Report: 44% of adults in the U.S. are uninsured or underinsured
The high cost of medical insurance and care is leaving many U.S. adults either without coverage or forgoing care, according to a new survey from the Commonwealth Fund. The subsequent report from the healthcare policy nonprofit found that 35% of American adults were either without insurance for part of 2023 or had inadequate insurance that did not cover the full cost of care.
Another 9% reported having no health coverage at all.
Of those who reported being underinsured and unable to pay the full cost of care (23%), two-thirds (66%) were covered by an employer-provided health plan, while 30% were enrolled in Medicare or Medicaid. The remainder had acquired insurance on their own or through a health insurance marketplace.
Most underinsured adults (57%) reported skipping necessary care due to cost, and 44% said they had already accumulated medical debt. Nearly half (48%) are paying off $2,000 or more, with only half of them reporting that the debt originated from a hospital stay. The other half accumulated debt for outpatient care.
“Of survey respondents with employer coverage, those with low and moderate incomes reported paying off medical debt at higher rates than those with higher incomes. People in employer plans and the individual market and marketplaces reported significantly higher rates of medical debt than people who had Medicaid,” the authors of the survey, Sara R. Collins, PhD, and Avni Gupta, PhD, from the Commonwealth Fund, wrote.
Collins and Gupta said the Affordable Care Act (ACA) reduced the number of uninsured Americans. However, now with costs rising, it appears simply having insurance may not be enough.
“The United States has made considerable gains in health insurance coverage since the Affordable Care Act’s passage, but more work is needed to cover the remaining uninsured, eliminate gaps in coverage, and ensure that all health insurance does what it’s supposed to: enable people to get health care when it’s needed, without fear of incurring debt,” they added.
Policy shifts recommended
Collins and Gupta recommend several policy changes to reduce the number of uninsured Americans and improve access to affordable care.
For starters, they said the enhanced marketplace premium tax credits should be permanently extended to counter premium hikes and prevent millions from losing coverage. Further, the federal government should support states that opted out of the ACA’s Medicaid expansion, which leaves millions of patients without access to public health programs.
They also call on lawmakers to ease Medicaid eligibility requirements and create an auto-enrollment mechanism to ensure eligible individuals don't fall through the cracks.
“Research shows that many uninsured people are eligible for Medicaid or subsidized marketplace coverage. By allowing auto-enrollment in comprehensive health coverage, Congress could move the nation closer to universal coverage,” Collins and Gupta said.
As for medical debt, the authors argue that the issue is largely driven by premiums and deductibles. They suggest subsidies be improved to support middle-income workers and families. Additionally, there should be more laws on the books to protect consumers from the negative effects of medical debt.
“In June 2024, the Biden-Harris administration released a new proposed rule to prohibit medical debt information from appearing on consumer credit reports. Earlier, it had taken steps to ensure greater scrutiny of providers’ bill collection tactics, among other actions. Many states have passed legislation to relieve medical debt, such as strengthening standards to ensure patients have access to hospital financial assistance programs, banning aggressive collection activities by hospitals, and prohibiting or capping interest on medical debt,” Collins and Gupta wrote.
Their analysis is based on survey results from 6,480 respondents, ages 19–64. The full Commonwealth Fund report can be found here.
Chad is an award-winning writer and editor with over 15 years of experience working in media. He has a decade-long professional background in healthcare, working as a writer and in public relations.