Half of working-age Americans struggle to afford medical care

Paying for health care is increasingly straining U.S. adults as escalating medical costs converge with rising prices throughout the economy.

More than half of working-age Americans said they had difficulty paying for health care in 2023, according to a Commonwealth Fund survey published Thursday. Among people without insurance, more than three-quarters reported trouble affording care. But 43% of people with employer health plans said they had difficulty paying, and the rate was even higher among people on public health plans like Medicare and Medicaid.

The results highlight a fundamental problem in the $4.3 trillion U.S. health system: Despite spending more on medical care than any other wealthy country, the U.S. fails to make it broadly accessible to much of the population. The rising financial burden squeezes families and leads people to delay care, which can hurt their health over the longer term, researchers said.

"As a primary care provider, I've seen the impact of this grow over the past several years," said Joseph Betancourt, president of the Commonwealth Fund, a health research nonprofit. "These affordability challenges are real, they're getting worse and they're a clear and present danger." 

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With health costs eating into budgets and medical debt weighing down much of the population, almost 40% of people reported delaying care or not filling prescriptions because they can't afford it.

The issue has become more acute as inflation further erodes people's buying power: Nearly two-thirds of respondents said that rising prices for other goods and services affected their ability to pay for health care.

Insurers and employers have embraced plan designs that put people on the hook for thousands of dollars in medical expenses in the form of deductibles, co-pays and other cost-sharing. While that can lower the premium expense, it shifts cost to those who need care. The Commonwealth Fund has long tracked rates of underinsurance, when even people with coverage struggle to pay for care.

"We found that insurance did not appear to protect people sufficiently from the budget squeeze," said Sara Collins, lead author of the report and a senior scholar at the Commonwealth Fund.

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Employer-sponsored insurance premiums jumped this year. Total healthcare spending in the U.S. continues to rise, accounting for 18.3% of gross domestic product — a share that is expected to grow over the next decade as the increase in healthcare spending outpaces GDP growth, according to the Centers for Medicare and Medicaid Services. 

The Commonwealth Fund report analyzed the responses of more than 6,000 U.S. adults between the ages of 19 and 64 who responded to surveys between April and July.