501 adults age  
19 and older living in the continental United States. The 25-minute  
telephone interviews were completed in both English and Spanish,  
according to the preference of the respondent. The survey achieved a  
45-percent response rate (calculated according to the standards of the  
American Association for Public Opinion Research). The survey sample  
was drawn using standard list-assisted random digit dialing  
methodology, which selected telephone numbers disproportionately from  
area-code/exchange combinations with higher-than-average density of  
low-income households. Using this stratified sampling design, this  
study obtained an oversample of low-income, African American and  
Hispanic adults. To correct for the disproportionate sample design and  
make the final total sample results representative of all adults age  
19 and older living in the continental U.S, the data are weighted by  
age, sex, race/ethnicity, education, household size, and geographic  
region, using the U.S. Census Bureau's 2006 Annual Social and Economic  
Supplement (ASEC). The report restricts the analysis to the 2,616  
respondents under age 65. The resulting weighted sample is  
representative of the approximately 177 million adults ages 19 to 64.  
The survey has an overall margin of sampling error of ±2 percent at  
the 95 percent confidence level.
Adapted from materials provided by Commonwealth Fund.

author of "The Black Holocaust for Beginners"