Hospitals lead the league in bill collections, but it’s not lonely at the top of that hill

Close to two-thirds of Americans carrying medical debt, 64%, owe the money to hospitals, whether for inpatient, outpatient or ER services. 

Many other patients are similarly—or additionally—burdened by bills for more routine care like doctor’s office visits (43%) and lab work or diagnostic tests (38%).

And almost half of people who owe provider organizations have unpaid bills totaling $2,000 or more. 

The figures are from a survey conducted by The Commonwealth Fund, which reported the results this month. 

For the project, the NYC-based philanthropic foundation interviewed a nationally representative sample of 6,353 U.S. adults last summer and fall. 

For the report, Commonwealth Fund analysts concentrated on 4,121 responses that came in from people covered by private insurance over the prior 12 months.   

The analysts additionally conducted eight online focus groups on coverage denials, medical debt and billing errors with 45 privately insured adults. The September report presents input from this subgroup. 

Here are three key discussion points as published in the report. 
 

1. Families dealing with medical debt suffer emotionally and financially, and many avoid getting needed health care after their experience. 

Two-thirds of people with unpaid medical bills, 68%, told The Commonwealth Fund the debt brought on worry and other forms of anxiety. Some 30% delayed or avoided needed healthcare, and 30% cut back on basic living necessities such as food, heat or rent.

More from the report authors: 

‘Medical debt seriously impacted many people’s quality of life. Several participants said they delayed or avoided seeking medical care because they were worried about having coverage denied and taking on additional debt.’

2. When asked whether they would be able to pay a $1,000 bill within 30 days for an unexpected medical expense, more than a third of adults with any type of private insurance said no. 

This rose to more than half for people with incomes under 200% of the federal poverty level and for Black and Hispanic adults, the authors write. “Many of our focus group participants said they were caught off guard by unexpected bills for emergency department visits or acute health issues,” they add, “with amounts ranging from $1,000 to $5,000.”

More: 

‘Confronted with such costs, several people wondered how it was possible that their insurance left them so unprotected when they have paid so much in premiums.’

3. When asked whom they consider responsible for their struggles with medical debt, a majority blamed their insurance company. 

However, more than half blamed the healthcare system in general. “Others viewed their providers as responsible,” the authors report, “and more than one-third blamed the government for their experience.” 

More: 

‘People also said they are frustrated that employers take so much out of their paychecks for insurance—yet necessary care still wasn’t covered.’

Taking up the question of what can be done to address and prevent medical debt, The Commonwealth Fund recommends a handful of legislative action items. These include: 

• Congress could pass legislation to ban all medical debt from all credit reports.
   
• The federal government and states could strengthen and enforce financial assistance requirements for hospitals. 
   
• Eliminate deductibles in commercial insurance plans and cap provider payment rates.
   
• Cover the remaining uninsured. 

Fleshing out the latter recommendation, the authors note the Congressional Budget Office projects the number of uninsured people in the U.S. to jump to 37 million in 10 years as a result of recently erected barriers to access of Medicaid and ACA marketplaces. 

“This will only exacerbate the medical debt problem and shift more of the cost of care to local hospitals and health systems,” they write. “To head off this impending crisis, Congress will need to reverse the policy changes of the last year, fill the gaps in the ACA and once again place the United States on a path to universal coverage.”

The report is posted in full for free.